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Old Peds > HEENT 2- Nose, Sinus, Throat > Flashcards

HEENT 2- Nose, Sinus, Throat Flashcards

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1
Q

is rhinitis usually viral or bacterial?

A

Viral

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2
Q

what is the most common pediatric infectious dz?

A

Viral

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3
Q

How many colds do kids <5 get usually?

A

6-12 colds / years

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4
Q

when does rhinitis peak?

A

early fall to late spring

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5
Q

does color of mucus indicate bacterial infection?

A

No

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6
Q

patient presents with nasal congestions, mild sever, sore “scratchy throat” due to post nasal drip. Nose, throat, TM red+ inflamed.

A

Viral rhinitis

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7
Q

when do you call viral rhinitis sinusitis?

A

Until >10-14 days

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8
Q

Tx for viral rhinitis

A

antihistamines
decongestants
(only if >6 years old)

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9
Q

one cold after another

A 
recurrent rhinitis  (viral)
1/3 of these are allergic rhinitis or recurrent rhinosinusitis
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10
Q

patient presents w/ nasal congestions, sneezing, rhinorrhea, itchy nose, palate, throat and eyes.
Nasal turbinates swollen, red or pale pink

A

Allergic rhinitis

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11
Q

tx for allergic rhinitis

A

intranasal corticosteroids
oral and intranasal antihistamines
decongestants

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12
Q

if a kid <10 has nasal polyps, what would you be worried about?

A

cystic fibrosis

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13
Q

what is the number one cause of nose bleeds?

A

trauma up the nose

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14
Q

The nosebleed usual arises from the ___________ part of the nasal septum.

A

anterior Kiesselbach’s plexus

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15
Q

tx for epistaxis

A

leaning forward, clear passages, pinch nose below nasal bones, pack with gel sponge or foam.

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16
Q

would you get an x-ray for sinus problems on a 5 year old?

A

No, because they don’t have well developed sinuses

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17
Q

sinuses that present at birth pneumatized ~ 4 yr

A

maxillary sinuses

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18
Q

present and pneumatized at birth

A

ethmoid sinuses

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19
Q

sinuses develop by the 5th or 6th birthday

A

sphenoid

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20
Q

sinuses that begin dev 7th or 8th birthday- not fully dev until adolescence

A

frontal sinuses

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21
Q

Frontal sinusistis unusual before age _____

A

10 years

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22
Q

Infection of paranasal sinuses
Almost always preceded by URI.
Nasal drainage, congestions, facial pressure or pain, PND, fever, cough, fatigue, maxillary dental pain, ear pressure or fullness. HA.

A

Rhinosinusitis

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23
Q

is a PE helpful with rhinosinusitis?

A

not usually

may have sinus tenderness with older children

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24
Q

what bacterial are most sinusitis caused by?

A

Strep pneumo

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25
viruses that cause sinusitis?
adenovirus parainfluenza influenza rhinovirus
26
recurrence of rhinosinusitis. Hx that every time they get a cold they get sinusitis. Chronic if patient hasn't cleared infection in expected amount of time
Chronic or recurrent rhinosinusitis
27
some cases what do you need to order with crhonic or recurrent rhinosinusitis?
CT
28
what should you ask your patient with recurrent sinusitis
allergies? reflux?
29
when should you get plain films for ABS?
older children with recurrent ABS vague symptoms poor response to therapy
30
first line tx for ABS
amoxicillin 90 mg/kg/day for 10-14 days (or 7 days after symptoms resolve) (lack of blood supply to the sinuses)
31
If it is chronic sinusitius or trying to avoid sx how do you treat ABS
amoxicillin for 3-4 weeks and add vancomycin
32
alternatives to amoxicillin
Cefuroxime axcetil, cefopodoxime, macrolides
33
if recent treatment with amoxicillin, or failure of clinical improvement on amoxicillin within 72 hours
give amoxicillin-clavulanate (augmentin)
34
sx for chronic sinusitis
adenoidectomy effective in 50-75% children with chronic.
35
adjuvant therapies for ABS
antihistamine, decongestants, anti-inflammatories (not a lot of data supporting this) topical intranasal steroids (not a lot of benefit) nasal irrigation w/ saline
36
complications with rhinosinusitis
``` orbital cellulitis (abscess, empyema) meningitis ```
37
cellulitis found in the lids and skin surroudning the eye
Preseptal cllulitis
38
cellulitis found back in the bone. behind the septum. will have greater fever, more widespread rxn
Orbital cellulitis
39
most common organisms for preseptal cellulitis
staph aureus | strep pyogenes
40
complications of orbital cellulitis
cavernous sinus thrombosis or meningitis
41
organisms you think of for orbital cellulitis
respiratory flora and anerobes | staph auresus
42
tx for orbital cellulitis
hospitalization IV antibiotics amy need sinus drainage
43
Leading cause of halitosis in children is ____________________________
nasal foreign body
44
anticongestant used to stop the swelling with an obstruction
pseudophed topical
45
what is associated with strep throat.
petechiae
46
the most common cause of pharyngitis is.....
viral (upwards on 90%) | usually adenovirus and enterovirus
47
what is the name for pharyngoconjunctival virus?
adenovirus
48
Caused by Coxsackie A. Ulcers 3 mm with halo on anterior pillars, soft palate, uvula
Herpangina
49
Ulcers anywhere in the mouth/throat. | Vesicles, pustules, papules on palms, soles,interdigital, buttocks
Hand Foot Mouth by Coxsackie A
50
what is Pharyngoconjunctival Fever caused by?
Adenovirus
51
Fatigue, high fever, exudative pharyngitis, lymphadenopathy (ant & post cervical) splenomegaly, rash
Mono; EBV
52
Labs to get for mono
``` CBC heterophile antibodies (monospot) may not appear until 2nd week of illness ```
53
what is a white coating over the tonsils. Usually more membranous with mono.
Exudative pharyngitis
54
where are lymph nodes especially enlarged in mono
posterior
55
Tx for mono
Rest, fever control, steroids if airway obstruction, avoid contact sports if splenomaegaly
56
what will seen on CBC with mono
>10% atypical lymphocytes (usually have 0)
57
what meds may cause a rash in someone with mono.
Penicillin + Amoxicillin
58
what is definitive for diagnosis of mono
> 10% Atypical Lymphs in blood, or + Monospot, IgM for Epstein Barr is definitive
59
headache and belly pain can indicate what?
Strep
60
Acute onset, - fever ,headache , nausea (no cough, conjunctivitis, sneezy)
Bacterial pharyngitis
61
who is bacterial pharyngitis most common in?
5-15 years old
62
complications of bacterial pharyngitis
rheumatic fever glomerulonephritis (abx doesn't help this) scarlet fever
63
Complication of strep that presents with sandpaper rash on groin and torso.
Scarlet fever
64
Diagnostics of strep throat
``` throat culture (gold standard) rapid antigen test (negative doesn't guarantee) do both of these ```
65
tx for bacterial pharyngitis
Penicillin V BID/TID for 10 days | amoxicillin and ampicillin are acceptable
66
when should you give Pen G shot to someone with bacterial pharyngitis?
won't follow up
67
next best choice for strep throat if allergic to penicillin
Erythromycin
68
is test of cure needed for strep throat
no, carrier state is usually self limited and not contagious little risk for rheumatic fever but tx if they have recurrent infections
69
antistreptococcal antibodies form immune complexes that cross react cardiac sarcolemma antigens causing inflammatory response in myocardium and valves .
Rheumatic Fever
70
antigen-antibody complexes deposit in glomeruli and incite inflammation and activate the complement system.
Acute glomerulonephritis
71
who does rheumatic fever have a greater incidence in?
girls | african americans
72
pt. presetns with tea or cola color urine- gross hematuria after having strep.
Acute Glomerulonephritis
73
Tx for Acute Glomerulonephritis
supportive, (dietary, diuretics or hypertensives) most recover completely 2-3wk
74
patient presents with severe sore throat, high fever, one beefy red tonsil. patient previously have group A strep
Peritonsillar Abscess (quinsy)
75
tx for peritonsilar abscess
penicillin or clindamycin
76
Patient presents with Fever, Respiratory symptoms, Neck hyperextension Dysphoria, drooling, dyspnea
Retropharyngeal Abscess
77
organisms that cause retropharyngeal abscess
GAS | staph aureus
78
who is retropharyngeal Abscess often seen in
3 years and younger
79
Tx for retropharyngeal Abscess
Surgical emergency | hospitalization with IV PCN or clindamycin
80
most often lymph node involved in acute cervical adenitis
Anterior cervical node (tends to be a single node, mono has more)
81
Patient presents with neck pain and dysphagia, high fever. Often caused by GAS
acute cervical adenitis
82
tx for acute cervical adenitis
penicillin IM or IV antibiotics
83
what are tonsillectomy and adenoidectomy reserved for
``` Obstructive sleep apnea recurrent infection Swallowing disorders (speech abnormality) ```
84
Short lingual frenulum | Can cause feeding problems, speech problems, dental problems
Ankyloglossia
85
when does someone need to be referred for ankyloglossia
tongue cannot protrude beyond gums
86
tx for ankyloglossia
frenulectomy
87
pink eye” and now sore throat. On exam you find conjunctivitis, enlarged beefy red tonsills, and cervical lymphadenopathy
Adenovirus

Old Peds (15 decks)

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