HEENT Flashcards
(88 cards)
1
Q
Bacterial conjunctivitis #1 etiology in NEWBORNS
A
Chlamydia trachomatis
2
Q
Bacterial conjunctivitis si/sx
A
- Thick, Purulent, Ropy discharge: “crusted shut”
2. Unilateral
3
Q
Bacterial conjunctivitis treatment
A
Infants=Abx ointment
Children=Abx drops
*Tx both eyes
4
Q
Viral conjunctivitis etiology
A
Adenovirus
5
Q
Viral conjunctivitis si/sx’s
A
- Bilateral
- Injected conjunctiva
- “Gritty sensation”, watery
6
Q
Allergic conjunctivitis si/sx
A
- Bilateral
- PRURITIC!
- water, red eyes
- Allergic rhinitis sx’s: coughing, sneezing, atopic dermatitis
7
Q
Allergic conjunctivitis treatment
A
Children > 2 years= Olopatadine
Reduce exposure
8
Q
Define Preseptal/Periorbital cellulitis
A
infxn ANTERIOR to orbital septum
D/t exogenous source: eyelid abrasion, chalazion, insect bite
9
Q
What are the two MC pathogen in Periorbital cellulitis
A
S. aureus
S. progenies
10
Q
Periorbital cellulitis si/sx’s
A
- Eyelid swelling, redness, pain
- Mild fever
- Vision & EOMS are NORMAL
11
Q
Define Orbital cellulitis
A
infxn POSTERIOR to orbital septum
Children>Adults
12
Q
What is Orbital cellulitis commonly associated with/complication of?
A
Bacterial Rhinosinusitis
13
Q
Orbital cellulitis si/sx
A
- Eyelid swelling, redness, pain
- Fever (high grade)
- PAIN with EOMS, proptosis
- Decreased vision
14
Q
Orbital cellulitis treatment
A
Emergent Ophthalmology consult
IV abx: Ceftriaxone, Vancomycin, Unasyn, Clindamycin
+/- surgical drainage
15
Q
What is the leading cause of acquired heart disease in children in the US?
A
Kawasaki Disease
16
Q
Define Kawasaki Disease
A
Widespread inflammation of medium and small arteries (including coronary arteries)
17
Q
Who is Kawasaki Disease MC in?
A
Boys>Girls
Asian Ancestry
Children <5
18
Q
Kawasaki Disease clinical presentation
A
CRASH & BURN (Fever >5 days)
- Conjunctivitis (B/L)
- Rash: Starts on perineum, skin peels, spreads
- Adenopathy: Cervical
- Strawberry Tongue
- Hands & Feet involvement: edema, redness
19
Q
Kawasaki Disease treatment
A
IVIG (Intravenous immune globulin) + ASA
20
Q
What must you NOT administer within 11 months of IVIG treatment?
A
Live Vaccines
21
Q
Complications of Kawasaki Disease
A
CV:
- Coronary artery aneurysms: Myocardial ischemia/infarction
- Myocarditis
- Arrhythmias
22
Q
How do you diagnose a Corneal Abrasion?
A
Apply Fluorescein stain & eval w/ Wood’s Lamp
23
Q
When do you refer to ophthalmology for a corneal abrasion?
A
- Foreign body on exam
2. No decrease in size post abx ointment treatment for 24-48 hrs
24
Q
What is the MC cause of persistent tearing & eye discharge in infants & children?
A
Dacryostenosis
25
Define DacryOstenosis
Nasolacrimal duct Obstruction
26
Dacryostenosis si/sx's
1. Tearing: Chronic or Intermittent
2. NO conjunctival irritation
3. Palpable nasolacrimal sac
4. +/- discharge
27
Dacryostenosis treatment
1. Lacrimal sac massage
| 2. Observation
28
When do you refer to ophthalmology for Dacryostenosis?
Sx's persist > 6 months
29
Dacryocystitis etiology
2ry infxn of Dacryostenosis
Upper respiratory tract bacteria:
S. aureus, S. pneumoniae, S. progenes, S. viridian's, M. catarrhalis, Haemophilus
30
Dacryocystitis si/sx
Swelling & erythema over nasolacrimal sac
31
SEVERE Dacryocystitis treatment
Culture
| IV abx
32
Otitis Media 1st line treatment
Amoxicillin 80-90 mg/kg per day x10 days
33
Who always receives abx treatment in OM?
Up to 2 years
34
When would you treat OM with abx If > 2
1. Appear toxic
2. Ear pain >48 hrs
3. Fever >102.2
4. B/L OM or discharge
5. Uncertain access to F/U
35
Treatment of OM w/ PE tubes w/ drainage
Fluoroquinolone abx drops
+/- corticosteroids
= Ciprofloxacin + dexamethasone (Ciprodex)
36
Define Serous Otitis Media
Middle ear effusion WITHOUT INFXN
37
Serous Otitis Media si/sx's
1. Pain
2. Pressure, "popping"
3. Decreased hearing
4. Disequilibrium
38
Serous Otitis Media physical exam findings
1. Bubbles/fluid
2. TM grey, shiny
3. TM immobile
4. TM normal or retracted
39
Otitis Externa physical exam findings
1. Significant ear pain (tragal), unilateral
| 2. Malodorous discharge/exudate
40
Otitis Externa treatment
Abx drops: Polymyxin B, Neomycin
41
Otitis Externa with TM perforation treatment
Fluoroquinolone suspension
42
Otitis Externa prevention
1. Swim-Ear OTC
| 2. 50/50 rubbing alcohol & white vinegar after swimming
43
Allergic Rhinitis physical exam findings
1. Allergic Shiners
2. Allergic Salute: Nasal crease
3. Dennie Lines: d/t puffiness beneath eyes
4. "Cobblestone": posterior pharynx
5. Pale, blueish/boggy nasal mucosa
6. Clear Rhinorrhea
44
Allergic Rhinitis treatment
1. Intranasal Steroid Sprays: Nasacort AQ (>2), Flonase OTC (>4)
2. Antihistamines:
Oral-Diphenhydramine (1st gen), Cetirizine (2nd gen)
Intranasal-Olopatadine
45
BACTERIAL sinusitis si/sx's
>10-14 days of sx's without improvement
1. Fever (102.2)
2. HA
3. Purulent nasal discharge
4. Sinus pain
46
What is the MC bacterial pathogen in bacterial sinusitis?
S. pneumo
47
1st line treatment in bacterial sinusitis
1. Amoxicillin-Clavulanate 45 mg/kd/d BID (covers H. flu)
| 2. Amoxicillin 90 mg/kg/d
48
Symptomatic treatment for mild/questionabile sx's in sinusitis (likely viral)
1. Intranasal saline irrigation
2. Analgesics
3. Humidifier/vaporizer
49
Infectious Mononucleosis etiology
EBV
50
EBV incubation period
4-8 weeks
51
Infectious Mononucleosis (EBV) si/sx's
1. Exudative Tonsillitis
2. Cervical Lymphadenopathy
3. Splenomegaly
52
Infectious Mononucleosis (EBV) labs/diagnostics
1. Fingerstick: Monospot
| 2. EBV titers
53
Infectious Mononucleosis (EBV) treatment
1. Spleen precautions x6-8 weeks*
2. Analgesics
3. Fluids
4. +/- steroids
54
GABHS si/sx's in children >3 y.o.
1. Rash
2. HA
3. Nausea, abd pain
4. Absent cough
55
GABHS si/sx's in children <3 y.o.
Atypical sx's:
1. Anterior cervical LAD
2. Nasal congestion
3. Low grade fever
56
GABHS physical exam findings
1. Palatal Petechiae*
2. Enlarged/Tender Anterior Cervical LAD
3. Exudative tonsillitis
57
What is the INITIAL test you will order in GABHS?
Rapid Strep Antigen Test
58
If rapid strep antigen test is negative, what should you perform?
Throat Culture=Gold standard
59
What is Gold Standard Abx tx in GABHS
Penicillin VK: BID x 10 days
60
Abx treatment if the patient has a NON-anaphylactoid PCN allergy
1st gen. cephalosporin: Cephalexin
61
Abx treatment if the patient has anaphylactoid PCN allergy
Clindamycin TID x 10 days
62
Major/Minor Criteria that indicates high likelihood of Acute Rheumatic Fever
2 Major Jones Criteria OR
| 1 Major + 2 Minor
63
What is the #1 cause of acquired valve dz WORLDWIDE?
Rheumatic heart disease
64
Rheumatic Fever Diagnosis
+ ASO titers
65
Rheumatic Fever Treatment
1. Amoxicillin (tx strep pharyngitis)
2. ASA
3. Eval for carditis: Cardiomegaly, CHG, 3rd degree AV block
66
Post-Streptococcal Glomerulonephritis (PGN) sis/x
1. Edema
2. Hematuria: Tea colored urine
3. HTN
4. Proteinuria
67
PGN diagnosis
ASO titers
68
What is the MC bacterial pathogen in a Peritonsillar Abscess
S. pyogenes (progression of bacterial tonsillitis)
69
Peritonsillar Abscess si/sx's
1. Drooling
2. Muffled/"Hot potato" voice
3. Dysphagia
70
Hand, Foot & Mouth Disease etiology
Cocksackie virus
71
Herpetic Gingivostomatitis etiology. What is it?
HSV-1
| Ulcerative lesions of gingiva and mucous membranes
72
Herpetic Gingivostomatitis si/sx's
1. 3-4 day "prodrome"
| 2. Ulcerated lesions that bleed if disturbed
73
Herpetic Gingivostomatitis treatment
1. Oral Acyclovir: if sx <4 days
2. NSAID
3. HYDRATION
74
Measles (Rubeola) prodrome sx's
1. Conjunctivitis
2. Coryza
3. Cough
4. Koplik Spots: 48 hr BEFORE rash
75
Measles (Rubeola) physical exam findings
Exanthem rash: Maculopapular, blanching rash starting from HEAD to TOE
76
Measles diagnosis
IgM assay
77
Mumps incubation period
14-18 days
78
Complications of mumps
1. Orchitis=38% of post-pubertal males
2. Oophoritis
3. Sensorineural hearing loss
79
Congenital Rubella (German measles) Syndrome si/sx
Purpuric "blueberry muffin" rash @ birth
80
Congenital Rubella Syndrome complications
1. Hearing loss
2. Mental retardation
3. CV & ocular defects
4. Deafness
5. Jaundice, thrombocytopenia
81
Rubella prevention
VACCINATE
82
Diaper Candidiasis appearance
Beefy red erythema with satellite lesions
| Involves skin folds
83
Diaper Candidiasis treatment
Topical Antifungal: Clotrimazole
84
Cradle Cap (seborrheic dermatitis) appearance
Greasy, yellow scales: Scalp, ear, face
85
What is Cradle Cap (seborrheic dermatitis) associated with?
Malessezia furfur
86
Cradle Cap (seborrheic dermatitis) treatment
Apply emollient + soft baby brush to gently remove from scalp
87
Mild Impetigo treatment
Topical Abx: Mupirocin (Bactroban)
88
Severe Impetigo treatment
Mupirocin ointment + PO Keflex
