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PEDS- Clinical Disciplines Exam 2 > Peds HEENT > Flashcards

Peds HEENT Flashcards

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
Q

Organisms involved in dacrocystitis?

A

commonly caused by bacteria that colonize upper respiratory tract:

S. aureus, S. pneumoniae, S. pyogenes, S. viridans, M. catarrhalis & Haemophilus species

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26
Q

S/s of dacrocystitis?

A

Swelling, erythema/edema over nasolacrimal sac

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27
Q

Tx of dacrocystitis?

A

severe acute dacryocystitits = IV antibiotics (after culture & staining)

milder cases = PO antibiotics (topical in conjunction)

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28
Q

S/s AOM?

A

+/- fever

ear pain

infants: poor feeding, pulling at ear

older children: ear pain, HA, dizziness

usually concurrent or following URI

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29
Q

PE findings of AOM?

A

Erythematous, bulging TM & MEE (middle ear effusion)

If perforation of TM : canal w/ exudate, may visualize perf on TM

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30
Q

Tx for AOM?

A

up to 2: tx with abx

> 2 yrs: healthy, unilateral, mild sxs: observe for 48hrs

> 2 yrs: toxic sxs, bilateral: tx with abx

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31
Q

First line drugs for AOM? 2nd line alternatives?

A

amoxicillin 80-90mg/kg per day x 10d
Augmentin

Cefdinir
Cefpodoxime

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32
Q

Management for recurrent AOM?

A

refer to ENT

> 4episodes/yr, possible hearing problems

myringotomy with tympanostomy tubes

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33
Q

tx of OM with tympanostomy tubes?

A

otic fluoroquinolone abx drops +/- corticosteroid

oral abx if severe infection

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34
Q

What is serous OM?

A

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

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35
Q

S/s of Serous OM?

A

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

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36
Q

PE findings for serous OM?

A

TM grey, shiny

TM normal or retracted

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37
Q

Diagnosis of serous OM?

A

clinical

pneumatic otoscope: TM immobile

bubbles/fluid may be visible

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38
Q

RF for serous OM?

A

may follow undx AOM, fam hx OM, bottle feeding, day care, exposure to tobacco smoke

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39
Q

S/s of otitis externa?

A

Significant ear pain, usually unilateral

Malodorous discharge from ear canal

40
Q

PE for otitis externa?

A

Tragal tenderness, exudate in ear canal

41
Q

Tx of otitis externa?

A

abx drops: ciprodex, ofloxacin, hydrocortisone

If TM perforation: suspension fluroquinolone

42
Q

What can you use to prevent swimmer’s ear? (otitis externa)

A

OTC 50/50 rubbing alcohol & white vinegar after swimming

43
Q

Presentation of nasal FB?

A

usually asxs early on

congestion, foul smelling/purulent/blooding DC

periorbital cellulitis in severe cases

44
Q

removal of nasal FB?

A

tiny forceps, superglue/cotton swab mouth-mouth

avoid pushing object deeper–> refer to ENT

45
Q

aural FB removal

A

same as nasal but try irrigation first

46
Q

s/s allergic rhinitis

A

sneezing, rhinorrhea, nasal congestion, sore throat, pruritus, cough, tearing, etc.

47
Q

What is the atopic triad?

A

allergies, asthma and eczema (atopic dermatitis)

48
Q

PE findings in allergic rhinitis?

A

allergic shiners
nasal crease
pale/blueish nasal mucosa
clr rhinorrhea

cobblestoning of posterior pharynx

49
Q

tx of allergic rhinitis?

A

intranasal steroid sprays

antihistamines: oral and intranasal- usually 2nd gen

avoid triggers

immunotherapy

50
Q

s/s of sinusitis?

A

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
Q

pathogen for bacterial sinusitis?

A

S. pneumoniae
H. influenza
M. cattarhalis

52
Q

dx of sinusitis?

A

clinical

if chronic (>30days)

  • water’s view xray
  • culture
  • CT sinuses
53
Q

sxs tx for sinusitis?

A

Intranasal saline irrigation

Analgesics

Humidifier/vaporizer

54
Q

s/s of pharyngitis?

A

red throat, congestion, fever, fatigue, swollen cervical nodes

55
Q

Likely pathogen for pt with viral pharyngitis and bilateral conjuctivitis?

A

adenovirus

56
Q

tx for viral pharyngitis?

A

pt ed

pain control, fluids, rest

57
Q

What is EBV?

A

infectious mononucleosis

MC in adolescents

58
Q

s/s of EBV?

A

Exudative tonsillitis, cervical lymphadenopathy, fatigue & malaise, headache, fever, splenomegally

59
Q

Incubation of EBV?

A

4-8 wks

60
Q

Dx of EBV?

A

fingerstick (monospot)

EBV titers

61
Q

Tx of EBV

A

spleen precautions: no contact sports

monitor fluids/airways

analgesics

+/- steroids

62
Q

sxs of GABHS in children >3 y/o

A

usually abrupt onset

Fever, sore throat, headache, nausea, abdominal pain, rash

Watch fluid intake!

63
Q

sxs of GABHS in pts <3?

A

nasal congestion, low grade fever, ant cervical LA

64
Q

PE findings in GABHS?

A 
exudative tonsillitis
 enlarged tender anterior cervical lymph nodes, 
palatal petechiae
\+/- scarlatiniform rash 
Halitosis
Coated tongue
65
Q

Dx of GABHS

A

rapid strep antigen test

throat

66
Q

Tx of GABHS?

A

abx, pain control, fluids

Amoxicillin 50mg/kg/d divided BID x 10 days

67
Q

What is acute rheumatic fever?

A

2-3 weeks post strep infection, usually peds 5-15 yo

68
Q

s/s of acute rheumatic fever?

A

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
Q

high likelihood of ARH if…

A

2 major or 1 major and 2 minor criteria

70
Q

Why do we care about ARF?

A

can cause rheumatic heart disese 10-20 yrs later

71
Q

dx of ARF?

A

Antistreptolysin-O (ASO) titers

Strep antigen and/or throat cx will likely be negative

72
Q

Tx of ARF?

A

abx + antiinflammatories

Amoxicillin
ASA
eval for carditis

73
Q

What else can happen if strep throat is left untreated?

A

Post-streptococcal Glomerulonephritis (PGN)

Inflammation of the glomeruli secondary to deposition of immune complexes

74
Q

s/s of PGN?

A

Edema (#1), hematuria (tea-colored urine), proteinuria, hypertension (Na+ & H20 retention)

75
Q

dx of PGN? tx?

A

Antistreptolysin O titers (ASO titers)

usually self limited

diuretics if persistent HTN and edema

76
Q

Pathogen involved in peritonsillar abscess?

A

Usually S. pyogenes, but may be polymicrobial

77
Q

s/s of peritonsillar abscess?

A 
Difficulty &amp; pain with swallowing 
Drooling, decreased PO intake, 
Unwillingness to extend the neck, muffled/"hot potato“ voice, 
Respiratory distress, 
Neck swelling/lymphadenopathy
Trismus
78
Q

dx of peritonsillar abscess?

A

Clinical

Uvula deviated
Edema of anterior tonsilar pillar

CT w/ contrast

Aspiration

79
Q

management of peritonsillar abscess?

A

Airway!

Surgical drainage

Antibiotics

80
Q

Describe coxsackie virus

A

“Hand, foot & mouth disease”

Oral lesions (“Herpangina”), esp on tongue, palate & tonsillar pillars

Maculopapular or vesicular rash on hands and feet

81
Q

Presentation of hand foot mouth disease

A

usually < 5 y/o, day care

low grade fever, decreased POs, sore throat, HA

82
Q

tx for hand foot mouth disease?

A

supportive

popsicles

83
Q

Describe Herpetic Gingivostomatitis

A

Primary HSV-1 infection

Ulcerative lesions of the gingiva and mucous membranes, occasionally with perioral lesions

84
Q

s/s of herpetic gingivostomatitis?

A

3-4 day “prodrome”

Fever, sleeplessness, HA,
Ulcerated lesions that bleed if disturbed

85
Q

Tx of herpetic gingivostomatitis?

A

NSAIDs

HYDRATION

Oral acyclovir if sx < 4d & possibility of dehydration

86
Q

Incubcation period of measles? Prodrome of measles?

A

6-19 days

Fever, malaise, anorexia followed by conjunctivitis, coryza & cough, Koplik’s spots

87
Q

Presentation of diaper candidiasis

A

“Beefy Red” erythema with satellite lesions

Usually a result of poorly treated irritant dermatitis

involves skin folds

88
Q

Tx of diaper candidiasis?

A

topical antifungal agents:

clotrimazole cream first, apply barrier

cleanse gently, diaper free time

89
Q

Can you tx diaper candidiasis with steroids?

A

NO

90
Q

What is cradle cap? Presentation?

A

seborrheic dermatitis

Greasy, yellowish scales on scalp (#1), ear, face, diaper area.
Usually 3wks- 12mos of age

91
Q

Tx of cradle cap?

A

conservative: emollient (petroleum jelly), softbaby brush

severe/refractory: topical steroid or ketoconazole

92
Q

Epidemiology of impetigo? Types?

A

usually 2-5

bullous and non-bullous (MC)

93
Q

presentation of non-bullous impetigo?

A

Papules vesicles thick, “honey-colored” crust w surrounding erythema, usually face & extremities

94
Q

tx of imeptigo?

A

Mild: Mupirocin (Bactroban) topical antibiotic 3x a day for 5 days

More severe: Mupirocin ointment + PO antibiotic (Keflex) x 7 days

95
Q

Pathogen involved in impetigo?

A

s. aureus, poss strep

PEDS- Clinical Disciplines Exam 2 (5 decks)

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