Peds: Growth and Development > ENT > Flashcards

ENT Flashcards

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1
Q

Define Ophthalmia Neonatorum

A

Conjunctivitis in the newborn, occurring during first month of life

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2
Q

What is aseptic ophthalmia neonatorum?

A
  1. Inflammation

A. 2° to silver nitrate prophylaxis (rarely used)

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3
Q

What causes septic ophthalmia neonatorum?

A 
1. Bacterial infection 
A. Gonococcal 
B. Staphylococcal
C. Pneumococcal
D. Chlamydial (most common)
2. Viral infection
A. Herpes
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4
Q

How can ophthalmia neonatorum be prevented?

A
  1. Treat maternal infections prior to delivery
  2. Silver nitrate for GC
    A. Not effective against Chlamydia
  3. Erythromycin ophthalmic ointment
    A. Administered immediately after birth
    B. Not effective against Chlamydia
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5
Q

What are the clinical findings for ophthalmia neonatorum?

A
  1. Redness & swelling to eyelids / conjunctiva

2. Discharge

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6
Q

What are the complications for ophthalmia neonatorum?

A
  1. Chlamydia → delayed-onset pneumonitis

2. Gonococcal infections → blindness & sepsis

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7
Q

What are the sxs for gonococcal conjunctivitis?

A

Bilateral purulent conjunctivitis w/lid edema

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8
Q

What are the characteristics for gonococcal conjunctivitis?

A
  1. Gm (-)
  2. Most serious
  3. Usually occurring 24-48 hrs following birth
  4. If untreated→cornea cloudiness → ulceration → perforation → blindness
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9
Q

Describe chemical conjunctivitis

A
  1. Chemical conjunctivitis 2° to silver nitrate sol’t

2. Occurs in 1st day of life, resolves spontaneously w/in 2-4 days

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10
Q

Describe Chlamydial conjunctivitis/other bacteria

A
  1. Gm (-)
  2. Incubation period 5-14 days
  3. Unilateral or bilateral hyperemia w/watery discharge, may become more copious & purulent
  4. Most cases are mild & self-limited
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11
Q

Describe Herpetic conjunctivitis

A
  1. Presents w/vesicles on the skin
  2. Can cause keratoconjunctivitis
  3. Incubation period of ≈ 6-14 days
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12
Q

What gram positive bugs can cause conjunctivitis?

A

Staph aureus
Strep pneumoniae
Strep viridans
Staph epidermidis

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13
Q

What gram negative bugs can cause conjunctivitis?

A
  1. More common in low birth wt & low gestational age
  2. Milder presentation
  3. 5-14 day incubation
    E. coli
    Klebsiella pneumoniae
    Serratia marcescens
    Proteus
    Enterobacter
    Pseudomonas
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14
Q

What are the dx studies for conjunctivitis?

A
  1. Conjunctival swab for Gram stain
  2. Conjunctival swab for polymerase chain reaction assay (PCR) to detect Chlamydia
  3. Culture for bacteria
  4. HSV Cx if cornea is involved
  5. PCR done in cases of possible HSV conjunctivitis
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15
Q

How is GC conjunctivitis treated?

A
  1. Admit
    A. Risk for 2° infections (pneumonia, meningitis, sepsis)
  2. Tx empirically
    A. Erythromycin ophth ointment + ceftriaxone (75-100 mg/kg/d) IM or IV
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16
Q

How is chlamydia conjunctivitis treated?

A
  1. Oral erythromycin (50 mg/kg/d in divided doses qid) x 14 days
    OR
  2. Oral azithromycin(20mg/kg) qd X 3 days
  3. Erythromycin ophth ointment may be beneficial as adjunctive Tx
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17
Q

When must a mom be tested to GC?

A

When baby has dz

Obtain cervicalCx if indicated & Tx appropriately

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18
Q

How is herpetic conjunctivitis treated?

A
  1. Acyclovir 60 mg/kg/day IV divided tid x 14 days

2. If HSV keratitis: topical 1% trifluridine drops or 3% vidarabine ointment

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19
Q

How is chemical conjunctivitis treated?

A

Tx not necessary

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20
Q

Describe bacterial conjunctivitis

A
  1. Conjunctivitis that is accompanied by purulent discharge.

2. “ Pink Eye”

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21
Q

What organisms mc cause bacterial conjunctivitis?

A
  1. Haemophilus species
  2. Strep pneumoniae
  3. Moraxella catarrhalis
  4. Staph aureus
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22
Q

How can bact conjunctivitis be prevented?

A
  1. Proper hand-washing techniques

2. Contact precautions

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23
Q

What are the sxs of bacterial conjunctivitis?

A
  1. Purulent discharge
  2. Conjunctival injection to one or both eyes
  3. May be associated w/ URI
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24
Q

How is bacterial conjunctivitis treated?

A 
1. Topical antibiotic ointment/drops if not assoc. w/systemic Illness:
A. Erythromycin 
B. Polymyxin-bacitracin
C. SulfacetamidE
D. Aminoglycosides
E. Fluoroquinolones
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25
What organisms cause viral conjunctivitis?
1. Adenovirus 2. Enterovirus 3. Herpes Simplex
26
How can viral conjunctivitis be prevented?
1. Proper hand-washing techniques | 2. Contact precautions
27
What are the clinical findings for viral conjunctivitis?
1. Watery discharge 2. Conjunctival injection of one or both eyes 3. Vesicular rash involving eyelids or face suggests herpes simplex virus 4. “Pink eye”
28
What are the complications for viral conjunctivitis?
1. Usually self-limited 2. HSV can result in keratitis, & can affect vision 3. Needs ophthalmology referral
29
What is the treatment for viral conjunctivitis caused by HSV?
1. HSV A. Trifluridine (Viroptic) 1% qtts B. Ganciclovir (Z9rgan) Ophth 0.15% qtts C. Oral acyclovir
30
What is the treatment for viral conjunctivitis caused by adenovirus?
1. Supportive 2. Contagious 10-14 days from onset, as long as eyes are red & tearing 3. Strict hand-washing precautions
31
What is allergic conjunctivitis mc caused by?
1. Most common cause-hay fever (pollens & trees) | 2. Release of histamine by mast cells → stimulate dilation of blood vessels → irritate nerve endings → ↑ tear secretion
32
What are the sxs for allergic conjunctivitis?
1. Ocular itching 2. Eyelid swelling 3. Tearing 4. Photophobia 5. Watery discharge 6. FB sensation (pain)
33
What are the treatments for allergic conjunctivitis?
1. Avoid allergen 2. Oral antihistamines 3. Topical antihistamines around the eyes, but NOT in the eye A. Pheniramine maleate (Naphcon-A) 4. Topical Mast Cell Stabilizers A. Cromolyn (Opticrom) B. Olopatadine (Patanol)
34
Describe otitis externa
1. Infection of ear canal skin | 2. Common cause- loss of cerumen protection
35
What organisms cause otitis externa?
1. Staph aureus | 2. Pseudomonas aeruginosa
36
What are the sxs of otitis externa?
1. Edema of canal 2. Drainage 3. Severe pain, aggravated by manipulating pinna or tragus
37
How is otitis externa treated?
1. Topical antibiotic A. Fluoroquinolone otic qtts or cortisporins B. If TM not visible-assume TM perforation C. Use Pope ear wick if severe edema 2. Add oral antibiotics if local invasion A. Obtain Cx B. Cephalosporins, Amoxicillin clavulanate 3. Analgesics
38
How can recurrent OE be prevented?
1. Instill 2-3 qtts 1:1 solution of acetic acid & 70% ethyl alcohol before & after swimming 2. Avoid cotton swabs in canal 3. Proper fitting ear plugs
39
Describe acute otitis media
Infection associated w/ middle ear effusion (MEE) or w/ otorrhea (ear drainage) due to perforation of the tympanic membrane
40
What are the mc organisms that cause om?
1. Strep pneumoniae 2. Moraxella catarrhalis 3. Haemophilus influenzae 4. Strep pyogenes
41
What predisposing factors can lead to acute om?
1. Eustachian tube dysfunction 2. Viral URI 3. Impaired host immune defenses A. Immunocompromised children w/ selective IgA deficiency 4. Smoking exposure 5. Bacterial colonization A. Nasopharyngeal colonization increases risk (daycare exposure) 6. Genetic susceptibility A. Although AOM is multifactorial, 70% of risk is genetically determined 7. Bottle feeding A. Aspiration of contaminated secretions back up into middle ear space. B. Breast feeding reduces problem
42
What are the sxs for acute otitis media?
``` 1. Acute onset of symptoms A. Fever, pain, ↓ appetite, sleep disruption 2. Middle Ear Effusion (MME) A. Bulging tympanic membrane B. Limited or absent mobility of TM C. Air-fluid level behind TM D. Otorrhea 3. Inflammation A. TM erythema B. Otalgia ```
43
What are complications of aom?
1. Tympanosclerosis 2. Adhesions 3. Ossicular erosions 4. Cholesteatoma 5. Perforations 6. Facial nerve paralysis 7. Chronic suppurative OM 8. Mastoiditis 9. Hearing loss
44
How is the pain w/ aom treated?
1. Treat pain/fever w/ Acetaminophen or Ibuprofen 2. Topical anesthetic drop A. Auralgan Otic (benzocaine & antipyrine) B. May be used if TM is not perforated
45
What are the aom treatment: watchful waiting guidelines for 48-72 hrs?
1. 2 yr A. Certain dx: abx if severe illness, observe for nonsevere illness B. Uncertain dx: observation option 4. *Non-severe illness is mild otalgia and fever
46
What is the first line treatment for aom?
1. Amoxicillin, 90 mg/kg/d TID, up to 4 g/d A. > 2 y, give x 5 days B.
47
What is the 2nd line treatment for aom?
1. Amoxicillin-clavulanate A. Amoxicillin 90 mg/kg/d in divided BID dosing x 10 days B. If amoxicillin has caused allergic rash, give 3rd generation cephalosporin -Cefdinir (Omnicef) 14 mg/kg/d in QD-BID doses x 5-10 days -Cefpodoxime (Vantin) 10mg/kg/d in divided BID doses x 5 days
48
What is the 3rd line treatment for aom?
1. Tympanocentesis is recommended to determine the cause | A. Ceftriaxone (Rocephin), two doses given IM, 48 h apart, w/ optional 3rd dose
49
How is aom treated if Recurrences > 4 wk after first episode?
A new pathogen is likely, so restart 1st -line Tx
50
What are the sxs for tm perforation?
1. Perforations w/out infection → no pain 2. Perforation w/ infection → purulent drainage (may be sanguinous) 3. Whistling sounds during sneezing & nose blowing 4. Decreased hearing A. Mild conductive loss 5. Tendency to infection during colds & when water enters ear canal
51
What can cause tm perforation?
``` 1. Direct trauma, sudden impact A. Generally DO NOT heal 2. Acute OM A. Usually heals in 2 weeks B. If not healed w/in 6 mo → Tympanoplasty, Delayed until 7 yr old ``` 3. Monitor hearing, needs referral
52
How is tm perforation treated?
1. Goal control otorrhea 2. Ear plugs 3. Oral Abx occasionally used when controlling otorrhea A. Amoxicillin B. Trimethoprim-sulfamethoxazole 4. Avoid eardrops containing gentamicin, neomycin sulfate, or tobramycin A. Risk of ototoxicity
53
Describe acute bacterial rhinosinustitis
1. Bacterial infection of the paranasal sinuses 2. Almost always preceded by a viral URI A. URI sx’s last 10+ days or worsen w/ fever 39 C/102.2 F & purulent rhinorrhea x 3-4 days
54
What sinuses are asst. with acute bacterial rhinosinusitis?
1. Maxillary & ethmoid sinuses | 2. Most commonly involved, (present at birth)
55
What pathogens are asst. with acute bacterial rhinosinusitis?
1. Strep pneumoniae 2. Haemophilus influenzae 3. B-hemolytic streptococci 4. Moraxella catarrhalis
56
What sxs are asst. with acute bacterial rhinosinusitis?
1. Purulent nasal drainage 2. Nasal congestion 3. Facial pressure or pain 4. Fever 5. Cough 6. Fatigue 7. Ear pressure & fullness
57
What are the rx options for acute bacterial rhinosinusitis w/ mild-moderate sxs?
1. 1st line Tx if NOT in daycare & no antibiotics in past 3 mo, give: A. Amoxicillin 90 mg/kg/d ( 3rd gen. cephalosporin OR macrolide) 2. Change to amoxicillin-clavulanate if not improving 48-72 hr
58
What are the rx options for acute bacterial rhinosinusitis w/ severe sxs?
1. 1st line Tx if in daycare, severe sx’s, or took antibx in past 3 mo, give: A. Amoxicillin-clavulanate (3rd gen cephalosporin, macrolide) 2. If not improving 48-72 hr, add IV ceftriaxone, sinus x-ray/CT & refer to ENT for sinus aspiration
59
What are the complications asst. with acute bacterial rhinosinusitis?
1. Most common organism causing complications in children is Streptococcus anginosus A. Ethmoid sinusitis B. Frontal sinusitis
60
what are the sxs of ethmoid sinusitis?
1. Periorbital Cellulitis 2. Abscess 3. Associated signs & symptoms 4. Eyelid edema 5. Restricted extraocular movements 6. Altered visual acuity 7. Fever
61
what are the sxs of frontal sinusitis?
1. Unusual before age 10 2. Osteitis of frontal bone (Pott’s puffy tumor) 3. Meningitis risk 4. Epidural, subdural, or brain abscess risk
62
What causes thrush?
Candida albicans
63
What are the clinical findings for thrush?
1. Oral pain 2. Refusal of feeding 3. White curd-like plaques on buccal mucosa that can’t be washed away
64
How is thrush treated?
1. Nystatin oral suspension (100,000 units/mL) A. Infants: 2mL QID; use 48 hours after symptoms resolve B. Children: 5 mL QID, swish & swallow; use 48 hours after symptoms resolve
65
What causes 90% of sore throats and fever in children?
Viral Pharyngitis
66
What are the 4 types of viral pharyngitis?
1. Infectious mononucleosis (EBV) 2. Herpangina (Coxsackie Group A-type of enterovirus) 3. Hand, food,& mouth Dz (Coxsackie A-16-type of enterovirus) 4. Pharyngoconjunctival fever (Adenovirus)
67
What causes infectious mono?
1. Caused by Epstein-Barr Virus (EBV) 2. Young children can have no or very mild symptoms 3. Transported via saliva 4. Also transmitted by blood transfusion & organ transplantation
68
What are the clinical findings for mono?
1. Incubation period 1-2 months 2. 2-3 day prodrome of malaise & anorexia 3. Abrupt onset of fever > 39°C 4. Pharyngitis; 50% exudative 5. Lymph nodes enlarged, firm, mildly tender A. Anterior & posterior cervical B. Axillary, inguinal 6. Splenomegaly (50-75%) 7. Hepatomegaly (30%) 8. Rash (5%), macular, scarlatiniform, or uticarial 9. Soft palate petechiae 10 . Eyelid edema
69
What are the cbc findings for mono?
1. Leukopenia may occur early 2. Atypical lymphocytosis 3. Changes may not be seen until third week of illness
70
What are the monospot findings for mono?
1.Monospot (Heterophil antibodies) A, May not be detected until second week of illness B. Can persist for up to 12 months after recovery
71
What are the EBV antibody results for mono?
Done if the Monospot is consistently (-), but suspicion of mono is high
72
What complications can result from mono?
1. Splenic rupture 2. Hemolytic anemia 3. Thrombocytopenia 4. Neutropenia 5. Aseptic meningitis 6. Encephalitis 7. Guillain-Barre syndrome 8. Myocarditis 9. Atypical pneumonia 10. Pericarditis
73
What is the treatment for mono? What is the prognosis?
1. Rest 2. Acetaminophen for high fever 3. Corticosteroids for swollen pharyngeal tissue 4. Avoid contact sports for 6-8 weeks if splenomegaly develops 5. Prognosis A. Good B. Long recovery period
74
What % of kids with sore throat and fever have a group A strep infection?
10%
75
What causes bacterial pharyngitis?
1. Group A streptococcal 2. Mycoplasma pneumoniae (most common cause, over 1/3 of all pharyngitis cases in adolescents & adults) 3. Chlamydia pneumoniae 4. Groups C & G streptococci 5. Arcanobacterium hemolyticum
76
What are the clinical findings for bacterial pharyngitis?
1. Sudden onset of sore throat 2. Odynophagia 3. Fever 4. Headache 5. Anterior cervical lymphadenopathy 6. Palatal petechiae 7. Beefy-red uvula 8. Tonsillar exudate
77
How is bacterial pharyngitis dx?
1. Throat culture 2. Rapid strep test A. Very specific, but sensitivity only 85%-95%
78
What complications can arise from bacterial pharyngitis?
1. Scarlet fever 2. Rheumatic fever 3. Glomerulonephritis 4. Cervical adenitis 5. Peritonsillar abscess 6. Septicemia
79
What are the treatment options for bacterial pharyngitis?
1. Penicillin VK 50-70 mg/kg/d in 3 divided doses x 10 days A. Clinical cure rate 63%-64% 2. Benzathine penicillin G 600,000 units IM if 27 kg, single dose A. Clinical cure rate 63%-64% 3. Amoxicillin 50 mg/kg once daily x 10 days A. Clinical cure rate 86% 4. Azithromycin (Zithromax) 12 mg/kg once daily x 5 days. A. Clinical cure rate 82% 5. Cephalexin (Keflex) 25-50 mg/kg/d in divided doses x 10 days. A. Clinical cure rate 94%
80
How can the carrier state of bacterial pharyngitis be eradicated?
1. Clindamycin 20 mg/kg/d in 3 divided doses x 10 days A. Clinical cure rate 92% for carrier state 2. Penicillin VK 50-75 mg/kg/d in 3 divided doses x 10 days + Rifampin 20 mg/kg/d twice daily for 4 days 3. Benzathine penicillin G 600,000 units IM if 27 kg, single dose A. Clinical cure rate 55%
Peds: Growth and Development
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