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GK Clinical Disciplines II Exam 1 > PEDS HEENT 2 > Flashcards

PEDS HEENT 2 Flashcards

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1
Q

+/- fever ( ≥ 100.4 °F)

Ear pain

Infants- poor feeding, pulling at ear, batting at head, poor sleeping, fussiness

Older children- c/o ear pain, c/o sinus tenderness, headache, decreased hearing, c/o dizziness

Usually concurrent or following URI

Which condition?

A

AOM

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2
Q

What will you find on the PE of AOM?

A

erythematous, bulging TM & middle ear infection

If TM perforated: canal w/exudate

may visualize perf of TM

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3
Q

Tx of AOM

A

Up to 2 yrs: abx

> 2 yrs: Healthy, unilateral OM, mild sx, no drainage= Observe for 48h

Toxic, sx> 48h, T ≥ 102.2, F/U, bilateral OM or otorrhea= Abx

Abx of choice: Amoxicillin 80-90mg/kg/day x 10 days

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4
Q

When should you refer AOM pt to ENT for evaluation?

A

>4 episodes/yr, possible hearing problems

Myringotomy w/tympanostomy tubes (Pressure equalizing tubes)

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5
Q

How do you tx OM w/PE tubes?

A

Tympanostomy tube otorrhea (TTO)

fluoroquinolone +/- corticosteroid

ciprofloxacin + dexamethasone (Ciprodex)

Oral abx if severe infection

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6
Q

Presence of middle-ear effusion (fluid buildup) without infection

What condition is this?

A

Serous Otitis Media

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7
Q

Pain, pressure, “popping”, decreased hearing, disequilibrium

Sx of which condition?

A

Serous otitis media

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8
Q

What will you find on PE of Serous otitis media?

A

TM grey, shiny

TM normal or retracted

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9
Q

Dx of Serous otitis media

A

clinical: TM is immobile

Tympanometry

bubbles/fluid level may be visible

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10
Q

What are some common risk factors of serous otitis media?

A

follows resolution of undx AOM

daycare center attendance

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11
Q

Tx of serous otitis media

A

self limited, takes 12 wks

if persistent >3m0 = ENT referral

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12
Q

T/F: You can use steroids/antihitamines/decongestants for OME in children

A

False, you CANNOT use steroids/antihistamines/decongestants for OME in children

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13
Q

Common in AZ during the summer months

“swimmers ear”

What condition?

A

Otitis Externa

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14
Q

Significant unilateral ear pain

Malodorous discharge from ear canal

Sx of what condition?

A

Otitis Externa

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15
Q

What do you see on PE of Otitis Externa?

A

tragal tenderness

exudate in ear canal

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16
Q

Tx of Otitis Externa

A

Ciprodex (abx drops)

If TM perf: FQ suspension

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17
Q

How can you prevent Otitis Externa?

A

Swim-ear OTC

50/50 rubbing alcohol & white vinegar post swimming

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18
Q

How do you remove a foreign body?

A

Tiny forceps

superglue/cotton swab

mouth-to-mouth

Avoid pushing object deeper, refer to ENT if problematic

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19
Q

How do you tx aural foreign body?

A

attempt irrigation 1st if TM is intact

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20
Q

Sx of what condition?

  • Sneezing
  • Rhinorrhea
  • Nasal congestion
  • Scratchy sore throat
  • Pruritus
  • Tearing
  • Cough
  • Snoring
  • Sniffles
  • Anosmia
  • Headache
  • Fatigue
A

Allergic rhinitis

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21
Q

What do you see on PE in allergic rhinitis?

A

Allergic shiners

Nasal crease: “Allergic salute”

Pale, blueish/boggy nasal mucosa

Clear rhinorrhea

“cobblestone” appearance of posterior pharynx

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22
Q

Tx of allergic rhinitis for pts >2yo

A

Intranasal steroid sprays: Nasacort, Nasonex

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23
Q

Tx of allergic rhinitis for pts >4 yo

A

Flonase

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24
Q

Which antihistamines can you use to tx allergic rhinitis?

Study These Flashcards
A

1st gen: diphenhydramine

2nd gen: cetirizine

Intranasal: azelastine, olopatadine

25
What is a long term tx option for allergic rhinitis?
Immunotherapy
26
**_\> 10-14 d of sx without improvement_** Can be misleading due to overlap of sx w viral URI **Purulent nasal d/c** **Sinus pain** +/- Fever Halitosis Headache Dental pain Sx of which condition?
Sinusitis
27
What is the MC bacterial pathogen causing sinusitis?
S. Pneumo
28
Dx of sinusitis if \>30d (chronic)
Water’s view radiograph May culture- usually done by ENT
29
Tx of sinusitis
**(Augmentin) 45/mg/kg/d divided BID** or **Amoxicillin 90mg/kg/d divided BID**
30
What 3 pathogens are MCC of sinusitis?
H. flu S. pneumo M. catt
31
What other condition should you consider if sinusitis is recurrent/severe?
cystic fibrosis
32
What is the MCC of pharyngitis?
**Viral!** adenoviruses, rhinovirus, coxsackie A viruses, Epstein Barr Virus, influenza, or parainfluenza virus
33
red throat, congestion, fever, fatigue, swollen cervical nodes Sx of what condition?
Pharyngitis
34
Tx of pharyngitis
Education for parents Analgesics Fluids Rest
35
**Exudative tonsillitis, cervical lymphadenopathy,** fatigue & malaise, headache, fever, **splenomegally** ## Footnote **Incubation period 4-8 weeks** **Which condition?**
**Pharyngitis: EBV** aka **MONO**
36
Dx of Pharyngitis: EBV (MONO)
Fingerstick (Monospot® ) EBV titers
37
Tx of Pharyngitis: EBV aka MONO
Spleen precautions x 6-8 weeks No contact sports, rough-housing, etc.
38
Usually **abrupt onset** Fever, sore throat, **headache, nausea,** abdominal pain, **rash** Watch fluid intake! Which condition and for which age group?
**Sx \> 3 yo** of **Pharyngitis: GABHS**
39
atypical sx= nasal congestion, low grade fever, ant cervical LA Which condition and which age group?
\<3yo GABHS Pharyngitis
40
What would you find on PE of Pharyngitis: GABHS
exudative tonsillitis •enlarged tender anterior cervical lymph nodes, **palatal petechiae** **•+/- scarlatiniform rash** Halitosis Coated tongue
41
Dx of GABHS
Rapid strep antigen test
42
What is the gold standard dx of GABHS
throat culture
43
What should you do next if you get a negative rapid strep test?
throat culture may take \>48 h
44
Tx of GABHS
abx: **Penicillin VK 25-50 mg.kg/d div BID x 10 d** **Alt:** **Amoxicillin** 50 mg/kg/d divided BID x 10 days or **Penicillin G IM (one dose)**
45
Tx of GABHS in pt w/ **non-anaphylactoid** PCN allergy
Cephalexin
46
Tx of GABHS in pts w/ **Type 1 hypersensitivity PCN allergy**
Clindamycin 30mg/kg/d x 10 days divided TID
47
**2-3 weeks** post strep infection, usually peds **5-15 yo** ## Footnote **Which condition?**
Acute Rheumatic Fever
48
Major Jones Criteria for ARF
Migrating polyarthritis Carditis and valvulitis Chorea Erythema marginatum Subcutaneous nodules
49
Minor Jones Criteria for ARF
Arthralgia Fever Elevated **ESR or CRP** Prolonged **PR interval**
50
Dx of ARF
**2 major** or **1 major + 2 minor** **ASO titers**
51
**T/F:** Rheumatic heart disease is the #1 cause of acquired valve disease worldwide.
TRUE
52
Tx of ARF
**Amoxicillin (**may require ongoing prophylaxis through adulthood) + **Aspirin**
53
What must you evaluate for in ARF?
carditis (cardiomegaly, CHF, 3rd degree block)
54
Inflammation of the glomeruli secondary to deposition of immune complexes What condition?
Post-streptococcal Glomerulonephritis (PGN)
55
Edema (#1), hematuria (tea-colored urine), proteinuria, hypertension (Na+ & H20 retention) Sx of what condition?
PGN
56
Dx of PGN
ASO titers
57
Tx of PGN
self limited may require diuretics if HTN and edema persistent
58

GK Clinical Disciplines II Exam 1 (13 decks)

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