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Flashcards in PEDS HEENT 2 Deck (58)
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1

+/- 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? 

AOM 

2

What will you find on the PE of AOM? 

erythematous, bulging TM & middle ear infection

If TM perforated: canal w/exudate

may visualize perf of TM 

3

Tx of AOM

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

4

When should you refer AOM pt to ENT for evaluation? 

>4 episodes/yr, possible hearing problems

Myringotomy w/tympanostomy tubes (Pressure equalizing tubes) 

5

How do you tx OM w/PE tubes? 

Tympanostomy tube otorrhea (TTO)

fluoroquinolone +/- corticosteroid 

ciprofloxacin + dexamethasone (Ciprodex)

Oral abx if severe infection 

6

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

What condition is this? 

Serous Otitis Media

7

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

 

Sx of which condition? 

Serous otitis media

8

What will you find on PE of Serous otitis media? 

TM grey, shiny

TM normal or retracted

9

Dx of Serous otitis media

clinical: TM is immobile 

Tympanometry 

bubbles/fluid level may be visible

10

What are some common risk factors of serous otitis media

follows resolution of undx AOM

daycare center attendance

11

Tx of serous otitis media

self limited, takes 12 wks

if persistent >3m0 = ENT referral 

12

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

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

13

Common in AZ during the summer months

"swimmers ear" 

What condition? 

Otitis Externa

14

Significant unilateral ear pain

Malodorous discharge from ear canal

 

Sx of what condition? 

Otitis Externa

15

What do you see on PE of Otitis Externa? 

tragal tenderness

exudate in ear canal 

16

Tx of Otitis Externa

Ciprodex (abx drops)

If TM perf: FQ suspension

17

How can you prevent Otitis Externa?

Swim-ear OTC

50/50 rubbing alcohol & white vinegar post swimming

18

How do you remove a foreign body? 

Tiny forceps

superglue/cotton swab

mouth-to-mouth

Avoid pushing object deeper, refer to ENT if problematic

19

How do you tx aural foreign body? 

attempt irrigation 1st if TM is intact

20

Sx of what condition? 

•Sneezing

•Rhinorrhea

•Nasal congestion

•Scratchy sore throat

•Pruritus

•Tearing

 

•Cough

•Snoring

•Sniffles

•Anosmia

•Headache

•Fatigue

Allergic rhinitis

21

What do you see on PE in allergic rhinitis? 

Allergic shiners

Nasal crease: “Allergic salute”

Pale, blueish/boggy nasal mucosa

Clear rhinorrhea

“cobblestone” appearance of posterior pharynx

22

Tx of allergic rhinitis for pts >2yo

Intranasal steroid sprays: Nasacort, Nasonex

23

Tx of allergic rhinitis for pts >4 yo 

Flonase

24

Which antihistamines can you use to tx allergic rhinitis? 

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