PAEA Pediatrics EOR Topics
PAEA Pediatrics EOR Exam Topic List Quiz - used PPP, previous study guides,
and Current Diagnosis and Tx: Pediatrics, 23rd edition
what is the MC conjunctivitis seen in children? what is the cause? source?
Correct Ans - viral conjunctivitis; Adenovirus; swimming pools
Dx? preauricular lymphadenopathy, copious watery eye discharge, scanty
mucoid discharge, usually unilateral with punctate staining on slit lamp
examination; Tx? Correct Ans - dx: viral conjunctivitis
tx: supportive (cool compresses, artificial tears) +/- antihistamines for itching
(Olopatadine)
Dx? bilateral eye itching, tearing, redness, string discharge, chemosis
(conjunctival swelling) with cobblestone appearance to inner/upper eyelids;
Tx? Correct Ans - dx: allergic conjunctivitis
tx: topical antihistamines (H1 blockers) (Olopatadine,
Pheniramine/Naphazoline, Emedastine), topical NSAID (ketorolac), topical
corticosteroids (but s/e of long term use = glaucoma, cataracts, HSV keratitis)
Dx? purulent eye discharge, lid crusting, no visual changes, absence of ciliary
injection; Tx? Correct Ans - dx: bacterial conjunctivitis (MC S. aureus,
Strep pneumo, H. influenzae)
tx: topical abx (erythromycin, fluoroquinolones, sulfonamides,
aminoglycosides); if contact lens wearer cover for pseudomonas w/
fluoroquinolone or aminoglycoside
if bacterial conjunctivitis is found to be chlamydia or gonorrhea what is the tx?
Correct Ans - admit for IV and topical abx (ophtho emergency)
-gonoccoccal: IV ceftriaxone + topical
-chlamydia: IV azithromycin
neonatal conjunctivitis is aka? if left untreated can develop what? Correct
Ans - ophthalmia neonatorum; corneal ulceration, opacification/scarring,
visual impairment/blindness
standard prophylaxis given immediately after birth to prevent ophthalmia
neonatorum (neonatal conjunctivitis) includes: Correct Ans -
,erythromycin ointment, tetracycline ointment, silver nitrate, or povidone-
iodine
if ophthalmia neonatorum (neonatal conjunctivitis) develops on day 1 after
birth what is the most likely cause? day 2-5? day 5-7? day 7-11? Correct
Ans - day 1: silver nitrate (chemical cause- prophylaxis is what can cause
the condition)
day 2-5: gonococcal
day 5-7: chlamydia
day 7-11: HSV
orbital (septal) cellulitis is usually secondary to _________ infection in most
commonly what age group? Correct Ans - sinus; 7-12y; other causes
include dental/facial infxns or bacteremia
what is the most common sinus infection (90%) that causes secondary orbital
cellulitis? what organisms are the cause? Correct Ans - ethmoid; S.
aureus, Strep. pneumo, GABHS (Strep. pyogenes), H. influenzae
work up/Dx? decreased vision, pain w/ ocular movement, proptosis (bulging
eye), eyelid erythema and edema; tx? Correct Ans - dx: orbital cellulitis
work up: CT scan (showing infxn of fat & ocular muscles) or MRI
tx: IV antibiotics (Vanc, Clinda, Cefotaxime, Ampicillin/Sulbactam)
what is the difference b/t orbital (septal) cellulitis and preseptal cellulitis?
Correct Ans - preseptal may still have ocular pain, redness and swelling
but NO visual changes or pain w/ ocular mvmt (hasn't affected the muscles)
misalignment of the eyes is aka? when does stable ocular alignment present in
infants? Correct Ans - strabismus; 2-3 mos
convergent strabismus is aka? divergent strabismus is aka? Correct Ans -
convergent: esotropia (deviated inward "cross eyed")
divergent: exotropia (deviated ouward)
a + Hirschberg corneal light reflex test, diplopia, scotomas (blind spots), or
amblyopia (lazy eye) are clinical manifestations of what condition? what other
tests can be performed? Correct Ans - strabismus; cover-uncover test
to determine the angle of strabismus, cover test, convergence testing
,how can strabismus be treated? Correct Ans - -patch therapy: normal
eye is covered to stimulate and strengthen the affected eye
-eyeglasses
-corrective therapy: if severe or unresponsive to conservative therapy
if not treated before 2 y/o, amblyopia may occur and cause decreased visual
acuity that is not correctable
Dx? 1-2 days of ear pain, pruritis in the ear canal, auricular discharge,
pressure/fullness, hearing usually preserved, pain with tug test and tragus
pressure, auditory canal erythema/edema/debris, recent swimming pool use;
MC organisms? Tx? Correct Ans - Dx: otitis externa
MC organisms: *pseudomonas*, proteus, s. aureus, s. epidermis, GABHS,
anaerobes (peptostreptococcus), aspergillus
Tx: 1. protect ear against moisture (isopropyl alcohol and acetic acid) 2.
ciprofloxacin/dexamethasone (ofloxacin safe if there is an associated TM perf)
3. Aminoglycoside combo (neomycin/polytrim-B/hydrocortisone -BUT not
used if perf suspected bc ototoxic 4. amphotericin B if fungal
malignant otitis externa is osteomyelitis at the skull base secondary to
___________ infxn; MC seen in what pt populations; Tx? Correct Ans -
pseudomonas; MC in DM and immunocompromised pts; Tx w/ IV Ceftazidime
or Piperacillin + FQ or Aminoglycoside
acute otitis media is an infection of the middle ear, temporal bone and mastoid
air cells that is MC preceded by Correct Ans - a viral URI that causes
edema of eustachian tube, negative pressure, transudation of fluid and mucus
in middle ear that allows for bacterial growth
what are the 4 MC organisms seen in acute otitis media? Correct Ans -
*Strep pneumo*, H. influenza, Moraxella catarrhalis, Strep pyogenes (same as
seen in acute sinusitis)
Dx: fever, otalgia, ear tugging in infants, conductive hearing loss, stuffiness,
possible drainage from ear, bulging/erythematous TM w/ effusion, dec TM
mobility on pneumatic otoscopy; Tx? Correct Ans - dx: acute otitis
media
, tx: 1st line- amoxicillin, 2nd line- augmentin (amoxicillin-clavulate); if PCN
allergy- azithromycin, clarithromycin, erythromycin-sulfisoxazole,
trimethoprim/sulfamethoxazole, if PCN adverse effect but not allergy-
ceftriaxone, cefdinir, cefixine
don't forget to treat pain as well (ibuprofen or tylenol); can also perform
myringotomy (surgical drainage) to relieve pain
tympanostomy if recurrent >4 times in 1 yr
if bullae are seen on the TM of a pt with AOM what should you suspect?
Correct Ans - mycoplasma pneumoniae
Dx? deep ear pain (worse at night), fever, mastoid tenderness and possibly
fluctuance (abscess), following AOM infxn; complications? Correct Ans -
-dx: mastoiditis (inflammation of the mastoid air cells of the temporal bone-
mastoid and middle ear are connected)
-complications: hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain
abscess
how is mastoiditis diagnosed and treated? Correct Ans - dx: by CT scan
is 1st line test
tx: IV abx (same as w/ AOM- amoxicillin 1st line, augmentin 2nd line,
azithromycin for allergy to PCN, ceftriaxone for ADR to PCN) + middle
ear/mastoid drainage (myringotomy +/- tympanostomy tube placement- can
obtain Cx)
if mastoiditis refractory to tx or complicated = mastoidectomy
what are the 2 auditory examination tests (and what order do you perform
them in)? Correct Ans - 1st Weber (tuning fork placed on top of head)
2nd Rinne (tuning fork placed on mastoid bone by ear)
if a child has conductive hearing loss in their L ear what will the Weber and
Rinne tests show? Correct Ans - Weber: lateralizes to L ear
Rinne: BC > AC
if a child has sensorineural hearing loss in the R ear what will the Weber and
Rinne tests show? Correct Ans - Weber: lateralizes to L ear (the
normal one)
PAEA Pediatrics EOR Exam Topic List Quiz - used PPP, previous study guides,
and Current Diagnosis and Tx: Pediatrics, 23rd edition
what is the MC conjunctivitis seen in children? what is the cause? source?
Correct Ans - viral conjunctivitis; Adenovirus; swimming pools
Dx? preauricular lymphadenopathy, copious watery eye discharge, scanty
mucoid discharge, usually unilateral with punctate staining on slit lamp
examination; Tx? Correct Ans - dx: viral conjunctivitis
tx: supportive (cool compresses, artificial tears) +/- antihistamines for itching
(Olopatadine)
Dx? bilateral eye itching, tearing, redness, string discharge, chemosis
(conjunctival swelling) with cobblestone appearance to inner/upper eyelids;
Tx? Correct Ans - dx: allergic conjunctivitis
tx: topical antihistamines (H1 blockers) (Olopatadine,
Pheniramine/Naphazoline, Emedastine), topical NSAID (ketorolac), topical
corticosteroids (but s/e of long term use = glaucoma, cataracts, HSV keratitis)
Dx? purulent eye discharge, lid crusting, no visual changes, absence of ciliary
injection; Tx? Correct Ans - dx: bacterial conjunctivitis (MC S. aureus,
Strep pneumo, H. influenzae)
tx: topical abx (erythromycin, fluoroquinolones, sulfonamides,
aminoglycosides); if contact lens wearer cover for pseudomonas w/
fluoroquinolone or aminoglycoside
if bacterial conjunctivitis is found to be chlamydia or gonorrhea what is the tx?
Correct Ans - admit for IV and topical abx (ophtho emergency)
-gonoccoccal: IV ceftriaxone + topical
-chlamydia: IV azithromycin
neonatal conjunctivitis is aka? if left untreated can develop what? Correct
Ans - ophthalmia neonatorum; corneal ulceration, opacification/scarring,
visual impairment/blindness
standard prophylaxis given immediately after birth to prevent ophthalmia
neonatorum (neonatal conjunctivitis) includes: Correct Ans -
,erythromycin ointment, tetracycline ointment, silver nitrate, or povidone-
iodine
if ophthalmia neonatorum (neonatal conjunctivitis) develops on day 1 after
birth what is the most likely cause? day 2-5? day 5-7? day 7-11? Correct
Ans - day 1: silver nitrate (chemical cause- prophylaxis is what can cause
the condition)
day 2-5: gonococcal
day 5-7: chlamydia
day 7-11: HSV
orbital (septal) cellulitis is usually secondary to _________ infection in most
commonly what age group? Correct Ans - sinus; 7-12y; other causes
include dental/facial infxns or bacteremia
what is the most common sinus infection (90%) that causes secondary orbital
cellulitis? what organisms are the cause? Correct Ans - ethmoid; S.
aureus, Strep. pneumo, GABHS (Strep. pyogenes), H. influenzae
work up/Dx? decreased vision, pain w/ ocular movement, proptosis (bulging
eye), eyelid erythema and edema; tx? Correct Ans - dx: orbital cellulitis
work up: CT scan (showing infxn of fat & ocular muscles) or MRI
tx: IV antibiotics (Vanc, Clinda, Cefotaxime, Ampicillin/Sulbactam)
what is the difference b/t orbital (septal) cellulitis and preseptal cellulitis?
Correct Ans - preseptal may still have ocular pain, redness and swelling
but NO visual changes or pain w/ ocular mvmt (hasn't affected the muscles)
misalignment of the eyes is aka? when does stable ocular alignment present in
infants? Correct Ans - strabismus; 2-3 mos
convergent strabismus is aka? divergent strabismus is aka? Correct Ans -
convergent: esotropia (deviated inward "cross eyed")
divergent: exotropia (deviated ouward)
a + Hirschberg corneal light reflex test, diplopia, scotomas (blind spots), or
amblyopia (lazy eye) are clinical manifestations of what condition? what other
tests can be performed? Correct Ans - strabismus; cover-uncover test
to determine the angle of strabismus, cover test, convergence testing
,how can strabismus be treated? Correct Ans - -patch therapy: normal
eye is covered to stimulate and strengthen the affected eye
-eyeglasses
-corrective therapy: if severe or unresponsive to conservative therapy
if not treated before 2 y/o, amblyopia may occur and cause decreased visual
acuity that is not correctable
Dx? 1-2 days of ear pain, pruritis in the ear canal, auricular discharge,
pressure/fullness, hearing usually preserved, pain with tug test and tragus
pressure, auditory canal erythema/edema/debris, recent swimming pool use;
MC organisms? Tx? Correct Ans - Dx: otitis externa
MC organisms: *pseudomonas*, proteus, s. aureus, s. epidermis, GABHS,
anaerobes (peptostreptococcus), aspergillus
Tx: 1. protect ear against moisture (isopropyl alcohol and acetic acid) 2.
ciprofloxacin/dexamethasone (ofloxacin safe if there is an associated TM perf)
3. Aminoglycoside combo (neomycin/polytrim-B/hydrocortisone -BUT not
used if perf suspected bc ototoxic 4. amphotericin B if fungal
malignant otitis externa is osteomyelitis at the skull base secondary to
___________ infxn; MC seen in what pt populations; Tx? Correct Ans -
pseudomonas; MC in DM and immunocompromised pts; Tx w/ IV Ceftazidime
or Piperacillin + FQ or Aminoglycoside
acute otitis media is an infection of the middle ear, temporal bone and mastoid
air cells that is MC preceded by Correct Ans - a viral URI that causes
edema of eustachian tube, negative pressure, transudation of fluid and mucus
in middle ear that allows for bacterial growth
what are the 4 MC organisms seen in acute otitis media? Correct Ans -
*Strep pneumo*, H. influenza, Moraxella catarrhalis, Strep pyogenes (same as
seen in acute sinusitis)
Dx: fever, otalgia, ear tugging in infants, conductive hearing loss, stuffiness,
possible drainage from ear, bulging/erythematous TM w/ effusion, dec TM
mobility on pneumatic otoscopy; Tx? Correct Ans - dx: acute otitis
media
, tx: 1st line- amoxicillin, 2nd line- augmentin (amoxicillin-clavulate); if PCN
allergy- azithromycin, clarithromycin, erythromycin-sulfisoxazole,
trimethoprim/sulfamethoxazole, if PCN adverse effect but not allergy-
ceftriaxone, cefdinir, cefixine
don't forget to treat pain as well (ibuprofen or tylenol); can also perform
myringotomy (surgical drainage) to relieve pain
tympanostomy if recurrent >4 times in 1 yr
if bullae are seen on the TM of a pt with AOM what should you suspect?
Correct Ans - mycoplasma pneumoniae
Dx? deep ear pain (worse at night), fever, mastoid tenderness and possibly
fluctuance (abscess), following AOM infxn; complications? Correct Ans -
-dx: mastoiditis (inflammation of the mastoid air cells of the temporal bone-
mastoid and middle ear are connected)
-complications: hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain
abscess
how is mastoiditis diagnosed and treated? Correct Ans - dx: by CT scan
is 1st line test
tx: IV abx (same as w/ AOM- amoxicillin 1st line, augmentin 2nd line,
azithromycin for allergy to PCN, ceftriaxone for ADR to PCN) + middle
ear/mastoid drainage (myringotomy +/- tympanostomy tube placement- can
obtain Cx)
if mastoiditis refractory to tx or complicated = mastoidectomy
what are the 2 auditory examination tests (and what order do you perform
them in)? Correct Ans - 1st Weber (tuning fork placed on top of head)
2nd Rinne (tuning fork placed on mastoid bone by ear)
if a child has conductive hearing loss in their L ear what will the Weber and
Rinne tests show? Correct Ans - Weber: lateralizes to L ear
Rinne: BC > AC
if a child has sensorineural hearing loss in the R ear what will the Weber and
Rinne tests show? Correct Ans - Weber: lateralizes to L ear (the
normal one)
