HEENT Flashcards Preview

PNP Board Review > HEENT > Flashcards

Flashcards in HEENT Deck (92)
Loading flashcards...
1

Head growth 0-3 months (cm)

2 cm/month

2

Head growth 4-6 months (cm)

1 cm/month

3

Head growth 6-12 months (cm)

0.5 cm/month

4

Head growth _____cm/year from 2-7 years; ____cm/year 8-12 years.

0.5 cm/year ... 0.3cm/year

5

Primary microcephaly

Familial and genetic etiologies

6

Secondary microcephaly

Acquired from multiple noxious causes that may affect the infant in utero or during first 2 years of life; i.e., fetal exposure to infection, substances, radiation; extreme poor nutrition, placental insufficiency, trauma, maternal hypoglycemia.

7

Microcephaly management

Most etiologies untreatable. Thorough H&P to identify treatable causes - hypopituitarism, metabolic disorder, severe malnutrition.

8

Obstructive hydrocephalus

Major cause, involves obstruction of CSF flow within ventricular system. May be congenital malformation, associated with syndrome (dandy-walker, Arnold-chiari), or acquired from space occupying lesson.

9

Nonobstructive hydrocephalus

Impairment of reabsorption of CSF in subarachnoid space - usually secondary to hemorrhage or meningitis.

10

Physical findings in infant hydrocephalus

Bulging fontanel
"Setting sun sign"
Separated sutures
Hypotonia
Hyperreflexia
Slow PERRL

11

Caput succedaneum

Diffuse swelling of infant scalp, crosses suture lines

12

Caput succedaneum complications

May require phototherapy for hyperbilirubinemia if extensive

13

Cephalohematoma

Subperiosteal collection of blood; does not cross suture lines - no ecchymosis

14

Cephalohematoma resolution

Usually spontaneous over days to weeks
May prolong jaundice
May calcify into bony prominence

15

Suture lines close at _________ (age)

2-3 years

16

Palpable bony ridge along a suture line

Found over affected suture line in craniosynostosis and indicates premature fusion

17

Opthalmia Neonatorum (definition)

Infection and/or inflammation of conjunctiva in first month of life

18

Opthalmia Neonatorum (pathogens)

Chlamydia trachomatis (MOST COMMON)
N. gonorrhoea
Herpes
Staph
Strep
M. cat
Klebsiella
Pseudomonas

19

Most common cause of neonatal conjunctivitis

Chlamydia trachomatis

20

Acute, profuse, purulent conjunctival discharge 2-4 days after birth with lid edema

N. gonorrhoea

21

Mild mucopurulent conjunctival discharge presenting 5-14 days after birth

Chlamydia trachomatis

22

Gonococcal conjunctivitis

OCULAR EMERGENCY!! Admit immediately for IV antibiotics; irrigate eye to remove discgmharge and treat with IM ceftriaxone (unless jaundiced) or IV cefotaxime.

23

Treatment of Chlamydia conjunctivitis

Oral erythromycin - treats conjunctivitis and may prevent subsequent pneumonia

24

Conjunctivitis-otitis syndrome

Concurrent infections, typically if ipsilateral eye and ear

Very common

Usually H. influenzae

25

Bacterial conjunctivitis - Pathogens

Staph aureus
Strep pneumo
M catarrhalis
H. flu

26

Conjunctivitis with corneal involvement

Refer to opthalmologist

27

Dacryostenosis

Incidence and resolution

30% incidence

90% resolve by 12 months

28

Chalazion + definition

noninfectious obstruction of a meibomian gland causing extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation

29

Chalazion - management

Warm compresses
May require incision and curettage if persists beyond several weeks

30

Hordeolum definition

Acute infectious inflammation of eyelash follicle, aka stye

31

Blepharitis

Acute or chronic inflammation of bilateral eyelid margins

32

Blepharitis treatment

Hot compresses
Daily mechanical scrubbing and cleaning with q-tips or soft cloth
Topical antibiotic ointment (sulfacetamide or bacitracin)

33

Hordeolum pathogen

Most often staph aureus

34

Hordeolum treatment

Warm compresses
Sulfacetamide or bacitracin ointment
HYGIENE

35

Orbital cellulitis

Typically secondary to sinusitis, more common in older children (average age 12 years)

EMERGENT due to possible complications, requires hospitalization

36

Orbital cellulitis- signs and symptoms

Key= proptosis and opthalmoplegia (⬇️ EOM)

Insidious onset of unilateral lid edema and redness - not extending into eyebrow

Orbital pain and headache

Decreased vision and EOM

37

Cataract - physical findings

Strabismus may be first sign
Absent red reflex - leukocoria, black dot surrounded by red reflex, opacities
Decreased acuity

38

Congenital glaucoma = that occurring in first _______ _______ of life. More common in (male/female)

First three years

Males

39

Physical findings of glaucoma

Increased IOP - may be appreciated on palpation
Epiphora (abnormal overflow of tears)
Blepharospasm
ENLARGED CORNEA >10mm
Tunnel vision
Ocular pain
IRREGULAR CORNEAL REFLEX
Corneal haziness or edema
Cupping of optic disc

40

Tropia

Misalignment of eyes that is ALWAYS present

Ie. exotropia or esotropia

41

Phoria

Misalignment of eyes that is only present when binocular vision is disrupted

P is for Part of the time

42

Amblyopia

Decreased vision secondary to Central suppression of visual input from one eye - adaptive response to untreated strabismus to eliminate diplopia

43

Strabismus

Definition and incidence

Misalignment of eyes

Blanket term including tropias and phorias

Affects 4% of children < 6yoa

44

Intermittent exotropia during first 4 to 6 months of life

Normal variant

45

Strabismus after 4 months of age

REFER

46

Fixed or constant stabismus at any age

REFER!

47

Hypertropia or hypotropia

Upward and downward strabismus

REFER!!

48

Congenital esotropia treatment

Usually surgical repair between 6mos and 2 years

Patching, eyeglasses, dilation of good eye may be used

49

Mild nystagmus during first few days of life

Normal variant

50

Passing vision screen

__/__ for children 3-4 years
__/__ for older children

20/40

20/30

51

Quivering iris

Lens dislocation

52

Corneal abrasion

Diagnosis and treatment

Fluorescein stain and woods lamp

Topical abx ointment/drops and NSAIDS (topical ketorolac or PO NSAID)

53

Hyphema

Accumulation of blood in anterior chamber

54

Hyphema management

Refer to optho, may require hospitalization and surgery

Supine bedrest and eye patching for protection

55

Hyphema complications

Primarily rebleed, especially with sickle cell
Glaucoma, cataracts and sympathetic ophthalmia possible

56

Otitis Externa pathogens

Pseudomonas MOST COMMON
Staph aureus
Strep pyogenes
Klebsiella
Fungus
Staph epidermis
Proteus
Enterobacter

57

OE treatment

Topical drops - fluoroquinalone, neomycin or polymyxin; add hydrocortisone if edemetous
Abx saturated cotton wick for first 24-48 hours if significant edema

58

Systemic abx use for OE

If fever, facial cellulitis or lymphadenitis present

59

Swimmer's ear prevention

Instill 50/50 mixture of white vinegar and rubbing alcohol after swimming

Earplugs while swimming

60

Natural history of untreated AOM

70-90% will spontaneously resolve

61

Fever incidence in AOM

30-50%

62

AOM referral to otolaryngology

Persistent AOM resistant to treatment over 1-2 months
Recurrent AOM, 3 in 6 months or 4-5 in 12 months
Chronic OME >3 months
Evidence of hearing impairment or language delay

63

Mastoiditis

AOM complication - requires prompt referral to ENT and IV antibiotics

64

Cholesteatoma

Cyst-like growth in lining of middle ear filled with desquamated debris

65

Cause of cholesteatoma

Most common cause of acquired type is chronic OME

May also be congenital

66

Pearly white opacity on or behind TM

Most likely cholesteatoma

May have history of chronic OM with foul smelling otorrhea

67

Mild hearing loss = ____dB

15-30 dB

68

Moderate hearing loss = ____dB

30-50 dB

69

Severe hearing loss = ____dB

50-70 dB

70

Profound hearing loss = ____dB

>70 dB

71

Congenital sensorineural hearing loss
Causes

Genetic
TORCH infections, particularly CMV and rubella
Erythroblastosis fetalis
Anoxia
Exposure to ototoxic drugs

72

Acquired sensorineural hearing loss

Causes

Meningitis
Mumps, measles
Noise-induced hearing loss
Severe trauma
Ototoxic drugs

73

First line therapy for allergic rhinitis

Allergen avoidance

74

Chronic rhinitis

chronic nasal discharge, with or without acute exacerbation

May be due to underlying disorder, FB, CF, nasal polyps, infection, allergy, or congenital malformation

75

Epistaxis - etiology

Most cases benign secondary to increased vascularity
Assess for recurrent episodes, other bleeding, petechiae, family history

76

Epistaxis referral

If recurrent or severe, or with hematoma, refer to ENT

77

Acute sinusitis duration

10-30 days

78

Chronic sinusitis duration

>30 days

79

Acute Sinusitis pathogens

S. pneumoniae, H. influenzae, M. catarrhalls

80

Chronic Sinusitis pathogens

GABHS, S. aureus

81

Complications of sinusitis

orbital cellulitis, intracranial abcess, osteomyelitis

82

Most common cause of an abnormal pupillary reflex

cataracts

83

Diseases associated with cataracts

Diabetes, Marfan syndrome, and atopic dermatitis

84

Classic triad of pediatric galucoma

tearing, photophobia, and excessive blinking

85

Etiology of retinopathy of prematurity

Hypovascularized retina is slow to develop blood supply with high oxygen administration

86

ROP referral criteria

All infants < 30 weeks gestation or <1500g
29-34 weeks or >1500g with unstable hospital course
within two weeks of NICU discharge

87

Management of gonococcal conjunctivitis

IM cephtriaxone
If hyperbilirubinemia present, use cefotaxime
If extraocular manifestation present, 7d course of IV abx

88

Management of C. trachomatis conjunctivits

Systemic erythromycin to prevent pneumonia sequelae

89

Keratitis with corneal ulcer

OCULAR EMERGENCY
refer immediately
may be caused by HSV, bacteria, VZV, HCV

90

Trachoma

second leading cause of blindness worldwide, though rare in US
Caused by second biovar of C. trachomatis

91

Auditory brainstem response audiometry

Measures brainstem response to tones
requires sedation beyond about 6 months

92

Ototoxic drops

Neomycin
Polymyxin
Hydrocortisone
Domebro (acetic acid)