Flashcards in HEENT Deck (92)
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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
