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PEDS- Clinical Disciplines Exam 2 > Peds HEENT > Flashcards

Peds HEENT Flashcards

(95 cards)

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1
Q

Presentation of bacterial conjunctivitis?

A

Thick, purulent, ropy disharge

Usually starts unilaterally

eyelids may be crusted shut in AM

+/- preauricular lymphadenopathy

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2
Q

Pathogens responsible for bacterial conjunctivitis? In newborns?

A

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

Newborns: Chlamydia trachomatis #1

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3
Q

Tx for bacterial conjunctivitis?

A

Antibiotic ointment-infants
Antibiotic drops- older children
**treat both eyes!!

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4
Q

Organism involved in viral conjunctivitis?

A

adenovirus

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5
Q

Presentation of viral conjunctivitis?

A

usually present w/ injection of the conjunctiva of one or both eyes & watery ocular discharge

Typically bilateral
injected conjunctiva

DC is typically watery, some crusting in a.m

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6
Q

Tx for viral conjunctivitis?

A

supportive

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7
Q

What is periorbital cellulitis?

A

infections arising ANTERIOR to the orbital septum

generally mild, minimal comps

usually arises from exogenous source (i.e. abrasion of eyelid, hordeolum, chalazion, dacryocstitits, insect bite, etc)

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8
Q

What is orbital cellulitis?

A

infection POSTERIOR to the orbital serum

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

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9
Q

Is orbital cellulitis MCly seen in adults or children?

A

children

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10
Q

What is Kawasaki disease?

A

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

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11
Q

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

A

Kawasaki disease

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12
Q

epidemiology of Kawasaki disease?

A

Boys > girls

More common in Asians

80% in children <5

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13
Q

Dx criteria for KD?

A

Fever +

conjunctivitis: bi, bright red

Mucositis

Polymorphous rash & desquamation

Lymphadenopathy

extremity changes: edema, redness of palms/soles

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14
Q

Tx of KD?

A

IVIG +ASA 80-100mg
(most effective within 7-10d)

Baseline echo, then repeat at 2 and 6wks

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15
Q

Complications of KD?

A

coronary artery aneurysms: MI, infarction, sudden death

myocarditis, arrhythmias

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16
Q

What may be seen on CBC in pt with KD?

A

anemia and thrombocytosis

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17
Q

What is a corneal abrasion?

A

Loss of the most superficial layer of corneal cells

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18
Q

S/s of corneal abrasion?

A

Severe ocular pain

Red eye, watery d/c,
blephorospasm (tight closure of eyelid)

others: fussy baby, rubbing eye, squinting

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19
Q

Dx of corneal abrasion?

A

Apply fluorescein stain & evaluate w/ Wood’s lamp**

If FB refer to Opthalmology

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20
Q

Tx of corneal abrasion?

A

abx ointment and recheck in 24-48 hrs
-erythromycin ointment

if no decrease in size, refer to optho

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21
Q

What is dacryostenosis?

A

Nasolacrimal duct obstruction

occurs in up to 6% of newborns

MC of persistent tearing and eye DC in infants and children

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22
Q

S/s of dacryostenosis?

A

chronic or int. tearing, debris on lashes
generally NO conjunctival irritation, but, injection may occur from irritation or overflow tearing

palpable nasolacrimal sac +/- DC or reflux of tears

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23
Q

Tx of dacryostenosis?

A

Lacrimal sac massage in downward direction 2-3x a day

Obs

refer to optho if sx persist past 6 mo

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24
Q

What is dacrocystitis?

A

infection of the nasolacrimal sac that causes erythema & edema over the nasolacrimal sac

Secondary infection of Dacryostenosis

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25
Organisms involved in dacrocystitis?
commonly caused by bacteria that colonize upper respiratory tract: S. aureus, S. pneumoniae, S. pyogenes, S. viridans, M. catarrhalis & Haemophilus species
26
S/s of dacrocystitis?
Swelling, erythema/edema over nasolacrimal sac
27
Tx of dacrocystitis?
severe acute dacryocystitits = IV antibiotics (after culture & staining) milder cases = PO antibiotics (topical in conjunction)
28
S/s AOM?
+/- fever ear pain infants: poor feeding, pulling at ear older children: ear pain, HA, dizziness usually concurrent or following URI
29
PE findings of AOM?
Erythematous, bulging TM & MEE (middle ear effusion) If perforation of TM : canal w/ exudate, may visualize perf on TM
30
Tx for AOM?
up to 2: tx with abx >2 yrs: healthy, unilateral, mild sxs: observe for 48hrs >2 yrs: toxic sxs, bilateral: tx with abx
31
First line drugs for AOM? 2nd line alternatives?
amoxicillin 80-90mg/kg per day x 10d Augmentin Cefdinir Cefpodoxime
32
Management for recurrent AOM?
refer to ENT >4episodes/yr, possible hearing problems myringotomy with tympanostomy tubes
33
tx of OM with tympanostomy tubes?
otic fluoroquinolone abx drops +/- corticosteroid oral abx if severe infection
34
What is serous OM?
Presence of middle-ear effusion (fluid buildup) without infection
35
S/s of Serous OM?
Pain, pressure, “popping”, decreased hearing, disequilibrium
36
PE findings for serous OM?
TM grey, shiny TM normal or retracted
37
Diagnosis of serous OM?
clinical pneumatic otoscope: TM immobile bubbles/fluid may be visible
38
RF for serous OM?
may follow undx AOM, fam hx OM, bottle feeding, day care, exposure to tobacco smoke
39
S/s of otitis externa?
Significant ear pain, usually unilateral | Malodorous discharge from ear canal
40
PE for otitis externa?
Tragal tenderness, exudate in ear canal
41
Tx of otitis externa?
abx drops: ciprodex, ofloxacin, hydrocortisone If TM perforation: suspension fluroquinolone
42
What can you use to prevent swimmer's ear? (otitis externa)
OTC 50/50 rubbing alcohol & white vinegar after swimming
43
Presentation of nasal FB?
usually asxs early on congestion, foul smelling/purulent/blooding DC periorbital cellulitis in severe cases
44
removal of nasal FB?
tiny forceps, superglue/cotton swab mouth-mouth avoid pushing object deeper--> refer to ENT
45
aural FB removal
same as nasal but try irrigation first
46
s/s allergic rhinitis
sneezing, rhinorrhea, nasal congestion, sore throat, pruritus, cough, tearing, etc.
47
What is the atopic triad?
allergies, asthma and eczema (atopic dermatitis)
48
PE findings in allergic rhinitis?
allergic shiners nasal crease pale/blueish nasal mucosa clr rhinorrhea cobblestoning of posterior pharynx
49
tx of allergic rhinitis?
intranasal steroid sprays antihistamines: oral and intranasal- usually 2nd gen avoid triggers immunotherapy
50
s/s of sinusitis?
10-14 d of sx without improvement Can be misleading due to overlap of sx w viral URI purulent nasal DC, sinus pain, +/- fever, halitosis, HA, dental pain
51
pathogen for bacterial sinusitis?
S. pneumoniae H. influenza M. cattarhalis
52
dx of sinusitis?
clinical if chronic (>30days) - water's view xray - culture - CT sinuses
53
sxs tx for sinusitis?
Intranasal saline irrigation Analgesics Humidifier/vaporizer
54
s/s of pharyngitis?
red throat, congestion, fever, fatigue, swollen cervical nodes
55
Likely pathogen for pt with viral pharyngitis and bilateral conjuctivitis?
adenovirus
56
tx for viral pharyngitis?
pt ed pain control, fluids, rest
57
What is EBV?
infectious mononucleosis MC in adolescents
58
s/s of EBV?
Exudative tonsillitis, cervical lymphadenopathy, fatigue & malaise, headache, fever, splenomegally
59
Incubation of EBV?
4-8 wks
60
Dx of EBV?
fingerstick (monospot) EBV titers
61
Tx of EBV
spleen precautions: no contact sports monitor fluids/airways analgesics +/- steroids
62
sxs of GABHS in children >3 y/o
usually abrupt onset Fever, sore throat, headache, nausea, abdominal pain, rash Watch fluid intake!
63
sxs of GABHS in pts <3?
nasal congestion, low grade fever, ant cervical LA
64
PE findings in GABHS?
``` exudative tonsillitis enlarged tender anterior cervical lymph nodes, palatal petechiae +/- scarlatiniform rash Halitosis Coated tongue ```
65
Dx of GABHS
rapid strep antigen test throat
66
Tx of GABHS?
abx, pain control, fluids Amoxicillin 50mg/kg/d divided BID x 10 days
67
What is acute rheumatic fever?
2-3 weeks post strep infection, usually peds 5-15 yo
68
s/s of acute rheumatic fever?
Jones’ criteria: Major criteria - Migrating polyarthritis - Carditis and valvulitis - Chorea ( - Erythema marginatum - Subcutaneous nodules Minor criteria - Arthralgia - Fever - Elevated ESR or CRP - Prolonged PR interval
69
high likelihood of ARH if...
2 major or 1 major and 2 minor criteria
70
Why do we care about ARF?
can cause rheumatic heart disese 10-20 yrs later
71
dx of ARF?
Antistreptolysin-O (ASO) titers Strep antigen and/or throat cx will likely be negative
72
Tx of ARF?
abx + antiinflammatories Amoxicillin ASA eval for carditis
73
What else can happen if strep throat is left untreated?
Post-streptococcal Glomerulonephritis (PGN) Inflammation of the glomeruli secondary to deposition of immune complexes
74
s/s of PGN?
Edema (#1), hematuria (tea-colored urine), proteinuria, hypertension (Na+ & H20 retention)
75
dx of PGN? tx?
Antistreptolysin O titers (ASO titers) usually self limited diuretics if persistent HTN and edema
76
Pathogen involved in peritonsillar abscess?
Usually S. pyogenes, but may be polymicrobial
77
s/s of peritonsillar abscess?
``` Difficulty & pain with swallowing Drooling, decreased PO intake, Unwillingness to extend the neck, muffled/"hot potato“ voice, Respiratory distress, Neck swelling/lymphadenopathy Trismus ```
78
dx of peritonsillar abscess?
Clinical Uvula deviated Edema of anterior tonsilar pillar CT w/ contrast Aspiration
79
management of peritonsillar abscess?
Airway! Surgical drainage Antibiotics
80
Describe coxsackie virus
“Hand, foot & mouth disease” Oral lesions (“Herpangina”), esp on tongue, palate & tonsillar pillars Maculopapular or vesicular rash on hands and feet
81
Presentation of hand foot mouth disease
usually < 5 y/o, day care low grade fever, decreased POs, sore throat, HA
82
tx for hand foot mouth disease?
supportive popsicles
83
Describe Herpetic Gingivostomatitis
Primary HSV-1 infection Ulcerative lesions of the gingiva and mucous membranes, occasionally with perioral lesions
84
s/s of herpetic gingivostomatitis?
3-4 day “prodrome” Fever, sleeplessness, HA, Ulcerated lesions that bleed if disturbed
85
Tx of herpetic gingivostomatitis?
NSAIDs HYDRATION Oral acyclovir if sx < 4d & possibility of dehydration
86
Incubcation period of measles? Prodrome of measles?
6-19 days Fever, malaise, anorexia followed by conjunctivitis, coryza & cough, Koplik's spots
87
Presentation of diaper candidiasis
“Beefy Red” erythema with satellite lesions Usually a result of poorly treated irritant dermatitis involves skin folds
88
Tx of diaper candidiasis?
topical antifungal agents: clotrimazole cream first, apply barrier cleanse gently, diaper free time
89
Can you tx diaper candidiasis with steroids?
NO
90
What is cradle cap? Presentation?
seborrheic dermatitis Greasy, yellowish scales on scalp (#1), ear, face, diaper area. Usually 3wks- 12mos of age
91
Tx of cradle cap?
conservative: emollient (petroleum jelly), softbaby brush severe/refractory: topical steroid or ketoconazole
92
Epidemiology of impetigo? Types?
usually 2-5 bullous and non-bullous (MC)
93
presentation of non-bullous impetigo?
Papules vesicles thick, “honey-colored” crust w surrounding erythema, usually face & extremities
94
tx of imeptigo?
Mild: Mupirocin (Bactroban) topical antibiotic 3x a day for 5 days More severe: Mupirocin ointment + PO antibiotic (Keflex) x 7 days
95
Pathogen involved in impetigo?
s. aureus, poss strep

PEDS- Clinical Disciplines Exam 2 (5 decks)

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