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PEDS exam 2 > PEDS HEENT > Flashcards

PEDS HEENT Flashcards

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1
Q

etiology of bacterial conjunctivitis

A
  • streptococcus pneumoniae
  • Haemophilus influenzae
  • moraxella catarrhalis
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2
Q

clinical presentation

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

bacterial conjunctivitis

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3
Q

how is bacterial conjunctivitis diagnosed

A

clinically

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4
Q

treatment of bacterial conjunctivitis

A
  • 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

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5
Q

etiology of neonatal conjunctivitis

A

chlamydia trachomatis

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6
Q

clinical presentation

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

neonatal conjunctivitis

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7
Q

how do you diagnose neonatal conjunctivitis

A

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

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8
Q

treatment of neonatal conjunctivitis

A
  • Oral Erythromycin
    • 50 mg/kg per day in 4 divided doses x 14 days
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9
Q

etiology of hyperacute bacterial conjunctivitis

A

Neisseria gonorrhoeae

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10
Q

clinical presentation

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

hyperacute bacterial conjunctivitis

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11
Q

treatment of hyperacute bacterial conjunctivitis

A

immediate opthalmologic referral

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12
Q

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

A

pseudomonal keratitis

  • can cause ulcerative keratitis ->perforation
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13
Q

clinical presentation

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

keratitis

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14
Q

treatment of keratitis

A
  • stop contact lens use
  • appropriate Abx coverage (anti-pseudomonal)
  • follow-up eye care provider within 12-24 hours
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15
Q

etiology of viral conjunctivitis

A

adenovirus

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16
Q

clinical presentation

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

viral conjunctivitis

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17
Q

how do you diagnose viral conjunctivitis

A
  • clinical
  • rapid (10 min) test available (adenovirus)
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18
Q

treatment of viral conjunctivitis

A
  • self-limited process
  • warm, or cool compresses
  • topical antihistamine or decongestant
    • OTC: Naphcon-A, Ocuhist
  • lubricant eye drops/ointment (OTC)
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19
Q

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

A
  • stay home until there is no longer any discharge
  • most daycare/schools require at least 24 hrs of topical therapy before returning
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20
Q

clinical presentation

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

allergic conjunctivitis

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21
Q

how do you diagnose allergic conjunctivitis

A

clinically

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22
Q

treatment of allergic conjunctivitis

A

antihistamine with mast cell stabilizing properties

  • olopatadine (patanol, pataday)
  • azelastine HCL (optivar)
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23
Q

Kawasaki disease presents with what symptoms?

A
  • 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)
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24
Q

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

A

Kawasaki disease

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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

PEDS exam 2 (3 decks)

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