Peds EENT
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| Causes of conjunctivitis in the infant | within a day of birth think chemical conjunctivitis from erythromycin. 3-7 days post birth: Neisseria gonorrhoeae (has copious purulence). 5days to several weeks post birth think Chlamydia trachomatis. Stapyhylococcal,pneumococcal& viralare possible.
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| Tx of infant with Chlamydia conjunctivitis | oral erythromycin for 14 days plus topical. Topical tx alone will not eradicate nasopharyngeal carriage, leaving the infant at risk for development of pneumonitis.
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| Causes of conjunctivitis | may be infectious, allergic, or associated with systemic disease.
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| Causes of conjunctivitis associated with oculoglandular syndrome (lymphadenopathy is a finding) | S. aureus, group A beta-hemolytic streptococi, Mycobacterium tuberculosis, atypical mycobacteria, Francisella tularensis (the agent of tularemia) and Bartonella henselae (agent of cat-scratch fever)
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| Common bacterial causes of conjunctivitis in older children | Haemophilus species, S. pneumoniae, M. catarrhalis, and S. aureus. If no systemic illness associated, topical tx is adequate.
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| What type of tx is recommended for Chlamydia trachomatis, N. gonorrhea, and N. meningitidis | systemic
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| Causes of Viral conjunctivitis | Adenovirus infection often associated with pharyngitis, a follicular rxn of the palpebral conjunctiva and preauricular adenopathy (contagious for 10-14 days post onset). HSV can cause conjunctivitis or blepharoconjunctivitis.
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| Allergic conjunctivitis | eyes are red and itchy with mucoid discharge. Tx with ophthalmic solutions that have antihistamine and mast cell stabilizers
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| Common causes of otitis externa | Most common cause: loss of protective function of cerumen - qtips, swimming, contact dermatitis. Infections due to Staph aureus and Pseudomonas aeruginosa. Sx: pain and itching.
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| Tx of otitis externa | ototopical abx (FQs) for 5-7 days. Oral abx if any invasive sx: fever, cellulitis of the auricles, tender postauricular lymph nodes. Prescribe an antistaphylococcal abx while awaiting results of cultured ear discharge. Sys + topical + narcotic analgesic
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| Sx associated with AOM | rapid onset of sx such as otalgia, fever, irritability, anorexia, or vomiting.
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| How is AOM separated from acute otitis media with effusion (AOE)? | AOE has non-bulging TM, which may be retracted or neutral, but always has decreased mobility
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| Otoscopic findings in AOM | bulging TM, impaired visibility of the ossicular landmarks, a yellow, white or bright red color; apacification of the TM; squamous exudate or bullae on the TM
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| Factors that make Otitis media more common in children than adults | bacterial nasopharyngeal colonization (H.Flu, M.cat, S. pneumo S.pyogenes) in the absence of antibody, frequent URIs, exposure to parental cigarette smoke, unfavorable eustachian tube function, and allergies
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| common event that precedes an ear infection | respiratory viral infection. The two viruses most clearly shown to precipitate OM are: RSV and influenza
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| How has the widespread use of the pneumococcal conjugate vaccine (Prevnar; PCV-7) in children under 2 changed the causes of OM? | Decreased the incidence of Streptococcal pneumoniae. H. influenza may be on the rise.
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| Vascular flush of the eardrum can be caused by: | fever, crying, or even efforts to remove cerumen
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| How is cerumen protective? | It contains lysozymes and immunoglobulins that inhibit infection
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| AOM sx in infants | night-awakening, ear tugging, anorexia due to pain on swallowing, and unexplained crying.
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| AOM Tx | amoxicillin remains the 1st line abx tx for OM (90mg/kg/d up to 4g/d). 3 oral cephalosporins (cefuroxime, cefpodoxime, and cefdinir) are more b-lactamase stable & are choices for 2nd line tx in children who develop papular rashes with amoxicillin.
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| Misalignment of the eyes is known as ____ and occurs in ___% of children | strabismus; 4%
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| Diagnosis of strabismus | corneal light reflex and cover tests (with one eye covered, the patient fixes vision on an object. When the obscured eye is quickly uncovered, no eye movement should be detectable. If eye drift is noted when either eyes is uncovered, this is considered +)
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| Strabismus may be a marker of other ocular or systemic diseases including | retinoblastoma, CNS disorders such as hydrocephalus, space-occupying lesions, and an amaurotic (blind) eye
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| The treatment of Strabimus may include occlusion of the better seeing eye (forced the development of the affected eye)and | surgery (if present since infancy, this may occur anywhere from as early as 6mo to 2years), or corrective glasses. After age 5, any sudden onset of esotropia should raise suspicion for CNS dz
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| Characteristics and tx of chemical conjunctivitis | occurs w/in 24 hrs of birth, bilateral serous discharge, self limited, treatment: none
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| Characteristics and tx of N. gonorrhea conjunctivitis | 2-4 days post birth, bilateral purulent discharge, marked eyelid edema, chemosis. Complications: sepsis, meningitis, arthritis, corneal ulceration, blindness. Dx: culture on chocolate or thayer-martin agur.Tx:topical erythromycin, IV cefotaxime, tx parent
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| Characteristics and tx of Chlamydia trachomatis conjunctivitis | onset 4-10 post birth, unilateral or bilateral, mucopurulent discharge. Complications: corneal scarring, pneumonia. Dx: Chlamydia culture, direct immunofluorescent antibody test. Tx: oral plus topical erythromycin; tx parents
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| Characteristics and tx of thrush | Candida albicans is the culprit. Sx include soreness of the mouth and refusal of feedings. May or may not be painful. White curd-like plaques predominantly on the buccal mucosa. Tx: oral nystatin 4-6 times per day after feeding.Clotrimazole,Gentian violet
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| The most common and obvious sign of retinoblastoma is ___ | Leukocoria which is an abnormal white reflection from the retina of the eye
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| Tx for strep throat | 10 days penicillin V 250 mg PO tid to 500 mg in 2 divided doses or intramuscular benzathine penicillin or if penicillin allergic, erythromycin estolate 20mg/kg/d in two divided doses
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| Causes of bacterial pharyngitis | GAS (10%), Mycoplasma pneumoniae, Chlamydia pneumoniae, Groups C and G streptococci, and Arcanobacterium hemolyticum.
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| If left untreated, streptococcal pharyngitis can lead to | acute rheumatic fever, glomerulonephritis, and suppurative complications (cervical adenitis, peritonsillar abcess, otitis media, cellulitis, and septicemia).
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| Sx suggestive of streptococcal pharyngitis | anterior cervical nodes, palatal petechiae, a beefy-red uvula, and a tonsillar exudate.
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| A positive strep test indicates infection with | Streptococcal pyogenes. Only 85-95% sensitive. A negative result requires confirmation by performing a culture.
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| ___ % of sore throat and fever in children are due to viral infections | 90%
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| PE findings in infectious mononucleosis | exudative tonsillitis, generalized cervical adenitis, and prolonged fever, usually in a patient older than 5yo. A palpable spleen or axillary adenopathy increases the likelihood of the diagnosis.
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| lab dx of infectious mononucleosis | more than 10% atypical lymphocytes on a peripheral blood smear or a + mononucleosis spot test, although these tests are often falsely negative in children <5 yo. EBV serology showing an elevated IgM-capside antibody is definitive
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| Sx of infectious mononucleosis | malaise, anorexia, fever >39C, major complaint: pharyngitis (50% are exudative). Soft palate petechiae and eyelid edema.
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| Most common cause of peritonisillar abscess | B-hemolytic streptococcal infections. Other pathogens include: group D streptococci, S. pneumoniae, and anaerobes
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| Sx of Peritonsillar abscess | severe sore throat, a high fever, the process is almost always unilateral. The soft palate and uvula on the involved side are edematous and displaced toward the uninvolved side.In abscess formation,trismus,ear pain,dysphagia,and eventually drooling occur.
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| Tx of Peritonsillar abscess | it is reasonable to admit a child for 12-24 hours of IV antimicrobial tx (penicillin or clindamycin are appropriate). ENT referral for I and D or for aspiration under local or general anesthesia
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| nasal polyps | glistening, gray to pink, jellylike masses that are prominent just inside the anterior nares and occur singly or in clusters. They occur in cystic fibrosis and severe allergic rhinitis
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| hallmarks of allergic rhinitis | Episodic rhinorrhea, sneezing, obstruction of the nasal passages with lacrimation, and pruritus of the conjunctiva, nasal mucosa, and oropharynx
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| tx of allergic rhinitis | nasal steroids decrease airway obstruction and rhinorrhea. Sneezing and clear drainage are controlled by nonsedating antihistamines. Motelukast, a leukotriene antagonist, is effective in reducing nasal congestion
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