Pediatric Secretes (TEXTBOOK) > ENT > Flashcards

ENT Flashcards

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1
Q

What are the common URI bugs?

A

H. influenza
M. catarrhalis
Strep Pneumoniae

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2
Q

What are the classic clinical presentation of acute otitis media (AOM)?

A

unilateral ear pain relieved w/ pulling on pina

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3
Q

AOM physical exam findings

A
  • loss of light reflex (opaque)
  • bulging erythematous TM (esp. if yellow or hemorrhagic = bacterial)
  • fluid befind TM (bubbles)
  • if TM immobile = Dx
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4
Q

How is AOM Dx’d?

A

Clx: immobile TM

w/ pneumatic insulflation (puff air –> rigid TM = +)

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5
Q

What are signs that an AOM is bacterial in etiology?

A
  • A bulging tympanic membrane, especially if yellow or hemorrhagic
  • Perforation of the tympanic membrane with purulent discharge
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6
Q

How is AOM Tx’d?

A

<6wks:
- Ix bacteremia, go to ED

6wk-6mo:

  • analgesics
  • Amox x10 days

> 6mo

w/ RFs:
Immediate Tx for:
- child w/ high fever (>39)
- mod-sev systemically ill
or - very severe otalgia
or - significantly ill >48 hrs
low RFs:
- watchful waiting + analgesics 
OR give Abx Rx to parents to use if child doesn't improve w/in 48hrs 
Drug: Amoxicillin 
<2y/o - x10 days
>2 y/o - x5 days
- if/ Tx fail = 
Amox-clav
cefprozil, 
Ceftriaxone im/iv × 3 days
...consider tympanostomy tubes
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7
Q

How do you Tx recurrent AOM (medically and procedurally)?

A

Amox-clav 10-14 d

  • if >3x/6mo or 4x/yr = Tympanostomy tubes
  • pen allergic = Clarithromycin or azithromycin

if Tx fail:
Clindamycin
or FQ (levoflox)

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8
Q

How do the presentations of viral, allergic, and bacterial conjunctivitis generally differ?

A 
VIRAL:
- red eye
- minimal itch
- profuse serous d/c
"gritty" -affects 2nd eye 24-48 hrs later

BACTERIAL:

  • red eye
  • minimal itch
  • mod, mucopurulent-purulent (all day)
  • usually unilateral

HYPER-acute bacterial:
yellow-green purulent discharge, redness, irritation and tenderness to palpation.

ALLERGIC:

  • red eye
  • VERY ITCHY
  • mod, serous or mucoid
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9
Q

TX for conjunctivitis

A

all etiologies usually self-limiting

supportive:

  • throw out contacts
  • wash bed sheets

if Viral:
- OTC antihistamines

if Bacterial:

  • Abx (polymyxin B/gramicidin drops, 4-6x/day x7-10 days.. continue 2 days after sxs resolve)
  • if no improvement 48 hrs, switch to broad spec drops: trimethoprim/polymyxin B, ophthalmic ointments containing erythromycin or bacitracin
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10
Q

Dacryoadenitis definition

A

blocked lacrimal glands

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11
Q

Dacryoadenitis - signs and symptoms

A

Signs & symptoms

  • Swelling of upper lid
  • Lid redness & erythema
  • Lid pain
  • Excess tearing or discharge -Swelling of preauricular nodes
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12
Q

Darcryoadenitis - Tx

A

Management

  • Warm compresses
  • Think malignancy if no improvement

if purulent d/c, start first-generation cephalosporins to cover G+ves (eg, Keflex 500 mg qid) until culture results are obtained

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13
Q

Strabismus (Tropia) - Definition, Ix, Mx

A

Def: crossed eyed

Ix: light reflex, cover-uncover test
(Affected eye will drift when covered, then moves quickly back if cover is removed)
- Differentiate congenital from acquired (may be vision-threatening or life-threatening)

Mx: refer to ophtho

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14
Q

Otitis Externa - nick name/Etiology

A

“swimmer’s ear”
(pseudomonas)

digital trauma

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15
Q

Otitis Externa - Clinical presentation

A
  • unilat. ear pain (otalgia)
  • worse pain with manipulation of tragus
  • hearing loss
  • otorrhea
  • fullness
  • itching
  • recent exposure to water
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16
Q

What are the 2 most common pathogens that cause Otitis Externa?

A 
Pseudomonas aeruginosa (20–60%) and Staphylococcus aureus (10–70%)
(and strep)

AOE = bacterial 90% of time

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17
Q

How do you treat otitis externa?

A

TX = NONE, self resolving…
(analgesics)
summary: if doesn’t and prs looks toxic –> abx/steroid drops

Bacterial:

  • neo/poly/HC only if TM intact, - FQ ex. cipro (use a wick if canal is swollen),
  • systemic therapy if canal is swollen shut or pt is immunocompromised/DM
  • Fungal: acetic acid/HC drops, clotrimazole drops
  • Bacterial vs fungal? CASH (drying) powder covers both
  • Chronic treat eczema with steroid cream, then use vinegar/water washes and avoid Q-tips
  • Malignant emergent referral to ENT
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18
Q

What is a potential complication if otitis extern?

A

Malignant otitis externa = osteomyelitis of temporal bone as a result of chronic infection in DM, not cancerous!

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19
Q

What are the risk factors/causes for oral candidiasis?

A 
Newborns
Uncontrolled Diabetes
HIV/AIDS
Chemotherpy
Side effect of inhaled steroids
Side effect of antibiotics
Dentures or poor hygiene
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20
Q

What are the Signs & symptoms of oral candidiasis? aka- “thrush”

A

Signs & symptoms:
-Pseudomembranous form is most common: white plaques
(when you scrape, either red sore or still white under)
-Angular cheilitis with chronic lip-lickers
-Glossitis with broad spectrum antibiotic use
-Cottony feeling in mouth
-Loss of taste
-Pain with eating and swallowing
-May be asymptomatic

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21
Q

Tx for oral candidiasis?

A

Address underlying cause
Fluconazole 100mg x 7 days for non-immunocompromised patients
½ hydrogen peroxide mouth rinse

OR
-Infants: oral NYSTATIN swabs for 7-14 days, boiling of bottle nipples and pacifiers

-Older children: oral NYSTATIN rinses x14 days or systemic fluconazole PO if severe
(200mg po x1 day, then 100mg po x7 days)

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22
Q

What Ix do you do for oral candidiasis?

A

Workup

  • Lesions can be scraped off and may bleed
  • Culture of scrapings (KOH prep)
  • Microscopic examination of scrapings
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23
Q

What is Samter’s triad?

A

syndrome of:

aspirin sensitivity,
nasal polyposis, and
asthma

often seen with allergic rhinitis, frequently leading to severe pansinusitis

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24
Q

What are the S/Sxs of allergic rhinitis?

A

repetitive sneezing, pruritus of nose, eyes, palate, ears, clear rhinorrhea, nasal congestion, postnasal drip, epistaxis, allergic shiners, Dennie’s lines, allergic salute, retracted TMs, serous effusions, swollen or boggy turbinates, hyperplasia of palate or posterior pharynx

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25
Allergic rhinitis management is....?
- Instruct patients in allergen avoidance: closed windows, bed cases, washing linens weekly, removing stuffed animals, cockroach poison, mould precautions, HEPA filters - Nasal saline sprays or rinses - Oral decongestants - Nasal steroids: fluticasone, flunisolide - 1st or 2nd gen antihistamines: cetirizine and fexofenadine ok for infants > 6 mo - Leukotriene inhibitor - Refer to allergist for kids with mod-severe disease, prolonged rhinitis despite intervention, coexisting asthma or nasal polyps, recurrent otitis media or sinusitis
26
What are the possible etiologies of nasal polyps?
- Usually a reaction to bacterial infection in kids - Allergies - Chronic sinusitis
27
What are the S/Sxs of nasal polyps?
- Stuffiness - Feelings of pressure or fullness in the face - Trouble smelling
28
What is the Tx/Mx of nasal polyps?
- Steroid nasal spray 1-3mo - Saline rinses - Refer for surgical excision but may recur
29
List 2 complications of untreated Group A strep Pharyngitis
rheumatic fever | glomerulonephritis
30
What is the clinical presentation of viral pharyngitis?
sore throat, odynophagia - Concurrent rhinorrhea - Erythema, edema, dysphagia, fever, lymphadenopathy, diffusely pink throat, cough, fever
31
What is the clinical presentation of GAS pharyngitis? | common ages, s/sxs, dx criteria
- Uncommon in kids under 2-3 - Sore throat, dysphagia, odynophagia, erythema, airway obstruction, bright beefy red demarcated splotches - Centor criteria: tender cervical adenopathy, fever > 100.4, no cough, tonsillar exudate - Abdominal pain and vomiting in peds
32
What is the CENTOR criteria?
Dx of GAS pharyngitis: ``` Cough +1 Exudates +1 Nodules (LN) +1 Temp (fever >100.4/>38) +1 OR Age <14 (+1) >44 (-1) ``` ``` <1 observe, supportive care 2-3 - rapid strep test - if -ve and not concerned, observe - if -ve but concerned = Cx in kids - if +ve = Tx 4+ = Tx ```
33
1) What is sore throat + splenomegaly pathonemonic for? | 2) what are other s/sxs?
Mono - Fatigue, malaise, sore throat with tonsillar edema, erythema, and shaggy white-purple tonsillar exudate, lymphadenopathy, hepatosplenomegaly - Many will have 2° Strep tonsillitis
34
What is the likely pathogen in Mono?
EBV
35
How do you test for Mono?
Monospot -CBC to look for atypical lymphocytes Clx: shaggy white tonsillar exudate
36
How do you proceed after doing a Monospot test?
``` -ve = Cx +ve = Tx ```
37
How do you Tx GAS pharyngitis?
Penicillin 500 mg BID | Amoxicillin 500 mg TID
38
How do you tx mono?
- OTC pain control - ? steroids - Splenic precautions - Treat tonsillitis (if have 2e strep tonsillitis) but avoid ampicillin due to rxn with mono rash
39
What is the CP of tonsillitis?
-Swollen tonsils with white plaques
40
What are the pathogens responsible for tonsillitis?
Viral (can be mono) or bacterial (usually GAS)
41
What is the workup for ?tonsillitis?
- Rapid Strep | - Monospot
42
Tx for tonsillitis?
Abx - Amox
43
What is a surgical emergency/complication of otitis externa?
Mastoiditis
44
What pathogens cause mastoiditis?
URI bugs (M.cat, S.pneumo, S aureus)
45
How does Mastoiditis present?
looks like AOM + swelling behind the ear + anteriorly rotated ear
46
How is mastoiditis Dx'd and Tx'd?
Dx is Clx (don't do CT) Tx: surgical decompression (+ way you were already tx'ing for AOM)
47
How do you Tx viral pharyngitis?
Symptomatic treatment NSAIDS or tylenol Fluids - Salt water gargles - Lozenges or hard candy for kids over 4 - Acetaminophen or ibuprofen - Oral rinse with equal parts lidocaine, diphenhydramine, and Maalox - Benzydamine HCl mouth rinse
48
How does a peritonsillar abscess present?
- Severe, one sided sore throat - Odynophagia – difficulty swallowing - Fever - Tender glands – pain in head and neck - Trismus – difficulty opening the mouth - HOT Potato Voice – muffled voice
49
How do you Tx peritonsillar abscess?
-Urgent referral to ENT for I&D Needle aspiration Incision and drainage Tonsillectomy Antibiotic therapy: - Amoxicillin – though likely resistant to PCN - Clindamycin – probably the better choice here.
50
What are the two kinds of epistaxis?
1) Anterior nosebleed is the most common and originates from Kiesselbach’s plexus. 2) Posterior nosebleed is less common and much more difficult to treat.
51
What causes epistaxis?
``` Trauma Dry mucosa Chronic rhinitis Foreign body Clotting issue HTN ```
52
Epistaxis Ix
Initially a clinical diagnosis, but you may want to work up other suspicious medical issues
53
Epistaxis Tx
- Direct pressure – pinch the bridge of the nose for 15 minutes - Have patient lean forward to avoid swallowing blood leading to nausea and vomiting - Topical vasoconstrictor ie cocaine or oxymetazoline - If you can visualize the source silver nitrate may be used to cauterize the vessels - Packing for 24 hrs if necessary - Pneumatic tamponade - Surgical correction
54
Nasal polyps Ix
Endonasal Cope | CT
55
What are the usual chief complaints of patient's with acute pharyngitis?
``` Sudden onset Fever/chills Difficulty swallowing Tender, swollen throat No cough Typically younger than 15 years old ```
56
Ix/PE findings of peritonsillar abscess:
Erythematous pharynx Uvula displaced towards unaffected side Ultra sound CT with contrast
57
What causes epiglotitis?
Viral infection Bacterial infection Haemophilus influenzae – now less likely due to vaccination
58
What are the chief complaints of pt's w/ epiglotitis?
``` High fever Sore throat Difficulty moving air Difficulty swallowing Drooling ```
59
labs, Ix, PE findings of epiglotitis?
``` Stridor Cyanosis Laryngoscopy in OR as it may cause spasms Throat culture X-ray – Thumbprint sign on c-spine film CT ```
60
Tx for epiglotitis?
Be prepared for intubation Keep patient calm and breathing easily Antibiotics may be necessary Cephalosporins
61
Hot potato voice – associated w/?
peritonsilar abscess
62
Thumb print sign – associated w/?
x-ray finding associated with epiglotitis
63
White adherent plaque in the mouth – associated w/? (Adults)
– leukoplakia
64
White non adherent plaque in the mouth – associated w/?
candida
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