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Flashcards in PEDS HEENT Deck (82):
1

etiology of bacterial conjunctivitis 

  • streptococcus pneumoniae
  • Haemophilus influenzae
  • moraxella catarrhalis 

2

clinical presentation

  • usually unilateral eye affected; can be bilateral
  • injection (pronounced BV)
  • discharge
    • think, purulent (white, yellow, green)

bacterial conjunctivitis 

3

how is bacterial conjunctivitis diagnosed 

clinically

4

treatment of bacterial conjunctivitis

  • Erythromycin ophthalmic ointment
    • 0.5 inch applied inside lower lid
  • Trimethoprim-polymyxin B drops
    • 1-2 drops instilled QID x 5-7 days

**ointment preferred over drops in young children 

5

etiology of neonatal conjunctivitis 

chlamydia trachomatis 

6

clinical presentation

  • presents between 5-14 days of life
  • orbital swelling 
  • watery discharge become mucopurulent
  • chemosis 
  • pseudomembrane (exudate adheres to conjunctivae)
  • bloody discharge 

neonatal conjunctivitis

7

how do you diagnose neonatal conjunctivitis

culture (need to get epithelial cells, not just exudate) 

8

treatment of neonatal conjunctivitis

  • Oral Erythromycin
    • 50 mg/kg per day in 4 divided doses x 14 days 

9

etiology of hyperacute bacterial conjunctivitis 

Neisseria gonorrhoeae

10

clinical presentation 

  • rapidly progressive
  • profuse, purulent discharge
  • marked chemosis
  • typically accompanied by urethritis
  • severe and sight-threatening 

 

hyperacute bacterial conjunctivitis

11

treatment of hyperacute bacterial conjunctivitis

immediate opthalmologic referral 

12

contact lens wearers who use extended-use lens have a high risk of what 

pseudomonal keratitis 

  • can cause ulcerative keratitis ->perforation 

13

clinical presentation 

  • FB sensation
  • unable to spontaneously open eye
  • typically see corneal opacity with penlight

keratitis 

14

treatment of keratitis 

  • stop contact lens use
  • appropriate Abx coverage (anti-pseudomonal)
  • follow-up eye care provider within 12-24 hours 

15

etiology of viral conjunctivitis 

adenovirus 

16

clinical presentation

  • injection
  • burning, gritty sensation in the eye
  • discharge
    • watery, scant stringy mucus
  • +/- tender preauricular node 

viral conjunctivitis 

17

how do you diagnose viral conjunctivitis 

  • clinical
  • rapid (10 min) test available (adenovirus) 

18

treatment of viral conjunctivitis 

  • self-limited process
  • warm, or cool compresses
  • topical antihistamine or decongestant
    • OTC: Naphcon-A, Ocuhist
  • lubricant eye drops/ointment (OTC) 

19

when can an individual with infectious conjunctivitis return to school/sports

  • stay home until there is no longer any discharge 
  • most daycare/schools require at least 24 hrs of topical therapy before returning 

20

clinical presentation

  • bilateral injection
  • discharge
    • watery
  • ocular pruritus
  • eyelid edema
  • mild photophobia
  • +/- associated sneezing, allergic rhinitis 

allergic conjunctivitis 

21

how do you diagnose allergic conjunctivitis 

clinically 

22

treatment of allergic conjunctivitis 

antihistamine with mast cell stabilizing properties

  • olopatadine (patanol, pataday)
  • azelastine HCL (optivar) 

23

Kawasaki disease presents with what symptoms? 

  • fever: does not respond well to antipyretics 

CRASH

  • Conjunctivitis (bilat, nonexudative) 
  • Rash (morbilliform)
  • Adenopathy (cervical)
  • Strawberry tongue (cracked, red lips)
  • Hands (red, swollen with desquamation) 

24

what diagnosis should be considered in all children with prolonged unexplained fever > or = 5 days 

Kawasaki disease

25

Kawasaki disease has a high risk of what type of complication

cardiovascular complication 

26

treatment of Kawasaki disease 

  • intravenous immunoglobulins and high dose aspirin 
  • infectious disease and cardiology consults 

27

what is amblyopia 

  • vision in one of the eyes is reduced because the eye and the brain are not working together properly
  • brain is favoring the other eye
  • sometimes called lazy eye

28

what is stabismus 

misalignment of eyes 

*potential to cause amblyopia 

29

how is strabismus diagnosed 

  • abnormal corneal light reflection test
  • cover/uncover test demonstrates deviation 

30

management of strabismus 

refer to ophthalmology 

31

what is dacryostenosis

nasolacrimal duct obstrcution 

*most commo cause of persistent tearing and ocular discharge in infants and young children 

32

clinical presentation

  • chronic, intermittent tearing
  • mucoid discharge
  • debris on lashes
  • mild redness of lower lid from chronic rubbing 

dacryostenosis

33

how is dacryostenosis diagnosed 

clinically 

34

treatment of dacryostenosis

  • 90% resolve spontaneously
  • lacrimal sac massage - first line treatment 
  • beyond 12 months of age, unlikely to resolve spontaneously

35

dacryocystitis 

inflammation or infection of lacrimal sac 

36

etiology of dacryocystitis 

staphylococcus 

37

treatment of dacryocystitis 

  • obtain cultures
  • treat promptly with empiric Abx (x 7-10 days)
    • oral clindamycin (mild)
  • ophthalmology referral 

38

etiology of acute otitis media 

  • streptococcus pneumonia (50%)
  • Haemophilus influenza (45%)
  • Moraxella catarrhalis (10%) 

39

complications of acute otitis media 

  • TM perforation
  • hearing loss
  • cholesteatoma
  • mastoiditis 

40

treatment of acute otitis media 

  • amoxicillin 80-90 mg/kg/day divided q12 hrs
  • 48-72 hr follow up 

41

when should you give Abx to treat acute otitis media

  • ALL under 6 months
  • 6 mo-2 yrs if diagnosis is certain OR uncertain diagnosis + fever > 102.2F
  • > or = 2 yrs: fever >102.2F, bilateral ears affected, otalgia > 48 hrs

42

when can you observe and follow up instead of giving abx for AOM 

  • 6 mo - 2 years: unilateral, nonsevere AOM
  • > 2 years: unilateral or bilat nonsevere AOM 

43

when is AOM considered recurrent AOM 

  • > or = 3 episodes in 6 months
  • > or = 4 episodes per year 

44

treatment for recurrent AOM 

  • prophylactic abx
    • amoxicllin 40 mg/kg/day: daily during winter months 

45

clinical presentation

 

  • retracted TM
  • cloudy, opaque TM 
  • air-fluid level
  • decreased, absent mobility of TM 
  • hearing loss

otitis media with effusion 

46

management of otitis media with effusion 

  • usually resolves spontaneously
  • observation
    • clinical evaluation and hearing test q 3-6 months 

**DO NOT treat with Abx 

47

how do you diagnose acute otitis media 

  1. signs and symptoms of middle ear inflammation (otalgia, fever)

AND

  1. abnormal TM exam (bulging TM, erythema) 

48

etiology of otitis externa "swimmers ear" 

  • Pseudomonas aeruginosa
  • staph aureus 

49

clinical presentation

  • ear symptoms:
    • otalgia
    • pruritus
    • discharge
  • physical findings
    • hearing loss
    • tragus tenderness
    • erythema and/or edema of ear canal 

otitis externa "swimmers ear" 

50

treatment of otitis externa "swimmers ear" 

*treat inflammation and infection (topical) and avoid promoting factors 

  • Abx
    • ofloxacin, ciprofloxacin otic
    • cortisporin otic 
  • glucocorticoid 

51

atopy 

tendency to be “hyperallergic”.

  1. eczema (atopic dermatitis) 
  2. allergic rhinitis 
  3. allergic asthma

52

clinical presentation 

  • allergic shiners
  • accentuated lines/folds below lower lids
    • "Dennie-Morgan lines"

allergic rhinitis

53

 how do you diagnose of allergic rhinitis

clinical 

54

treatment of allergic rhinitis

  1. allergen avoidance
  2. pharmacotherapy
  3. allergen immunotherapy 

55

pharmacotherapy of allergic rhinitis 

  • steroids
    • intranasal -first line
      • fluticasone (flonase) 
  • antihistamine

56

when would you start immunotherapy for allergic rhinitis 

patient has maximized environmental control measures and on optimal medication regimen

57

etiology of viral Upper Respiratory Infection

rhinovirus (50%) 

58

clinical presentation in infants

  • fever
  • nasal discharge
  • nontoxic appearing
  • fussiness
  • difficulty feeding
  • decreased appetite
  • difficulty sleeping 

Viral Upper Respiratory Infection

59

clinical presentation is school-aged children

  • nasal congestion
  • nasal discharge
  • cough
  • nontoxic appearing
  • sneezing
  • feverish 

Viral Upper Respiratory Infection

60

treatment of viral URI 

anticipatory guidance

  • supportive measures: rest, fluids, nose suction, saline nasal spray

61

complications of Viral Upper Respiratory Infection

  • acute otitis media
  • asthma exacerbation
  • acute bacterial sinusitis
  • lower respiratory tract disease (PNA) 

62

6-8% of viral URI are complicated by what 

development of a secondary bacterial rhinosinusitis 

63

when do consider that a viral URI has become an acute bacterial rhinosinusitis

  • persistent symptoms that are not improving
    • > 10 d, less than 30 days
  • severe symptoms
    • >102.2 F
    • purulent nasal discharge > 3 days
  • worsening symptoms
    • double sickening 

64

when is rhinosinusitis considered chronic 

  • persists for 12 weeks or longer
  • at least two of following:
    • mucopurulent drainage (anterior or posterior)
    • nasal obstruction
    • facial pain
    • decreased sense of smell 

65

treatment for bacterial rhinosinusitis

amoxicillin-clavulanate (augmentin) 45 mg/kg/day

66

etiology of pharyngitis 

viral is most common

67

If a patient presents with sore throat and a fever, what other symptoms would suggest the pharyngitis is viral 

  • rhinorrhea
  • nasal congestion
  • conjuctivitis
  • cough
  • GI symptoms

68

etiology of infectious mononucleosis

epstein-Barr virus 

69

clinical presentation

  • fever
  • sore throat
  • fatigue
  • PE
    • tender cervical lymphadenopathy
    • splenomegaly 

infectious mononucleosis

70

how do you diagnose infectious mononucleosis

  • heterophile antibody test
    • monospot-rapid serologic test

 

71

treatment for infectious mononucleosis

  • may persist 7-21 days
  • supportive therapy
  • activity restriction for 4 weeks 

72

primary etiology of bacterial pharyngitis 

30% group A streptococci 

73

clincal presentation

  • abrupt onset
  • sore throat
  • odynophagia
  • +/- fever
  • PE
    • pharyngeal erythema
    • exudate
    • uvular swelling
    • palate swelling
    • tender cervical lymphadenopathy

group A streptococci pharyngitis

74

what are the 6 symptoms that lead towards group A streptococci pharyngitis 

*score of 6, likelihood of  GAS strep is 85%

 

  1. age (5-15)
  2. season (late fall, winter, early spring)
  3. acute pharyngitis
  4. tender, enlarged cervical lymph nodes
  5. fever (101-103)
  6. absence of symptoms associated with viral URI

75

how do you diagnose group A streptococci pharyngitis

  • rapid antigen detection testing for GAS
  • if negative, obtain throat culture 

76

treatment of group A streptococci pharyngitis

  • oral penicillin, amoxicillin
  • 1st generation cephalosporin 

77

complications of group A streptococci pharyngitis

  1. acute rheumatic fever 
  2. post-streptococcal glomerulonephritis 

78

what are the 5 major manifestations of acute rheumatic fever 

  1. migratory arthritis
  2. carditis
  3. CNS involvement
  4. subcutaneous nodules
  5. erythema marginatum 

79

clinical presentation

  • edema
  • gross hematuria
  • hypertension 
  • history of recent group A streptococci pharyngitis (1-6 weeks) 

post-streptococcal glomerulonephritis 

80

indications for tonsillectomy 

  • paradise criteria for tonsillectomy
    • > or = 7 episodes in the last year, at least 5 in each of the past 2 years, at least 3 episodes in the past 3 years
    • episode: Strep throat + fever (>100.9F) OR tonsillar exudate OR cervical adenopathy OR culture confirmed 

81

etiology of oral candidiasis (thrush) 

candida albicans 

82

treatment of oral candidiasis 

nystatin oral suspension