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Clinical Medicine Lecture - Professor Kramer > Pediatrics: Review of Eye, Ears, Nose, Throat and Respiratory Disorders > Flashcards

Pediatrics: Review of Eye, Ears, Nose, Throat and Respiratory Disorders Flashcards

(73 cards)

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1
Q

Blepharitis tx ?

A

Gentle lid scrubs

Warm compresses

Ophthalmic antibiotic ointment
Erythromycin OR
Bacitracin

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2
Q

Hordeolum tx ?

A

Gentle lid scrubs

Warm compresses

Ophthalmic antibiotic ointment
Erythromycin OR
Bacitracin

consider - I/D

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3
Q

Chalazion tx ?

A

Gentle lid scrubs

Warm compresses

Ophthalmic antibiotic ointment
Erythromycin OR
Bacitracin

consider - I/D

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4
Q

Allergic conjunctivitis sxs ?

A 
Lacrimation
Sneezing
Cobblestoning 
Stringy discharge
Pruritus
Rhinorrhea
ass. UR allergies as well
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5
Q

Allergic conjunctivitis tx. ?

A

remove source

Ophthalmic antihistamines (olaptadine)

Ophthalmic mast cell stabilizers (ketotifen)

Ophthalmic NSAID (ketorolac)

corticosteroids (prednisolone)

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6
Q

Ophthalmic antihistamines ?

A

olaptadine

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7
Q

Ophthalmic mast cell stabilizers ?

A

ketotifen

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8
Q

Ophthalmic NSAID ?

A

ketorolac

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9
Q

Viral conjunctivitis sxs. ?

A

Watery discharge

Preauricular lymphadenopathy

URI symptoms

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10
Q

Viral conjunctivitis herepes sxs. ?

A

Vesicular rash

Keratitis– corneal involvement
Visual disturbance

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11
Q

Viral conjunctivitis tx. ?

A

Supportive

Hand washing! - cause they are contagious

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12
Q

Viral conjunctivitis herepes tx. ?

A

Ophthalmic trifluridine OR

Oral acyclovir

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13
Q

Bacterial conjunctivitis tx ?

A

Ophthalmic antibiotics

Macrolide (erythromycin)

Aminoglycoside (gentamicin)

Sulfacetamide

Polymixin-bacitracin

If due to pseudomonas
Fluoroquinolone (ofloxacin)

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14
Q

Periorbital cellulitis ?

A

Warm compresses

Oral antibiotics - Augmentin

keep eye on they as out patient

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15
Q

Orbital cellulitis ?

A

IV antibiotics - Unasyn

Ophthalmology STAT referral

admit

Consider adding
Clindamycin
Metronidazole

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16
Q

Amblyopia tx ?

A

Earlier treatment improves outcome

Refractive– glasses

Cataracts– early removal

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17
Q

Amblyopia unilateral tx. ?

A

Make correction early

Patch dominant eye

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18
Q

Strabismus tx. ?

A

Congenital– surgery
cataracts then remove then and male the EOM intoaligment

Accommodative– glasses

Unilateral
Patch dominant eye

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19
Q

Retinoblastoma tx. ?

A

Chemoreduction

Then local options

  • laser photocoagulation
  • cryotherapy
  • plaque radiotherapy
  • thermotherapy
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20
Q

Otitis externa pathogens ?

A

Staph aureus

Pseudomonas aeruginosa

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21
Q

Otitis externa tx. ?

A

Remove debris if present ( for drops to be absorbed better)

Otic antibiotics

  • Fluoroquinolones (ciprofloxacin, ofloxacin)
  • –With or without hydrocortisone

Consider

Neomycin, bacitracin, polymyxin B and hydrocortisone (Cortisporin)

If complicated (perichondritis/ fever)
Oral quinolone (ciprofloxacin)
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22
Q

Acute Otitis Media (AOM) pathogens ?

A

Strep pneumoniae

Haemophilus influenzae

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23
Q

Otitis media tx. ?

A

Amoxicillin

If failure in 48-72 hrs
Amoxicillin-clavulanate OR
Cephalosporins (cefuroxime, cefdinir)

Observation option
Watch 48-72 hours for improvement

If recurrent
Tympanostomy tubes ( refer to ENT )
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24
Q

Mastoiditis tx. ?

A

piperacillin/tazobactam

Surgical debridement if
Abscess
No improvement within 48 hours

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25
Epistaxis tx. ?
Lean forward and hold nose 5 min Consider - Vasoconstrictors (oxymetazoline) - Nasal saline twice daily - keep mucosa moist - Gelatin sponge (Gelfoam)
26
Nasal foreign body tx. ?
Nose blowing Forceps removal
27
Allergic rhinitis tx. education ?
Remove source Saline spray may irrigate
28
Allergic rhinitis tx. intranasal corticosteroids ?
Fluticasone
29
Allergic rhinitis tx. oral and intranasal antihistamines ?
Loratadine (Claritin) oral Olopatadine (Patanase) nasal
30
Allergic rhinitis tx. leukotriene antagonists ?
Montelukast (Singulair)
31
Allergic rhinitis tx. Decongestants ?
Guaifenesin
32
Viral upper respiratory infection tx. ?
Pain medication Humidified air Nasal saline Consider Cough suppressants
33
Bacterial sinusitis 1st line ?
Amoxicillin high dose (40 mg/kg is average, 90 mg/kg is high does) OR Amoxicillin-clavulanate SEVERE, if they in daycare or they have been on ABS for something els e
34
Bacterial sinusitis 2nd line ?
Cephalosporin (cefuroxime, cefdinir) Clindamycin Levofloxacin
35
Strep pharyngitis centor criteria ?
Fever Tonsillar exudates Tender anterior cervical lymphadenopathy Absence of cough in this case there is not testing
36
Strep pharyngitis tx. 1st line ?
Penicillin VK oral OR Benzathine penicillin IM 600,000 units OR Amoxicillin oral
37
Strep pharyngitis Tx if PCN allergic ?
Clindamycin Cephalexin Azithromycin
38
Mononucleosis tx. ?
Supportive care Avoid contact sports
39
Epiglottitis
(Supraglottitis) tx. ?
AIRWAY FIRST! Consider intubation Do not delay for testing Antibiotics 3rd generation cephalosporin (Ceftriaxone)
40
Croup (Laryngeotracheobronchitis) tx. home ?
Steaming bathroom Cold weather exposure Oral hydration
41
Croup (Laryngeotracheobronchitis) tx. mild ?
Humidified oxygen
42
Croup (Laryngeotracheobronchitis) tx. more significant ?
Racemic epinephrine nebulized Dexamethasone IM/ oral
43
Croup (Laryngeotracheobronchitis) tx. severe or persistent ?
Consider heliox Consider intubation Admit to hospital
44
Bacterial tracheitis
(pseudomembranous croup) tx. ?
Intubation Debridement of airway -with Suctioning IV antibiotics Need staph and h flu coverage 3rd generation cephalosporins (Ceftriaxone)
45
Pertussis (Whooping cough) tx. prevention ?
DTaP immunizations Herd immunity for infants
46
Pertussis (Whooping cough) tx. ?
azithromycin consider: CCS, nebulizer
47
Laryngomalacia H and P ?
At birth or within the first few months of life. Intermittent, high-pitched, inspiratory stridor. Worse supine and with activity
48
Laryngomalacia tx. ?
Mild Observation Moderate-Severe Surgical epiglottoplasty
49
Infant Respiratory Distress Syndrome
(Hyaline membrane disease)
 tx. ?
Prevention -Maternal glucocorticoids Exogenous surfactant -Can initiate in delivery room Synchronized mandatory ventilation
50
Bronchopulmonary dysplasia tx. ?
Ventilation Surfactant
51
Asthma common sxs. ?
Wheezing Expiratory Higher pitch if worse ``` recurrent cough shortness of breath "chest congestion" prolonged cough exercise intolerance Dyspnea ```
52
Asthma severe sxs. ?
No lung sounds Nasal flaring Accessory muscle use
53
Asthma spirometry ?
Lower FEV1 and FEV1/FVC Improvement with bronchodilator
54
Asthma CXR ?
Nonspecific, unless additional pneumonia Hyperinflation (flattening of the diaphragms), peribronchial thickening
55
Bronchiolitis H and P ?
``` Coughing Tachypnea Labored breathing Hypoxia Irritability Poor feeding Vomiting Wheezing and crackles ```
56
Bronchiolitis tx. ?
Suction Supplemental oxygen Hydration
57
Bronchiolitis severe ?
Ribavarin
58
Bronchiolitis prevention ?
Palivizumab
59
Cystic fibrosis H and P ?
Recurrent lung problems Cough With sputum Infertility Pancreatitis hx Steatorrhea Abd pain Finger clubbing Increased AP chest ( these kids are more 2:1) Percussion hyperresonance Nasal polyps
60
Cystic fibrosis tx. ?
Clear secretions Bronchodilators Pancreatic enzymes replace Consider as needed - Treat infections - Screen yearly for acid fast bacilli sputum (TB) - Lung transplant
61
Foreign body of trachea or bronchi prevention ?
Avoid small toys with children Careful with foods – grapes, carrot pieces
62
Foreign body of trachea or bronchi acutely ?
Heimlich maneuver | Bronchoscopy
63
Foreign body of trachea or bronchi PNA ?
IV antibiotics
64
Foreign body aspiration patient education ?
Carefully watch children Avoid small toys with children
65
Foreign body aspiration acutely ?
Heimlich maneuver
66
Foreign body aspiration if unable to remove ?
Bronchoscopy
67
Foreign body aspiration gastric aspiration ?
Abx only if evidence of pneumonia (only 1/4th of cases) Controversial on benefit of steroids
68
Pneumonia H and P ?
Fever Cough Wheezing Crackles
69
PNA CXR typical ?
Lobar infiltrate (strep pneumo)
70
PNA CXR atypical ?
Diffuse bilateral (mycoplasma)
71
PNA typical tx. ?
Amoxicillin OR Ceftriaxone
72
PNA atypical tx. mycoplasma ?
Macrolide antibiotics (azithromycin)
73
PNA atypical tx.
Ribavarin

Clinical Medicine Lecture - Professor Kramer (28 decks)

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