Peds E2: RED/TOPIC LIST ONLY

What is the MCC of acquired & conductive hearing loss?

Middle ear effusion

What is the MC congenital infxn causing sensorineural HL?

CMV

What is the MC acquired infection causing sensorineural HL?

meningitis

What medication is most commonly associated with acquired sensorineural hearing loss?

Aminoglycosides (gentamicin)

What is the medical term for "Swimmer's ear"?

Acute otitis externa

What are the MC organisms that cause acute otitis externa?

Pseudomonas, Strep, Staph

What is the biggest RF for AOE?

swimming

How does AOE present?

pain, pruritic, canal erythema, thick/white discharge, pulling on pinna & pressing on tragus elicits pain

What is the 1st line tx for acute otitis externa?

> 6 mo = Ciprodex drops; > 2 yo = Cortisporin drops

*if TM ruptured or unsure use systemic

What usually precedes AOM?

viral URI

What are the MC bacterial causes of AOM?

S. pneumo, H. influenzae, M. catarrhalis

What are RF for AOM?

exposure to cigarette smoke, sick contacts, immunodeficiency, high risk in < 6mo d/t horizontal Eustachian tube

How does AOM present?

TM bulging/retracted/perforated and erythematous, hearing may be dec

At what age can Ibuprofen be given for symptom relief in patients w/ AOM?

6+ months

What is the tx for AOM?

Amoxicillin

When do you tx AOM w/ Augmentin instead?

Amoxicillin is not working in 48-72 hrs OR recent tx with other beta-lactam w/in 30 days OR concomitant purulent conjunctivitis

What is the tx for AOM in patient with Type 1 allergy to PCN?

(anaphylaxis/angioedema)

Macrolide (Azithromycin)

What is the tx for AOM in patient with Non-Type 1 allergy to PCN?

Cephalosporin (cefdinir)

You should refer a patient with > ____ AOM episodes in < 6 mos

3

When should you consider tympanostomy tubes?

> 4 OM in 1 yr

How does Serous otitis media present?

clear grey or yellowish colored fluid behind the eardrum, retracted ear drum

Treat or don't treat:

AOM with bulging TM

YES- abx!

Treat or don't treat:

Serous otitis media (OME) with opacification of TM or air-fluid level

No!

What is the tx for chronic recurrent otitis media?

Tympanostomy tubes

What is one of the most serious lesions of the ear drum?

-consists of trapped epithelial tissue growing beneath the surface of the membrane

Cholesteatoma

What is the MCC of aural polyps?

Old, retained tympanostomy tube

What are the MC organisms that cause mastoiditis?

S. pneumo, S. pyogenes, Staph aureus

Mastoiditis associated with recurrent OM/recently treated with abx is d/t what pathogen?

Psuedomonas

How does Mastoiditis present?

pain, edema, erythema, tenderness behind ear; pinna may be displaced

What is the most reliable exam for diagnosis of mastoiditis?

CT scan

What is the tx for mastoiditis without recurrent AOM/recent abx (>6 mos)?

IV Unasyn

What is the tx for mastoiditis with recurrent AOM/recent abx (<6 mos)?

IV Zosyn

What is the tx for mastoiditis with severe PCN allergy?

IV Vanco (or Linezolid) + Metronidazole

What should any child presenting with nasal polyps should be evaluated for?

CF and asthma

When does the sphenoid sinus cavity mature?

5 yo

What does the frontal sinus cavity mature?

> 7 yo (avg 10-11)

What is the MCC of sinusitis?

Viral URI/Allergic rhinitis

What are the bacterial causes of sinusitis?

S. pneumo, H. flu, M. catarr

How does Sinusitis present?

Prolonged URI for 7-10 days with halitosis

What is the tx for sinusitis?

Augmentin

What is a Pott Puffy tumor?

complication of sinusitis with frontal bone osteomyelitis associated with subperiosteal abscess

How does a Pott Puffy tumor present?

erythematous forehead swelling that’s exquisitely tender, HA, fever

What is the dx test & tx for a Pott Puffy tumor?

Dx: head CT

Tx: surgical drainage & broad spec IV abx

What are complications of sinusitis?

periorbital or orbital cellulitis, intracranial abscess, subdural empyema, meningitis

Where does the infxn that leads to Orbital cellulitis originate from?

spread from infected ethmoid sinus

How does Orbital cellulitis present?

appears ill, toxic/lethargic, proptosis, painful EOMs, dec vision

intense retro-orbital pain aggravated by ocular movement

What is the diagnostic test for Orbital cellulitis?

CT w/ contrast or MRI

What is the tx for orbital cellulitis?

Aggressive IV abx (Vanco + Rocephin) + Ophtho/ENT referral

What is acute tonsillopharyngitis?

Sore throat

How does Acute tonsillopharyngitis d/t EBV present?

posterior adenopathy, fatigue, and splenomegaly

How does Acute tonsillopharyngitis d/t GAS present?

fever, HA, erythematous tonsils w/wo exudate, and anterior adenopathy

Centor criteria for strep pharyngitis

1 pt: Fever, Lack of cough, Tender anterior adenopathy, Tonsillar exudates, 3-14 yo

0 pt: 15-44 yo

-1 pt: 45+

What is the tx for GAS acute tonsillopharyngitis?

Pen V or Amoxicillin

What is the tx for GAS acute tonsillopharyngitis with PCN allergy?

Azithromycin

How long after tx initiation are patients with strep throat still contagious?

24 hours

What dx tests can be used to dx EBV?

MonoSpot

What is the tx for EBV (mono)?

supportive, rest, NO contact sports x 6 weeks!!

Recurrent tonsillitis = > _____ episodes in 1 calendar year

6

Recurrent tonsillitis = > _____ episodes per year for 2 consecutive years

5

Recurrent tonsillitis = > _____ episodes per year for 3 consecutive years

3

What is the MCC of a Peritonsillar Abscess?

GAS

*next is S. Aureus

How does a Peritonsillar abscess present?

Hot potato voice, fever, Unilateral sore throat, radiating pain, drooling, dysphagia, head tilted

What is the tx for a Peritonsilar abscess?

I&D + Abx (clindamycin OR amoxicillin-clavulanate)

What are the MC organisms that cause retropharyngeal abscesses?

S. pyogenes or S. aureus

Retropharyngeal abscesses typically affect what demographic?

2-4 y/o with antecedent URI

How does a Retropharyngeal abscess present?

uvula & I/L tonsil displaced anteriorly, dysphagia, drooling, neck stiffness, erythematous pharynx w/ asymmetrical swelling

What is the initial imaging of choice for retropharyngeal abscess?

Lateral neck XR

What is the definitive imaging for retropharyngeal abscess?

CT of neck with IV contrast

What would an XR of a Retropharyngeal abscess show?

Widening of the prevertebral soft tissue

What is the tx for a Retropharyngeal abscess?

IV abx (Ampicillin-Sulbactam or clindamycin), airway management, I&D

What are the MC organisms that cause epiglottitis?

H. influenzae type b (Hib)

How does Epiglottitis present?

Drooling, Dysphagia, Distress, tripod posture, sudden onset w/ rapid progression

What would be seen on lateral neck XR of Epiglottitis?

"Thumb sign"

What type of diagnostic testing is NOT safe in children to diagnose epiglottitis?

Laryngoscopy

What is the tx for Epiglottitis?

Severe = immediate intubation

Mild = IV abx w/ ICU observation

**3rd gen ceph (Ceftriaxone + Vanc)

What virus causes laryngotracheobronchitis (croup)?

Parainfluenza virus type 1 & 2

What is the medical term for Croup?

Laryngotracheobronchitis

How does Croup present?

Barky or seal-like cough, high pitched INspiratory stridor, ± fever, ± labored breathing

What is seen on a lateral XR of Croup?

"Steeple sign"

What is the tx for mild Croup?

vaporizer, shower steam, steroids (Dexamethasone)

What is the Gold standard tx for mod/severe croup?

Racemic epinephrine

What objects are commonly aspirated by kids?

Seeds, nuts, popcorn, coins, hot dogs, small toys, balloons, jewelry

Most foreign bodies lodge in the (left/right) mainstem bronchus

Right

What is a common CXR finding in lower FBA?

hyperinflated lung distal to obstruction

What is a pathognomonic sign of a Thyroglossal duct cyst?

Vertical motion of mass with swallowing and tongue protrusion

How does a Lymphangioma present?

painless, compressible, on head or neck

**only mass that consistently transilluminates

When are neck masses concerning?

if they are growing, > 2 cm in children, or > 1.5 cm in adolescents

What are nasal polyps associated with?

CF

What is the MC congenital anomaly of the larynx?

Laryngomalacia

Subglottic stenosis presents most commonly as what disease?

recurrent Croup

What lobe is most commonly affected by congenital lobar emphysema?

Left upper lobe

What would you see on a CXR of congenital lobar emphysema?

distention of affected lobe + mediastinal shift, compression and atelectasis of non-affected lung

What type of defect is most common in congenital diaphragmatic hernias?

Posterolateral on left side

What would you see on a CXR of a Congenital diaphragmatic hernia?

Loops of bowel in chest with mediastinal shift

How does a Congenital diaphragmatic hernia present?

respiratory distress, barrel chest, scaphoid abdomen

URIs are most commonly (viral/bacterial)

Viral

What seasons are URIs most common?

Fall/winter

What is the tx for URIs?

Supportive- saline and suction

What is Acute bronchitis associated with?

recent viral URI and more common in older children

Acute bronchitis becomes chronic bronchitis if there is no improvement within how long?

4 weeks