PEDS HEENT 1

Question 1

Thick, purulent, ropy disharge

Usually starts unilaterally

Eyelids may be “crusted shut” in a.m.

+/- preauricular lymphadenopahty

Clinical px of what condition?

Answer 1

Bacterial conjunctivitis

Question 2

Cause of Bacterial conjunctivitis

Answer 2

S. pneumoniae, H. influenza, M. cattarhalis, S. aureus

Newborns: Chlamydia trachomatis #1

Question 3

Tx of bacterial conjunctivitis

Answer 3

Antibiotic ointment-infants

Antibiotic drops- older children

_**treat both eyes!!_

Question 4

Cause of viral conjunctivitis

Answer 4

adenovirus: one of the primary causes of ‘colds’ (URI)

Question 5

conjunctival injection of one or both eyes

watery ocular discharge, some crusting in a.m.​

Typically bilateral

May be accompanied by URI sx, feels “gritty”

Clinical Px of what?

Answer 5

Viral conjunctivitis

Question 6

Viral conjunctivitis Tx

Answer 6

self-limited

Question 7

bilateral itchy, watery, red eyes

watery discharge/tearing

“Bumpiness” of tarsal conjunctivae

Accompanied by sx of allergic rhinitis

Sneezing, dry cough, atopic dermatitis

Clinical Px of what?

Answer 7

Allergic Conjunctivitis

Question 8

Allergic conjunctivitis Tx

Answer 8

symptomatic:

olopatadine in children > 2 years

Reduce exposure

Question 9

Cause of Periorbital cellulitis (preseptal)

Answer 9

exogenous source ( eyelid abrasion, horedolum, chalazion, dacrocystitis, insect bite)

MC pathogen = Staph aureus & pyogenes

Question 10

MC pathogen of orbital cellulitis

Answer 10

Staph aureus & pyogenes

Question 11

T/F:

Periorbital cellulitis/orbital cellulitis infections arise POSTERIOR to the orbital septum

Answer 11

False, Periorbital cellulitis/orbital cellulitis infections arise ANTERIOR to the orbital septum

Question 12

T/F:

Periorbital cellulitis has mild, minimal complications

Answer 12

TRUE

Question 13

Periorbital Cellulitis Tx

Answer 13

oral/systemic abx

Question 14

infection POSTERIOR to the orbital serum

may cause serious complications- such as an acute ischemic optic neuropathy or cerebral abscess

This describes which condition?

Answer 14

Orbital cellulitis

Question 15

Cause of Orbital cellulitis

Answer 15

Staph or Strep (S. aureus)

Question 16

T/F:

Orbital cellullitis is almost always associated w rhinosinusitis or sinus infection

Answer 16

True

Question 17

+/- fever (if present, it is high)

lid swelling & erythema

vision disturbances/decreased vision

Pain w EOMs, proptosis (protruding eye)

Clinical px of which condition?

Answer 17

Orbital Cellulitis

Question 18

Dx of orbital cellulitis

Answer 18

CT or MRI

Question 19

Tx of orbital cellulitis

Answer 19

Emergent Opthalmology Consult; IV abx

+/- surgical drainage

Question 20

Widespread inflammation of medium and small arteries, including the coronary arteries

aka “mucocutaneous lymph node syndrome”

Which condition?

Answer 20

Kawasaki Dz

Question 21

Dx of Kawasaki Dz

Answer 21

+/- anemia & thrombocytosis

no specific dx criteria

Question 22

What is the leading cause of acquired heart dz in children in US?

Answer 22

Kawasaki Dz

Question 23

Boys>girls (1.5:1)

Transmissible to household contacts; clustering

Some clinical features similar to adenovirus and scarlet fever

Seasonality (winter and spring)

80% of cases occur in children < 5 yo (median age at diagnosis is 2yo)

Epidemiology of which condition?

Answer 23

Kawasaki Dz

Question 24

Dx criteria of Kawasaki Dz

Answer 24

Fever plus:

- Conjunctivitis: bilateral, bright-red, non-exudative

- Mucositis: cracked lips, strawberry tongue

- Polymorphous rash & desquamation: starts in perineum, skin peels, then spreads

• Lymphadenopathy: cervical
• Extremity changes: edema, redness of palms/soles

“Can’t make pain leave, eek!”

Question 25

Details of Mgmt of Kawasaki Dz: **IVIG**

Answer 25

**IVIG (intravenous immune globulin) + Aspirin (ASA) (80-100mg/kg/d)** IVIG reduces incidence of **aneurysms** **DO NOT admin live vaccines within 11 mos of IVIG**

Question 26

General Mgmt of Kawasaki Dz

Answer 26

**IVIG + Aspirin** **Baseline Echo** + repeat @ **_2 & 6 wks_**

Question 27

Complications of Kawasaki Dz

Answer 27

**CV: coronary artery aneurysms** --\> myocardial ischemia, infarction, sudden death Highest risk: **\< 1yr & \>9yrs**

Question 28

Loss of the most superficial layer of corneal cells What is this?

Answer 28

Corneal Abrasion

Question 29

Red eye, watery d/c (tearing) **blephorospasm** (tight closure of eyelid) Severe ocular pain Fussy baby, irritable toddler Rubbing at eye **“squinting”/photophobia**

Answer 29

Corneal Abrasion

Question 30

Corneal Abrasion Dx

Answer 30

**fluorescein stain**, **Wood’s lamp**\*\* ## Footnote **If foreign body refer to Opthalmology**

Question 31

Corneal Abrasion Tx

Answer 31

**erythromycin ointment & recheck in 24-48 h** **patching** the affected eye? If no decrease in size, **refer to Opthalmology**

Question 32

Most common cause of persistent tearing & eye discharge in infants & children Which condition?

Answer 32

Dacryostenosis

Question 33

chronic or intermittent tearing, **debris on lashes** generally **NO conjunctival irritation**, however, injection may occur from irritation or overflow tearing palpable **nasolacrimal sac +/- discharge or reflux of tears** Clinical Px of which condition?

Answer 33

Dacryostenosis

Question 34

Tx of dacryostenosis

Answer 34

lacrima sac massage in downward direction 2-3x a day refer to optho if sx persist \>6mo

Question 35

infection of the nasolacrimal sac that causes **erythema & edema over the nasolacrimal sac** commonly caused by bacteria that colonize **upper respiratory tract** **S. aureus, S. pneumoniae, S. pyogenes, S. viridans, M. catarrhalis & Haemophilus species** Which condition?

Answer 35

Dacryocystitis

Question 36

Tx of dacryocystitis

Answer 36

milder cases = PO+ topical abx severe acute = IV antibiotics (after culture & staining)

Question 37

Functional reduction in visual acuity Caused by **abnormal vision development early in life** What dz?

Answer 37

amblyopia

Question 38

Most common cause of pediatric visual impairment

Answer 38

Amblyopia

Question 39

T/F: amblyopia is usually bilateral

Answer 39

False, amblyopia is usually unilateral

Question 40

Can occur only during the **critical period of visual development in the 1st decade of life when the visual nervous system is plastic** ## Footnote **Which condition?**

Answer 40

Amblyopia

Question 41

Misalignment of the eyes Categorized by the direction of the deviation: **esotropia, exotropia, hypertropia, hypotropia** **constant or intermittent** **Which condition?**

Answer 41

Strabismus

Question 42

Risk factors for strabismus

Answer 42

+ FH low birth weight (prematurity)