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Pediatrics Exam 2 > HEENT > Flashcards

HEENT Flashcards

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1
Q

Bacterial conjunctivitis etiology

A

strep pneumo, H influenza, Moraxella cat

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2
Q

Clinical presentation of bacterial conjunctivitis

A

unilateral injection, thick purulent discharge, eye “stuck shut”

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3
Q

Tx for bacterial conjunctivitis

A

EES ointment, trimethoprim-polymyxin B drops

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4
Q

Neonatal conjunctivitis

A

presents 5-14 days of life; watery to mucopurulent to bloody d/c, chemosis, pseudomembrane

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5
Q

Neonatal conjunctivitis etiology

A

Chlamydia trachomatis

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6
Q

Dx for neonatal conjunctivitis

A

CULTURE

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7
Q

Tx for neonatal conjunctivitis

A

Oral erythromycin (50 mg/kg per day in 4 doses x 14 days)

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8
Q

Hyperacute bacterial conjunctivitis etiology

A

N. gonorrhoeae

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9
Q

Hyperacute bacterial conjunctivitis

A

severe & sightpthreatening; keratitis and perforation can occur; 2-5 days after birth, profuse, purulent discharge, chemosis, urethritis

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10
Q

Tx for hyperacute bacterial conjunctivitis

A

REFER TO OPTHAMOLOGY, HOSPITILIZE

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11
Q

Contact lens wear

A

high risk of pseudomonal keratitis, can lead to ulcerative keratitis (perforation)

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12
Q

Keratitis features

A

foreign body snesation, blepharospasm, typically visible corneal opacity with penligh

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13
Q

Tx for keratitis

A

URGENT REFERRAL; discontinue contacts, abx (anti-psuedomonal)

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14
Q

Viral conjunctivitis etiology

A

Adenovirus

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15
Q

Viral conjunctivitis presentation

A

+/- prodrome; injection (burning, gritty sensation), watery d/c

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16
Q

Tx for viral conjunctivitis

A

self-limited; warm or cool compresses, topical antihistamines/decongestants (Naphcon-A), lubricant eye drops

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17
Q

Education for infectious conjunctivitis

A

stay home from school until there is no longer any discharge (@ least 24 hrs topical therapy); sports: non-contact when they feel okay, contact: once daytime d/c has stopped (usually 5 days)

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18
Q

Allergic conjunctivitis

A

bilateral injection, edema, d/c (stringy), ocular pruritus

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19
Q

Tx for allergic conjunctivitis

A

symptomatic (cool compress, avoid allergens, lubricants), pharm:
topical vasoconstrictor + antihistamine (<2 weeks) (Naphcon-A, Visine-A), ANTIHISTAMINE W/ MAST-CELL STABILIZING (olopatadine, azelastine), mast-cell stabilizer (cromolyn), NSAIDs, glucocorticoids by opthamology (don’t prescribe)

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20
Q

Kawasaki disease

A

mucocutaneous lymph node syndrom; small and medium vessel vasculitis

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21
Q

Kawasaki disease Sx.

A

(crash)
Conjunctivitis (bilateral, nonexudative)
Rash (morbilliform)
Adenopathy (cervical)
Strawberry tongue (cracked, red lips, fissuring)
Hands (red, swollen w/ subsequent desquamation)

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22
Q

Unexplained fever longer than 5 days

A

Consider KD

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23
Q

Dx for KD

A

fever >5 days plus 4/5:

  1. Bilateral conjunctivitis
  2. Oral mucous membrane changes, fissured lips, strawberry tongue
  3. peripheral extremity changes (erythema, edema, desquamation)
  4. Polymorphous rash
  5. Cervical LAD
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24
Q

KD complications

A 
cardiovascular complications (coronary aneurysms, carditis); manifestations: tachycardia, gallop, muffled heart tones
Young infants: fusiform aneurysms of brachial arteries: palpable/visible in axillae; cold pale, cyanotic digits
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25
Dx for KD
ECHOCARDIOGRAM
26
Tx for KD
ID and CV consults (long-term cardio f/u); Intravenous immunoglobin (IVIG)- provides extra antibodies, reduces prevalence of carotid artery aneurysms; high dose aspirin, delay vaccines
27
Strabismus
misalignment of eyes; potential to cause amblyopia (decreased acuity)
28
Dx of strabismus
abnormal corneal light reflection, cover/uncover test
29
Tx of stabismus
refer to opthamology
30
Dacryostenosis
nasolacrimal duct obstruction
31
Most common cause of tearing & ocular d/c in infants/young children
Dacryostenosis
32
Etiology of dacryostenosis
congenital
33
Presentation of dacrystenosis
chronic, intermittent tearing; mucoid d/c, debris on lashes, mild redness of lower lid from rubbing
34
Tx for dacryostenosis
most resolve spontaneously by 6 mo; lacrimal sac massage (1st line); refer to opthamology for sx >6-7 mo, complications; Surgical management for definitive treatment (surgical probe)
35
Dacryocystitis
inflammation or infection of lacrimal sac; rare complication of dacryostenosis
36
complication of dacryostenosis
dacryocystitis
37
Etiology of dacryocystitis
Staph epidermis and staph aureus
38
Clinical presentation of dacryocystitis
erythema, swelling, warmth, tenderness of lacrimal sac, purulent d/c
39
Tx of dacryocystitis
C&S, treat promptly with empiric abx (x7-10 days) (Clindamycin PO (mild), IV vanco (severe) + 3rd generation cephalosporin), Opthamology referral
40
AOM etiology
strep pneumonia, haemophilus influenza, moraxella catarrhalis
41
Risk factors for AOM
peak @ 6-18 mo, then 5-6 yo; family hx, day care, lack of breastfeeding, tobacco smoke or air polluiton, pacifier use
42
AOM Sx.
otalgia, irritability, fever, anorexia, vomiting, diarrhea
43
AOM PE findings
bulging, erythematous TM; TM with decreased mobility, otorrhea, hearing loss
44
Complications of AOM
perforation, hearing loss, cholesteatoma, facial nerve palcy, mastoiditis
45
Dx for AOM
bulging TM (or other signs of inflammation) AND middle ear effusion (decreased Tm mobility, otorrhea)
46
Tx for AOM
amoxicillin (90mg/kg/day divided by 12 hrs) (<2 yo = 10 days, >2 yo = 5-7 days)
47
AOM tx <2
amoxicillin x 10 days
48
AOM tx >2
amoxicillin x 5-7 days
49
Tx for AOM when resistance suspected
Amoxicillin-Clavulanate (Augmentin)
50
Resistance risk for AOM
recent beta-lactam, purulent conjunctivitis and recurrent AOM
51
AOM tx for PCN allergy
cefdinir (2nd line if not Type I allergic response) or azithromycin (3rd line), clindamycin, TMP-SMX
52
Tx for AOM
abx + follow up 48-72 hours
53
When are Abx given for AOM
- all children < 6 mo - all children w/ severe sx (moderate/severe ear pain, ear pain >48 hrs, temp >102) - bilateral AOM <2 yrs - unilateral AOM <2 yrs
54
Recurrent AOM
>3 episodes in 6 months; >4 episodes per year
55
Tx for recurrent AOM
daily abx (amoxicillin 40mg/kd or sulfisoxazole 50 mg/kg); myringotomy and tympanostomy tubes if prophylactic abx doesn't work
56
OME
amber, gray or blue, cloudy, opague, RETRACTED TM; decreased mobility of TM, hearing loss
57
OME tx
symptomatic; eval and heart test q 3-6 months (until resolved or tubes
58
Otitis externa etiology
P. aeruginosa, s. aureus, s. epidermis
59
OE Sx.
otalgia, pruritus, d/c
60
OE PE findings
hearing loss, tragus tenderness, erythema and/or edema of ear canal
61
OE Tx
Floxin Otic solution (ofloxacin) cortisporin otic suspension (not with perforated TM) ciprodex
62
Allergic rhinitis patterns
intermittent: Sx <4 day/week or <4 weeks Persistent: Sx >4days/week AND >4 weeks
63
Sx of allergic rhinitis
shiners, dennie-morgan lines, tears, allergic salute, pale/bluish boddy nasal mucosa, edematous turbinates; cobblestoning in pharynx
64
Dx for allergic rhinitis
clinica; IgE levels, skin testing, serum testing; imaging for chronic
65
Tx for allergic rhinitis
allergen avoidance, pharmacotherapy, allergen immunotherapy
66
Pharm tx for allergic rhinitis
intranasal steroids (Flonase), antihistamines, decongestants (pseudophedrine), anticholinergics (ipratropium), Mast cell stabilizer (cromolyn), LTR antagonist (montelukast)
67
Immunotherapy for allergic rhinitis
patient has maximized environmental control measure and optimal medication regimen; subq injections 1-2/week
68
Nasal polyps
benign pedunculated tumors, "pealed grape" appearance; formed from chronically inflamed nasal mucosa
69
Nasal polyps are associated with
CF (child <12 w/ polyps), chronic sinusitis, allergic rhinits
70
SAMTER's TRIAD
nasal polyps, ASA sensitivity & asthma
71
Nasal polyps PE findings
obstruction of nasal passages (hyponasal speech and mouth breathing), inflamed nasal mucosa, profuse unilateral mucoid/mucopurluent rhinorrhea
72
Tx for nasal polyps
decongestants, intranasal steroid, systemic steroids, surgical removal
73
Viral URI
"common cold"
74
Duration of viral URI
14 days
75
Etiology of viral URI
rhinovirus
76
Complications of viral URI
AOM, asthma exacerbation, acute bacterial sinustitis, lower respiratory tract disease (PNA)
77
Viral URI tx
avoid OTC without direction, Do not use <6 YO, avoid in 6-12 YO; use antitussive, expectorant
78
acute rhinosinusitis
preceding viral URI
79
Etiology of rhinosinusitis
viral infection; s. pneumoniae, h.influenzae, m. catarrhalis
80
Acute bacterial rhinosinusitis
nasal sx, cough worse at night, fever, HA, facial pain; mild erythema of turbinates, mucopurulent d/c, postnasal drainage in pharynx
81
Bacterial rhinosinusitis
sx >10 dyas, <30 days, not improving; severe sx or double sickening
82
Chronic rhinosinusitis
>12 weeks and 2 of the following: d/c, nasal obstruction, facial pain, decreased sense of smell
83
Dx for acute rhinosinusitis
XR/CT
84
Dx for chronic rhinosiusitis
XR, CT, MR, maybe culture
85
Tx for acute sinusitis
saline irrigation, decongestant, antihistamine; Abx if bacterial: Augmentin 45 mg/kg
86
Med for bacterial sinusitisi
augmentin 45 mg/kg/day
87
Etiology of pharyngitis
usually viral (adenovirus, coxsackie), bacterial (GAS)
88
Sx of pharyngitis
sore throat, fever; tonsillopharyngeal erythema, enlarged tonsils, LAD
89
Tx for viral pharyngitis
supportive, miracle mouth wash
90
Mono etiology
EBV
91
Sx of mono
fevere, sore throat, FATIGUE, malaise, LAD, SPLENOMEGALY
92
Dx of mono
CBC w/ differential, HETEROPHILE ANTIBODY TEST (monospot), strep test (RADT, culture)
93
Tx for mono
may persist 7-21 days; supportive; activity restriction for 4 weeks
94
Bacterial pharyngitis etiology
GAS; peak incidence winter/early spring (5-15 YO)
95
Grading system for strep
``` Age: 5-15 YO Season: late fall, winter, early spring pharyngitis (erythema, edema, exudates) LAD Fever (101-103) Absence of cough ``` Scoring: 6 = likelihood 85% scoring: 5: likelihood falls to 50%
96
GAS Sx
abrupt onset, sore throat, odynophagia; exudate, palatal petechiae, tender LAD, scarlet fever
97
Centor criteria
Tonsillar exudates tender LAD fever by hx Absence of cough 0-2 score: unlikely GAS >3 score: reform RADT
98
If clinical suspicion is high with negative RADT for strep what do you do next
Throat culture
99
Dx of strep
RADT; throat culture if RADT is negative
100
Tx for strep
abx in first 48 hours (penicillin, amoxicillin; 1st gen cephalosporin); Azithromycin for PCN allergy
101
GAS complications
Acute rheumatic fever (ARF)- 2-4 weeks after infection; | Post-streptococal glumerulonephritis (PSGN)
102
5 manifestations of Acute Rheumatic fever
``` migratory arthritis carditis (valve damage) CNS involvement Subcutaneous nodules (firm, painless) erythema marginatum (pink/non-pruritic rash to trunk and limbs, not face) ```
103
post-streptococcal glomerulonephritis (PSGN) sx
asymptomatic, microscopic hematuria; full blown = brown urine; Common sx: generalized edema, gross hematuria, hypertension
104
Dx of PSGN
Urinalysis: hematuria complement positive streptozyme test
105
Tx for PSGN
supportive; treat volume overload (sodium and water restriction, diuretics), dialysis if renal failure
106
Tonsillectomy indications
Paradise criteria: | 7 episodes in last year OR 5 episodes in each of the past 2 years OR 3 episodes in each of the past 3 years
107
Thrush
occurs often after abx; caused by candida albicans; adherent white plaque that brushes off
108
Tx for thrush
nystatin oral suspension
109
Mumps
late winter/early spring; incubation 16-18 days; infectious 3 days prior and 9 days after sx
110
Sx of mumps
within 48 hrs parotitis develops (fever, HA, myalgia, etc)
111
Complications of mumps
orchitis or oophoritis, neuro (meningitis, encepahlitis, deafness), arthritis, pancreatitis, etc.
112
Parotitis
cause: Mumps; bacterial (purulent d/c from stenson;s), noninfectious; ages 2-9
113
Sx of partotitis
salivary gland swelling for up to 10 days; orifice of stensen's duct is erythematous and enlarged
114
Tx for Mumps/partotitis
supportive (acetaminophen, cold/warm packs)

Pediatrics Exam 2 (3 decks)

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