HEENT- Peds Flashcards
(51 cards)
Mononucleosis: s/s
- Often begins with malaise, headache and low-grade fever before more specific sx develop
o Tonsillitis/pharyngitis
o Cervical LAD (typically posterior/occipital)
o Moderate to high fever
o Fatigue - LUQ abdominal pain
o Splenomegaly
Mononucleosis: supportive care
o Ibuprofen with food for swollen lymph nodes
o Warm compresses
o Rest
o Avoid contact sports d/t hepatomegaly
o Avoid sharing saliva: kissing, sharing utensils, sharing water bottles, etc…
o If co-contaminant strep A, do not treat with Amox/Penicillin: will develop a full body rash
If patient has both strep A and mono DO NOT TREAT WITH abx.. why?
full body rash will develop
Epiglottis: s/s
o Present with respiratory distress, anxiety, tripoding/sniffing posture (leaning forward at the trunk, hyperextending their neck/chin to maximize their obstructed airway).
o They may be reluctant to lay down
o Drooling is often present, but not always necessary
o Typically Hib
- Acute epiglottitis
o Above symptoms with accompanied acute onset, fever and stridor and hot potato (muffled) voice
tx of epiglottis
o Ensure no airway obstruction (intubate if necessary)
o Imaging: x-ray/CT (looking for Thumb sign)
o No laying down flat
o IV steroids
o ? IV antibiotics
o O2
PFAPA Syndrome: Periodic Fever with Aphthous Stomatitis, Pharyngitis, and Adenitis
- Fever begins abruptly with/without chills
- Prodrome: malaise, irritability, mood changes, sore throat or aphthous ulcers may occur during the preceding day. Fever ranges from 38.5C-41C for 2-7 days, then normalizes.
- Atypical symptoms: cough, inflamed nostrils, severe abdominal pain, vomiting/diarrhea, chest pain, rash, arthritis or significant neuromuscular symptoms
- Episodes last no greater than 7 days
- Periodic fever is the hallmark of PFAPA syndrome
- There is NO diagnostic lab test for PFAPA; it is based strictly on clinical hx and PE.
- Abnormal labs during flares potentially: leukocytosis, elevated ESR/CRP, neutrophilia, monocytosis and mild lymphopenia can be noted during flares, but normalize between attacks.
- You have to rule out other things to rule this in: strep, lyme, IBD, EBV, cyclic neutropenia.
- Careful documentation of the dates of fever episodes and PE during flares are IMPERATIVE for proper diagnosis.
- Primary features of PFAPA
o More than 3 documented stereotypical episodes of fever occurring at regular intervals
o Intervals between attacks are typically 2-8 weeks.
o Each episode lasts approximately 2-7 days
- Treatment of PFAPA
o Tylenol/Ibuprofen
o Fluids
o Rest
o 1-2mg/kg (max dose 60mg) PO Prednisolone given as a single dose OR 2 doses 12-48 hours apart
mumps
- Viral illness; affects saliva
*puffy/swollen cheeks
mumps: tx
- No definitive treatment: 1-2 weeks of symptoms typically; supportive treatment
o Rest
o Push fluids
o Tylenol/Ibuprofen (do not give aspirin to anyone under 16 years old)
o Warm/cool compresses
o Sucking on sour/lemon candy can help increase salivation which could help relieve some pressure from the parotid gland
mumps s/s
- Typically starts with a few days of: fever, headache, muscle aches, fatigue and loss of appetite, followed by swelling of their salivary glands
o This causes the jaw/cheek to become puffy/tender and a swollen jaw
o Parotitis: inflamed parotid gland
Stomatitis: Oral Mucositis
- Inflammation of the mouth; causes swelling and sores inside the mouth
- Post-viral (HFMD, HSV, Apthous Ulcers)
tx for stomatitis
- Push Fluids
- Tylenol/Ibuprofen
- “Magic mouthwash” combination of:
o Maalox
o Diphenhydramine
o Viscous Lidocaine
Peritonsillar Abscess/Retropharyngeal Abscess: s/s
o Rapid onset sore throat
o Unilateral
o With/without fever
o Can have neck swelling and referred ear pain
Peritonsillar Abscess/Retropharyngeal Abscess: presentation
o Tripoding
o Trismus
o potatoe/muffled voice
o unable to tolerate secretions
Peritonsillar Abscess/Retropharyngeal Abscess: exam
o Trismus
o Potato/muffled voice
o Extremely swollen/fluctuant unilateral tonsil with or without exudate
o Deviation of uvula to opposite side
o Erythematous pharynx
Peritonsillar Abscess/Retropharyngeal Abscess: tx
o Intra-oral Ultrasound
o Refer to ED for I&D and
* Augmentin: 45mg/kg/dose (max 875mg/dose) BID x 10 days
* Clindamycin: 10mg/kg/dose (max 600mg/dose) QID x 10 days
acute pharyngitis: tx
- Tylenol/Ibuprofen with food for pain/swelling
- Push fluids
- Warm salt water gargles
- Tea with honey and lemon
- Lozenges or Cepacol throat spray
acute pharyngitis: diagnosis
Modified Centor Criteria Score:
* fever: 1
* tonsillar exudate: 1
* absent cough: 1
* anterior cervial LAD: 1
* age 3-14 yrs: 1
* age 15-44 yrs: 0
* age > 44 yrs: -1
Streptococcal Pharyngitis: tx
- First line therapy
o Amoxicillin: 50mg/kg BID x 10 days (max 1gm/day) - If Penicillin/Amoxicillin allergy
o Cephalexin: 40mg/kg/day divided BID x 10 days (max 500mg/dose)
o Azithromycin: 12mg/kg/day (max 500mg/day) x 5 days
o Clindamycin: 7mg/kg/dose (max 300mg/dose) TID x 10 days - Ensure they change their toothbrush, wash pillowcases/towels/etc… after 24 hours on antibiotics.
Mastoiditis: s/s
o Postauricular tenderness
o Erythema
o Swelling
o Fluctuance or mass
o Protrusion of the auricle
o Ear pain, which is a nonspecific finding and may manifest as irritability in young children
Mastoiditis: tx
This should be ED referral, as they likely need to be admitted for aggressive IV antibiotics and potential surgery.
Otitis Externa (Swimmer’s Ear)
- Inflammation/infection of the external ear canal
o Often will be associated with tragal tenderness
o Green/black discharge in the edematous/erythematous canal
