SD- Pediatrics > ENT lecture > Flashcards

ENT lecture Flashcards

(55 cards)

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1
Q

Must measure head circumference at each visit up until ____ months

A

36

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2
Q

Anterior fontanelle closes between ___-___ months

A

10-24 months

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3
Q

Posterior fontanelle closes by….

A

2 months

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4
Q

Visible pulsations in the anterior fontanelle can be normal, but it may be a sign of…

A

increased intracranial pressure

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5
Q

A depressed anterior fontanelle can indicate..

A

Dehydration and malnutrition

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6
Q
  • Microcephaly (decreasing head circumference)
  • Craniosynostosis (ridging at suture lines)
  • Hyperthyroidism
  • Hypophosphatasia
  • Hyperparathyroidism

these can cause…

A

premature closure of the fontanelles

(but premature closure can also be normal)

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7
Q
  • Primary megalencephaly
  • Congenital hypothyroidism
  • Elevated intracranial pressure
  • Down syndrome
  • Rickets

these can cause….

A

delayed closure of anterior fontanelle

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8
Q
  • Premature fusion of cranial sutures
  • Occurs 1 in 2000 births
  • Affects sagittal >coronal>metopic>lambdoid sutures
  • Seldom involves multiple sutures

-More common twins and infants born to mothers with
uterine abnormalities

A

Craniosynostosis

(complications= increased ICP, inhibited brain growth, cognitive impairments)

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9
Q
  • More frequent due to general adoption of supine sleeping for SIDS prevention
  • Affects nearly half of infants between 7-12 weeks and resolves, without intervention, by age two in most cases
  • The ear is displaced anteriorly from the flattened region which can help differentiate from craniosynostosis.
A

Positional Plagiocephaly

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10
Q

Anomaly of eye alignment which can occur in either eye and in any direction

A

Strabismus

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11
Q

Nasal deviation strabismus?

Temporal deviation strabismus?

A

Nasal= Eso

Temporal= Exo

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12
Q

-phoria strabisumus is present only when…

A

fixation is interrupted

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13
Q

-tropia strabismus is present…

A

without interruption

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14
Q

agonist muscles in both eyes receive equal innervation to ensure coordinated movement (eg: as right eye abducts the left eye will adduct)

A

Hering’s Law

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15
Q

agonist/antagonist muscle pairs within each eye receive reciprocal innervation.

(eg: as muscle in the right eye contracts its antagonist muscle will relax)

A

Sherrington’s Law

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16
Q

Occurs in 2-4%
Risks= family hx, low birth weight, prematurity

Conditions that Predispose:
Vision depirvation: severe ptosis, cataracts
Amblyopia

A

Strabismus

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17
Q

retinoblastoma
optic nerve hypoplasia
head trauma
cranial nerve palsies
orbital fracture
myasthenia gravis and Graves’ disease

…can all cause?

A

Secondary strabismus

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18
Q

Amblyopia occurs in what percentage of strabismus pts?

A

50%

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19
Q

Optical illusion seen in children with wide nasal bridge and large epicanthal folds in first year of life which results in hiding the nasal sclerae.

can be confirmed with corneal light reflex and cover/uncover test (will have normal alignment)

A

Pseudoesotropia

(MC type of pseudostrabismus)

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20
Q

MC site of foreign bodies

A

R nostril

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21
Q

Unilateral purulent nasal discharge
Epistaxis
Nasal obstruction
Mouth breathing

A

Foreign body sxs

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22
Q

Gm positive, alpha hemolytic bacteria

MAJOR invasive pathogen in children
Main causes:
Otitis media
Pneumonia
Bacteriemia
Meningitis

A

Streptococcus pneumoniae

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23
Q

Adheres to epithelial cells of nasopharynx
Secretes pneumolysin, which binds cholesterol and can form pores in cellular membranes

PREVNAR vaccine helps protect against

Study These Flashcards
A

Strep Pneumoniae

24
Q

Since the Prevnar vaccine, Moraxella Catarrhalis is a common cause of….

Study These Flashcards
A

Otitis media

(clinically more mild than s.pnuemoniae)

PCN/amoxicillin resistant

25
Most frequent dx in sick children in US most prevalent in infancy (**6-18 mos**) risk factors: Family hx Daycare Lack of breast feeding Tobacco exposure
Acute otitis media (AOM)
26
S. pneumonia H. influenzae M. catarrhalis common causes of...
Acute otitis media
27
This bacteria usuaslly casues bilateral otitis media or otitis media with conjunctivitis increased frequency since Prevnar vaccine
H. influenzae
28
Tx pain with: ``` NSAIDs, acetominophen Auralgan drops (if older than 2) ```
Acute otitis media
29
First line otitis media antibiotic?
high dose Amoxicillin
30
If..... pt has been on antibitoics in last month pt has conjunctivitis pt is on daily amoxicillin for chemoprophylaxis DOC?
Augmentin! | (Amoxicillin/Clavulanate)
31
duration of high dose amoxicillin for AOM in kids under 5? kids over 6?
Kids under 5: high dose Amoxicillin for **10 days** Kids over 6: high dose Amoxicillin for **5-7 days**
32
Preseptal cellulitis Orbital cellulitis Septic cavernous sinus thrombosis Meningitis Osteomyelitis of frontal bone Brain abscess all potential complications of?
Untreated bacterial sinusitis
33
Tx of bacterial sinusititis?
Augmentin
34
aka exanthem subitum Caused by **herpes virus 6** Sx: High fever (\>104) for 3-5 days Irritability Anorexia Diffuse maculopapular rash as fever ends
Roseola (**tx= supportive**)
35
Caused by Group A Strep Sx: sore throat myalgias abdominal pain (usually no URI sxs) **Tx: Pen V or Amoxicillin**
Strep Pharyngitis
36
Tx with antibiotics will decrease risk of.... Peritonsillar abscess Mastoidits Rheumatic ever Risk of tranmission
Strep pharyngitis
37
Occurs 2-4 weeks after Group A Strep pharyngitis Usually ages 5-15 Uncommon in US, leading cause of cardiovascular death \<50 in developing world **Major sxs:** migratory arthritis, pancarditis/valvulitis, CNS involvement, erythena marginatum, subcutaneous nodules **Minor sxs**: arthralgias, fever, prolonged PR interval
Rheumatic Fever
38
Collection of pus between palantine tonsil and pharyngeal muscles Often polymicrobial MC deep neck infection in children
Peritonsillar Abscess
39
Sx: "hot potato" voice drooling **trismus** (good to distinguish between pharyngitis) ipsilateral ear pain fatigue decreased PO intake
Peritonsillar abscess
40
Causes mono Herpesvirus Symptomatic infection peaks 15-24 90-95% adults are seropositive
Ebstein Barr Virus
41
Malaise Ha Fever Exudative tonsillitis Pharyngitis **Posterior** cervical lymphadenopathy
EBV
42
Dx: CBC with dif showing increased atypical lymphocytes Presence of heterophile antibodies (usually absent in kids under 24 mos) EBV specific serology
Mono (EBV)
43
Is mono a highly contagious dz?
NO! but can be transmitted vi saliva up to 18 months after infection and may be intermittently shed for decades
44
Replicates in oropharyngeal epithelial cells and is released into saliva and infected B cells in oropharynx and is spread thru lymphoreticular system
EBV
45
If an EBV pt is given Ampicillin, they may develop a rash Is this rash an allergy?
NO
46
What type of lymphoma is EBV linked to?
Burkitt's lymphoma
47
Must consider if kid is coughing \>14 days, regardless of immunization status gm neg coccobacillus Bordatella Pertussis spread via respiratory droplets spread by coughing incubation 1-2 weeks **highly contagious!!**
Pertussis
48
Pts are infectious until completion on abx (cough may continue tho) **Paroxysmal**: 2-6 weeks coughing paroxysms worse inspiratory whoop after coughing **Convalescent**: weeks to months cough worsens with intercurrent URIs **Catarrhal**: 7-10 days, mild cough, runny nose, afebrile cough that worsens
Pertussis
49
In infants, may present as: feeding difficulties, tachypnea, cough paroxysms of cough that cause gagging, apnea, cyanosis and bradycardia \***infant can appear well in between episodes of coughing**
Pertussis
50
Apnea Pneumonia Vomiting Seizures Death
Complications of pertussis (**MC under 6 months**)
51
Tx of pertussis if **under 2 months**
Azithro or erythro (if vomiting develops within a month, must consider pyloric stenosis)
52
Pertussis tx for \>2 months
Macrolides or TMP/SMX (**NO TMP/SMX FOR UNDER 2 MONTHS BC RISK OF KERNICTERUS**)
53
Must avoid for tx in kids under 2 months with pertussis bc of risk of kernicterus
TMP/SMX
54
For pertussis vaccine, immunity wanes in....
5-10 years | (need Tdap booster)
55
Peak incidence in kids under 2 months sx: fever, vomiting, irritabilty, lethargy, anorexia, HA, confusion, back pain MC pathogens: 1-3 months: Group B Strep (ie E Coli) 3 months-10 years: S. pneumoniae, N. meningitidis
Bacterial meningitis
SD- Pediatrics
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