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54 Cards in this Set
- Front
- Back
what things lead you to suspect that there is a nasal foreign body and how do you manage it?
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usually its unilateral and there is a purulent, foul smelling discharge
-- sometimes there is bleeding involved and the foreign body can be a variety of items (erasers, beads, toys etc) Management (1) occlude side without foreign body and have child blow their nose (2) remove with instruments in office ****(3) button batteries must be removed immediately! -- causes rapid tissue damage |
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What causes allergic rhinitis and what are some associated risk factors
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allergic rhinits can be seasonal or pernnial and the prevalence peaks late in childhood
-- risk factors include: (1) family history of atopy (2) serum IgE >100IU/ml before 6 years of age (3) higher socioeconomic group |
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what clinical symptoms are associated with allergic rhinitis
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(1) may be mistaken for an upper respiratory infection
(2) sniffling/sneezing (3) allergic salute -- nasal crease (4) itchy, watery eyes morgan denny lines (due to heavy eyes) (5) allergic shiners |
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what are some physical finding associated with allergic rhinitis?
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--pale, boggy nasal mucosa
-- cobble stoning of posterior pharynx |
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what labs would you order for allergic rhinitis?
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diagnosis is usually done based on history and physical so labs are not ordered very often
-- what you can do is take a sample of the nasal secretions and see that the smear would revel eosinophilia |
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how would you treat allergic rhinitis?
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(1) oral antihistamines
(2) nasal steroids (3) montelukast (singulair) |
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what is the common cold and when/among which population is it more commonly found
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the common cold is also known as rhinits, rhinosinusitis or upper respiratory infection
-- it mostly occurs in the early fall through late spring and see a lot more in young children [young children will have 6-7 colds/year -- ***15% will have 12 infections/year ***] -- children in out-of-home daycare will have 50% more colds than children who stay at home |
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what prevents you from thinking a child that gets 6-7 colds a year is immunocompromised?
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immunocompromised kids have colds/sinus problems all year around including during the summer time and they get sick more frequently too!
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what are some clinical manifestations of the common cold?
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(1) typically occur 1-3 days after infection
(2) sore "scratchy" throat (3) nasal obstruction / rhinorrhea (4) cough (5) may have fever and/or myalgia |
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how do you make a diagnosis of the common cold
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CLINICALLY! -- labs aren't generally helpful (may obtain nasal smear for eosinophils if you suspect Allergic Rhinitis)
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how do you treat the common cold?
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treatment is symptomatic
you can try nasal saline and suction, humidifier and elevate the head of the bed ***DO NOT GIVE CHILDREN ASPIRIN** - OTC cough/cold meds are not indicated for children under the age of 4 |
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What is the natural course of the common cold? complications? how can you prevent it from happening in the first place?
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natural course: usually lasts 7-10 days (10% will last about 2 weeks)
complications: otitis media and/or sinusitis prevention: protective equipment in the hospital/clinic -- vitaminc C and echinacea have no significant effect in studies |
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** WHICH SINUSES ARE PRESENT?**
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-- ethmoidal and maxillary sinuses are present at birth [maxillary sinuses are not pneumatized until 4 years of age]
-- sphenoid sinuses present at about 5 -- frontal sinuses begin forming at 7-8 years of age and do not completely develop until adolescence (11-12) |
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what can cause sinusitis?
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sinusitis can be viral or bacterial
-- the most common bacterial pathogens include: (1) strep pneumo (2) H. influenza (nontypable) (3) moraxella catarrhalis |
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when does sinusitis usually occur and what are some predisposing conditions?
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sinusitis can occur at any age.
predisposing factors include: (1) viral URI (2) allergic rhinitis (3) cigarette smoke exposure -- seen in a lot of kids |
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clinical manifestation of sinusitis includes
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(1) nasal congestion
(2) nasal discharge (3) fever (4) cough (5) periorbital edema (6) headache and facial pain -- both of which are rare in children because they dont have maxillary of frontal sinus development yet |
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how do you diagnose sinusitis?
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diagnosis is based solely on history when it comes to children!
its based on having a persistent URI for 10-14 days without improvement OR severe respiratory symptoms including a temperature of at least 102 and purulent nasal discharge for 3-4 days [sinus aspirate culture is the only accurate method of diagnosis but its not practical] |
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how do you treat sinusitis and what are some complications associated with it?
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treatment: antibiotics?
complications: (1) periorbital cellulitis (2) orbital cellulitis <-- emergency (3) meningitis (4) cavernous sinus thrombosis (5) subdural empyema (6) epidural/brain abscess (7) osteomyelitis of frontal bone |
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*** what are the two main components of otitis media?
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(1) suppurative or acute ottitis media (AOM) --> INFECTION
(2) nonsuppurative or secretory otitis media /otitis media with effusion (OME) --> NONINFECTIVE INFLAMMATION ACCOMPANIED BY EFFUSION -- both are interrelated: usually infection leads to OME which predisposes to recurrent infection |
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what do you want to talk about if a child keeps getting recurrent ear infections?
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tube placement (which will fall out in a couple of years and the perforation will fill in over time) -- this will help the ear drum from constantly getting stressed and prevents formation of scars
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what are some factors that are known or believed to affect occurence of otitis media?
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(1) age -- peak incidence and prevalence 6-20 months of age [prone to URI and the Eustachian tube is a straight shot]
(2) sex (3) race - more prevalent and severe among native americans, inuit, and indigenous australian children (4) genetic background (5) socioeconomic class (6) breast milk vs. formula *** breast fed babies have fewere incidences of OM compaired to formula fed babies |
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**what causes otitis media?
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acute otitis media can be cause by a viral or bacteria pathogen.
bacterial pathogens include*** (1) strep pneumo (2) h. influenza (nontypable) (3) moraxella catarrhalis OME cultures are usually sterile |
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other factors that can cause otitis media include
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(1) exposure to tobacco smoke
(2) exposure to other children (3) season (4) congenital anomalies -- unrepaired cleft palatal clefts, other craniofacial anomalies, and down syndrome |
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what are some clinical manifestations of AOM
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(1) rupture of TM with purulent otorrhea
(2) ear pain due to holding or pulling on ear -- DOESNT ALWAYS MEAN EAR INFECTION THOUGH -- could be due to teething or strep throat (3) fever (4) irritability (5) no symptoms -- highly variable in presentation |
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what are some TM findings associated with AOM
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(1) fullness/bulging/complete retraction
(2) erythema (3) abnormal whiteness (4) scarring -- from repeated infections (5) decreased mobility |
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what are some OME findings that are consistent with middle ear effusion (MEE)
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(1) air fluid levels
(2) air bubbles |
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how do you diagnose otitis media?
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diagnosis is based mainly on physical findings.
You can do a tympanometry - gives objective evidence of MEE (middle ear effusion) |
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how do you treate AOM
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you can do a myringotomy or tympanocentesis (rarely necessary)
-- used when there is unremitting pain or systemic symptoms |
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how do you treat OME
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Antibiotics can be used if there is evidence of bacterial respirotry infection
efficacy of corticosteroids is debatable --used to relieve swelling and inflammation myringotomy with tympanostomy tubes are considered after: (1) 6-12 months of continuous bilateral OME (2) 9-18 months of continuous unilateral OME (3) evidence of hearing loss |
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what are some complications associated with otitis media?
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(1) mastoiditis
(2) facial paralysis (3) acquired pneumonia (4) chornic perforation (5) scarring of TM and hearing loss [with developmental sequelae] (6) tympanosclerosis |
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what is mastoiditis?
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Acute mastoiditis traditionally refers to spread of the infection (AOM) to the overlying periosteum, bony trabeculae, or petrous portion of the temporal bone
all cases of AOM are technically accompanied by mastoiditis by virtue of associated inflammation [inflammatory process usually readily reversible] |
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what are some signs/symptoms of acute mastoiditis?
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(1) redness and/or tenderness over mastoid
(2) swelling behind the ear (3) may cause the ear to stick out -- MUST obtain CT scan to clarify nature and extent of disease |
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how do you treat acute mastoiditis?
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IV antibiotics and/or surgery if there is enough obstruction/destruction --> need to drain
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what is otitis externa and what causes it?
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otitis externa is also known as 'swimmers ear' and its inflammation and/or infection of the external auditory canal and/or auricle
most common pathogens: **(1) pseudomonas aeruginosa (2) staph aureus (3) enterobacter aerogenes |
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what are some clinical manifestations associated with otitis externa
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(1) ear pain accentuated by manipulation of pinna or tragus
(2) itching (3) conductive hearing loss (4) serous or purulent secretions IT IS DIAGNOSED CLINICALLY |
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how do you treat otitis externa?
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(1) topical antibiotics and corticosteroids
(2) wick if there is significant edema of ear canal -- this is painful --> need to push into the ear with a cloth substance to allow the medication to seep into the canal (3) oral or parenteral antibiotics in severe infections with fever and lymphadenitis |
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what causes pharyngitis
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90% --> viral
10% --> bacterial |
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what is infectious mononucleosis
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its known as the 'kissing' disease
and the most common cause of it is the Epstein-Barr virus [other viruses like CMV may cause infectious mono-like illnesses -- rare in children <4 and adults >40 |
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what are some clinical manifestations of infectious mononucleosis
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(1) exudative tonsillitis
(2) generalized cervical adenitis (3) fever/fatigue (4) splenomegaly **** no contact sports allowed |
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what labs do you send for and how do you make the diagnosis of infectious mononucleosis?
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you send for EBV titers, check for atypical lymphocytes and heterophile antibody
DIAGNOSIS IS BASED ON PRESENTATION AND LABS |
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how do you treat infectious mononucleosis?
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(1) supportive
(2) limit activity if there is splenomegaly |
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what complications are involved with infectious mononucleosis?
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sub-capsular splenic rupture from trauma!
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what is herpangina?
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enteroviral infection (coxsackie virus) with clinical features such as
(1) sudden onset fever (2) headache, dysphagia (3) vomiting and abdominal pain (4) vesicular and ulcerative lesions with halo on posterior buccal mucosa, pharyngeal wall, soft palate, uvula, and anterior tonsillar pillars VERY PAINFUL -- there are ulcerations in the oropharynx rather than pus |
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how do you diagnose and treat herpangina?
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diagnosis is clinical and treatment is supportive
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what is stomatitis?
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stomatitis is very similar to herpangina and some causes are caused by HPV
clinical manifestations: (1) fever (2) mouth pain (refusal to eat) (3) ulcerative on any part of oral lining but USUALLY IN THE ANTERIOR PORTION OF THE MOUTH |
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what do you call it when there is gingivitis and stomatitis present?
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gingivostomatitis
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how do you treat stomatitis?
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supportive treatment -- give them lots of fluids (nothing spicy/salty)
acyclovir has little effect on symptoms |
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what is hand, foot, mouth disease?
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its an enteroviral (coxsackie A) infection wheren the patient can present with fever or no fever, they have vesicles/ulcers anywhere in the mouth, and maculopapular, vesicular, and/or pustular lesions on hands, fingers, feet, buttocks, and groin
THIS IS A CLINICAL DIAGNOSIS and treatment is supportive |
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what is pharyngoconjunctival fever?
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its caused by adenovirus and concurrent features are (1) conjunctivitis (2) fever (3) exudative phayngitis (4) GI symptoms
Diagnosis --> CLINICAL and the treatment is supportive care lasts for about 7-10 days |
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what is acute bacterial pharyngitis
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its cauesd by
(1) group A beta hemolytic strep (2) group C strep (3) neisseria gonorrhoeae (4) arcanobacterium haemolyticum (5) mycoplasma pneumoniae |
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What happens in GABHS (group A beta hemolytic strep) Pharyngitis
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its uncommon before 2-3 years of age
clinical manifestation: rapid onset, sore throat, exudate, peteciae on soft palate, anterior cervical adenopathy, fever, headache, abdominal pain, strawberry tongue and fine, sandpaper rash indicative of scarlet fever |
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how do you diagnose GABHS pharyngitis?
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you do a rapid antigen test which is very specific and 85-95% sensitive
**a negative test requires confirmation by culture ** |
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how do you treat GABHS pharyngitis?
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antibiotics
or tonsillectomy for recurrent GABHS infections (5 infections or more/year with positive strep screens) |
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What are some complications associated with GABHS pharyngitis?
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(1) acute rheumatic fever
(2) glomerulonephritis eradication only indicated if patient or close family member has : (1) recurrent strep infections (2) history of rheumatic fecer or glomerulonephritis |