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Flashcards in Pediatric ENT Deck (55):
1

Hordeolum definition

stye, a common staph abscess on the upper or lower eyelid

2

hordeolum s/sx

abrupt onset, localized PAIN (acutely tender) and edema

3

Management of hordeolum

warm compresses to bring to a head and open
Topical bacitracin or erythromycin ophthalmic may be considered
refer for surgical if no resolution in 48 hours

4

Definition of chalazion

a granulomatous (beady nodule) firm on the eyelid, infection or retention of cyst of the meibomian gland. PAINLESS

5

s/sx of chalazion

aymptomatic, red conjuctiva, itching, visual distortion if compression, eyelid swelling, light sensitivity, increased tearing

6

Management of chalazion

referral for surgical

7

conjunctivitis- bacterial- type of discharge and treatment

purulent
tx: erythromycin 0/5% opthalmic ointment, tetracycline 1%, polymyxin B ophthalmic solution or ointment

8

Gonococcal conjunctivitis- type of discharge and tx

(opthalmic emergency). Copious, purulent. IV Pen or ceftriaxone IM

9

Chlamydia conjunctivits- tx

erythromycin ophthalmic ointment
oral: tetracycline, erythromycin, clarithromycin, azithromycin, doxycyline

10

Conjunctivitis- Allergic- type of discharge and treatment

Discharge: Stringy, increased tearing.
tx: Oral histamines and refer to allergist or optho

11

Conjunctivitis- Viral- type of discharge and treatment

discharge: Watery
Treatment: Symptomatic care. Mild: cool saline/artifical tears
Moderate: decongestants/ antihistamines, mast cell stabilizers, NSAIDS

12

What can you use for recurrent conjunctival infections for prophylaxis

sulfacetamide 10% ophthalmic solution for bacterial (secondary) prophylaxis

13

Herpatic conjunctivitis- discharge and tx

Bright red and irritated, REFER TO OPTHO

14

Cataracts is co-morbid condition in children with

down syndrome, diabetes mellitus, Marfans syndrome and atopic dermatitis

15

S/SX of cataracts

PAINLESS, decreased visual acuity, cloudid blurred dim vision, white funded reflex, poor visual reflex, photophobia

16

strabismus definition

ocular misalignment as a result of uncoordinated ocular muscles. If acquired after 6 months of age- REFER for underlying problem

17

When to refer strabismus to opthomology

If fixed or continuous at six months of age or more
Immediately for hypertropia and hypotropia (bc could be space occupying lesion)
Signs of underlying cause present

18

Esotropia

eyes deviate inward

19

exotropia

eyes deviate outward

20

hypertropia

eyes deviate upward

21

hypotropia

eyes deviate downward

22

What is the hirschberg papillary light reflex

will be unequal in strabismus

23

Physical exam findings for otits externa

Erythema of the ear canal, edema of the ear canal, purulent excavate (sometimes with odor), pain upon manipulation of the auricle, lateral surface of tympanic membrane may be erythematous, tympanic membrane: normal

24

Management for otitis media

remove purulent debris, protect ear from moisture or injury, topical ear medications.
Bacterial: acetic acid with or without hydrocortisone, cortisporin (neomycin, polymixin B, HC)
Fungal: antifungal drops like clotrimazole 1%

25

Acute Otits media physical exam findings

™- Erythematous, edematous, usually convex
Purulent ecudate
Tympanic membrane rarely bulges, usually convex
Impaired mobility of tympanic membrane with pneumatic otoscopy

26

Management of acute otits media

pain management with acetaminophen, benzocaine otic drops
OBSERVATION PERIOD FOR HEALTHY CHILDREN- watchful waiting for 48-72 hours
Medications: Amoxicillin 80-90/kg/day, twice daily for 10 days

27

prevention of otitis media

vaccinations: Hib, PCV13, annual flu. Avoid second hand smoke

28

Serous otitis media/ otitis media with effusion (OME) definition and cause

The presence of fluid in the middle ears without the sign or symptoms of AOM; also known as chronic otitis media with effusion. Caused by blocked estachian tubes; inability to equalize pressure; allergy barotrauma influence

29

S/sx of OME

hearing loss, popping sensation when pressure is altered, fullness in ear

30

Physical exam findings of OME

Air bubbles behind the ™, decreased membrane mobility, weber and rinne tests suggestive of conductive hearing loss

31

management of OME

watchful monitoring for 3 months
anx tx and antihistamines ineffective
saline rinses?

32

Conduction hearing loss causes

decreased ability to conduct sound from external ear to inner ear. Causes
Cerumen impaction/ foreign body (most treatable)
Hematoma
otitis media
perforated tympanic membrane

33

Sensorineural loss causes

impaired transmission of sound through the nervous system (8th cranial nerve)
causes: acoustic neuroma, syphilis, CNS disease, medication toxicity(amino glycoside groups)

34

normal weber

sound should be heard equally in both ears and not lateralize

35

normal rinne

air conduction> bone conduction

36

Findings with conductive hearing loss

Weber: sound laterlizes to the affected ear
Rinne: Abnormal in affected ear (AC

37

Findings with sensorineural hearing loss

Weber: Sound materializes to the unaffected ear
Rinne: normal in the affected ear

38

Management of common cold

rest, hydration, nasal saline drops, humidifier, NO OTC preparations (decongestants, antihistamines, antitussives, expectorants), no antibiotics

39

Pharyngitis causes (offenders)

Viruses: RSV, influena A & B, epstein barr virus
Group A B-hemolytic streptococci
Neisseria Gonorrhoeae
Mycoplasma
Chlamydia trachomatis
Corynebacterium sp.

40

clinical features most suggestive of group A beta-hemolytic strep (GABHS) and when do you do a throat culture?

FLEA:
Fever >100.4
Lack of cough
Pharyngo-tonsillar Excudate
Anterior cervical adenopathy
Consider throat culture if 1+ of these
Rash and GI upset common

41

what kind of infection is more likely with posterior adenopathy?

VIRAL

42

What is the treatment for GABHS

PCN VK 250mh PO TID for 10 days or erythromycin 250mg QID for 10 days

43

cause of croup

parainfluenza viral infection of the larynx

44

s/sx of croup

3 months- 6 years, recent symptoms of upper respiratory infection (URI), Bark-like cough, low grade fever, vital signs consistent with infection, dyspnea, stridor if severe, lungs typically clear

45

steeple sign vs thumb sign

steeple sign- narrowing of the trachea on a frontal radiograph of the neck, in CROUP
Thumbs sign- a thumb shaped patch, appearing on a radiograph of the neck- in EPIGLOTTITS

46

infectious agent causing infectious mononucleosis

epstein barr virus

47

s/sx of infectious mononucleosis

fever, pharyngitis (most severe), malaise,anorexia, and myalgia

48

Physical exam findings

posterior cervical lypmhadenopathy, generalized lymphadenopathy, white exudate on tonsils (bilateral), SPLENOMEGALY, maculopapular or petechial rash

49

Labs for mono

1) lymphocytic leukocytosis, neutropenia
2) positive heterophil and mono spot +
3) early rise in Immunoglobulin M (IgM) EBV
4) Permanent rise in Immunobulin G (IgG)

50

Management of croup

mild: supportive
moderate: hospitalization for respiratory support, IV fluids
May need nebulizer epinephrine
Short course of corticosteroids

51

Management of infectious mononucleosis

Supportive (non-steroids, warm salt water gargles)
Oral corticosteroids when enlarged lymph tissue threatens airway obstruction
Avoidance of contact sports (3 weeks to several months) to avoid splenic rupture (even without clinical detectable splenomegaly)

52

age to consider sinusitis (rhino sinusitis)

9 years or older

53

Diagnosis of sinusitis

diagnosis is often made on clinical presentation
CT scan preferred over X-rays because it is more sensitive for COMPLICATED SINUSITIS, may culture purulent discharge

54

s/sx of sinusitis

pain and pressure over the cheek, headache, discolored nasal drainage, halitosis, post nasal drip and cough, dull, throbbing pain worsening when head is dependent

55

How do you treat uncomplicated sinusitis

Amoxicillin-clavunate for 10 days, change to levaquin if no improvement in 3 days
Decongestants and antihistamines are not useful in acute, maybe for chronic
Pain managed with acetaminophen
Nighttime humidification to reduce mucosal drying
Supportive care
Chronic/ refractory: refer