PAEA Pediatrics EOR Topics Questions with Answers
Graded A
what is the MC conjunctivitis seen in children? neonatorum; corneal ulceration,
what is the cause? source? - ANSWER - opacification/scarring, visual
viral conjunctivitis; Adenovirus; swimming pools impairment/blindness
Dx? preauricular lymphadenopathy, copious standard prophylaxis given immediately after
watery eye discharge, scanty mucoid discharge, birth to prevent ophthalmia neonatorum (neonatal
usually unilateral with punctate staining on slit conjunctivitis) includes: - ANSWER -
lamp examination; Tx? - ANSWER -dx: erythromycin ointment, tetracycline ointment,
viral conjunctivitis silver nitrate, or povidone-iodine
tx: supportive (cool compresses, artificial tears)
+/- antihistamines for itching (Olopatadine)
if ophthalmia neonatorum (neonatal
conjunctivitis) develops on day 1 after birth what
Dx? bilateral eye itching, tearing, redness, string is the most likely cause? day 2-5? day 5-7? day
discharge, chemosis (conjunctival swelling) with 7-11? - ANSWER -day 1: silver nitrate
cobblestone appearance to inner/upper eyelids; (chemical cause- prophylaxis is what can cause
Tx? - ANSWER -dx: allergic conjunctivitis the condition)
tx: topical antihistamines (H1 blockers) day 2-5: gonococcal
(Olopatadine, Pheniramine/Naphazoline, day 5-7: chlamydia
Emedastine), topical NSAID (ketorolac), topical day 7-11: HSV
corticosteroids (but s/e of long term use =
glaucoma, cataracts, HSV keratitis)
orbital (septal) cellulitis is usually secondary to
_________ infection in most commonly what age
Dx? purulent eye discharge, lid crusting, no group? - ANSWER -sinus; 7-12y; other
visual changes, absence of ciliary injection; Tx? - causes include dental/facial infxns or bacteremia
ANSWER -dx: bacterial conjunctivitis (MC
S. aureus, Strep pneumo, H. influenzae)
tx: topical abx (erythromycin, fluoroquinolones, what is the most common sinus infection (90%)
sulfonamides, aminoglycosides); if contact lens that causes secondary orbital cellulitis? what
wearer cover for pseudomonas w/ organisms are the cause? - ANSWER -
fluoroquinolone or aminoglycoside ethmoid; S. aureus, Strep. pneumo, GABHS
(Strep. pyogenes), H. influenzae
if bacterial conjunctivitis is found to be chlamydia
or gonorrhea what is the tx? - ANSWER - work up/Dx? decreased vision, pain w/ ocular
admit for IV and topical abx (ophtho emergency) movement, proptosis (bulging eye), eyelid
-gonoccoccal: IV ceftriaxone + topical erythema and edema; tx? - ANSWER -dx:
-chlamydia: IV azithromycin orbital cellulitis
work up: CT scan (showing infxn of fat & ocular
muscles) or MRI
neonatal conjunctivitis is aka? if left untreated tx: IV antibiotics (Vanc, Clinda, Cefotaxime,
can develop what? - ANSWER -ophthalmia Ampicillin/Sulbactam)
,PAEA Pediatrics EOR Topics Questions with Answers
Graded A
auricular discharge, pressure/fullness, hearing
usually preserved, pain with tug test and tragus
what is the difference b/t orbital (septal) cellulitis pressure, auditory canal erythema/edema/debris,
and preseptal cellulitis? - ANSWER - recent swimming pool use; MC organisms? Tx? -
preseptal may still have ocular pain, redness and ANSWER -Dx: otitis externa
swelling but NO visual changes or pain w/ ocular MC organisms: *pseudomonas*, proteus, s.
mvmt (hasn't affected the muscles) aureus, s. epidermis, GABHS, anaerobes
(peptostreptococcus), aspergillus
Tx: 1. protect ear against moisture (isopropyl
misalignment of the eyes is aka? when does alcohol and acetic acid) 2.
stable ocular alignment present in infants? - ciprofloxacin/dexamethasone (ofloxacin safe if
ANSWER -strabismus; 2-3 mos there is an associated TM perf) 3.
Aminoglycoside combo (neomycin/polytrim-
B/hydrocortisone -BUT not used if perf suspected
convergent strabismus is aka? divergent bc ototoxic 4. amphotericin B if fungal
strabismus is aka? - ANSWER -
convergent: esotropia (deviated inward "cross
eyed") malignant otitis externa is osteomyelitis at the
divergent: exotropia (deviated ouward) skull base secondary to ___________ infxn; MC
seen in what pt populations; Tx? -
ANSWER -pseudomonas; MC in DM and
a + Hirschberg corneal light reflex test, diplopia, immunocompromised pts; Tx w/ IV Ceftazidime
scotomas (blind spots), or amblyopia (lazy eye) or Piperacillin + FQ or Aminoglycoside
are clinical manifestations of what condition?
what other tests can be performed? -
ANSWER -strabismus; cover-uncover test acute otitis media is an infection of the middle
to determine the angle of strabismus, cover test, ear, temporal bone and mastoid air cells that is
convergence testing MC preceded by - ANSWER -a viral URI
that causes edema of eustachian tube, negative
pressure, transudation of fluid and mucus in
how can strabismus be treated? - middle ear that allows for bacterial growth
ANSWER --patch therapy: normal eye is
covered to stimulate and strengthen the affected
eye what are the 4 MC organisms seen in acute otitis
-eyeglasses media? - ANSWER -*Strep pneumo*, H.
-corrective therapy: if severe or unresponsive to influenza, Moraxella catarrhalis, Strep pyogenes
conservative therapy (same as seen in acute sinusitis)
if not treated before 2 y/o, amblyopia may occur
and cause decreased visual acuity that is not Dx: fever, otalgia, ear tugging in infants,
correctable conductive hearing loss, stuffiness, possible
drainage from ear, bulging/erythematous TM w/
effusion, dec TM mobility on pneumatic otoscopy;
Dx? 1-2 days of ear pain, pruritis in the ear canal, Tx? - ANSWER -dx: acute otitis media
,PAEA Pediatrics EOR Topics Questions with Answers
Graded A
tx: 1st line- amoxicillin, 2nd line- augmentin 2nd Rinne (tuning fork placed on mastoid bone
(amoxicillin-clavulate); if PCN allergy- by ear)
azithromycin, clarithromycin, erythromycin-
sulfisoxazole, trimethoprim/sulfamethoxazole, if
PCN adverse effect but not allergy- ceftriaxone, if a child has conductive hearing loss in their L
cefdinir, cefixine ear what will the Weber and Rinne tests show? -
ANSWER -Weber: lateralizes to L ear
don't forget to treat pain as well (ibuprofen or Rinne: BC > AC
tylenol); can also perform myringotomy (surgical
drainage) to relieve pain
tympanostomy if recurrent >4 times in 1 yr if a child has sensorineural hearing loss in the R
ear what will the Weber and Rinne tests show? -
ANSWER -Weber: lateralizes to L ear (the
if bullae are seen on the TM of a pt with AOM normal one)
what should you suspect? - ANSWER - Rinne: AC > BC (shows normal L ear)
mycoplasma pneumoniae
what are the causes of conductive vs
Dx? deep ear pain (worse at night), fever, sensorineural hearing loss? - ANSWER -
mastoid tenderness and possibly fluctuance conductive: *cerumen impaction* MC, damage to
(abscess), following AOM infxn; complications? - ossicles (otosclerosis, cholesteatoma),
ANSWER --dx: mastoiditis (inflammation of mastoiditis, otitis media
the mastoid air cells of the temporal bone- sensorineural: *presbyacusis* MC (age-related
mastoid and middle ear are connected) hearing loss), chronic loud noise exposure, CNS
-complications: hearing loss, labyrinthitis, vertigo, lesions (acoustic neuroma), labyrinthitis, meniere
CN VII paralysis, brain abscess syndrome
how is mastoiditis diagnosed and treated? - how is cerumen impaction treated? -
ANSWER -dx: by CT scan is 1st line test ANSWER -1. cerumen softening: hydrogen
tx: IV abx (same as w/ AOM- amoxicillin 1st line, peroxide 3% or carbamide peroxide (Debrox)
augmentin 2nd line, azithromycin for allergy to 2. aural toilet: irrigation (as long as no TM perf-
PCN, ceftriaxone for ADR to PCN) + middle H2O must be at body temp to prevent vertigo),
ear/mastoid drainage (myringotomy +/- curette removal, suction
tympanostomy tube placement- can obtain Cx)
if mastoiditis refractory to tx or complicated = Dx? acute ear pain, hearing loss, break in the
mastoidectomy tympanic membrane, +/- conductive hearing loss,
+/- bloody otorrhea, +/- tinnitus & vertigo; Tx? -
ANSWER -dx: tympanic membrane
what are the 2 auditory examination tests (and perforation
what order do you perform them in)? - tx: observation (most heal spontaneously) but
ANSWER -1st Weber (tuning fork placed can do surgical repair; avoid
on top of head) water/moisture/topical aminoglycoside (ototoxic)
, PAEA Pediatrics EOR Topics Questions with Answers
Graded A
in ear tx for acute viral pharyngitis/tonsillitis -
ANSWER -1. fever control: ibuprofen or
tylenol
Dx: sneezing, nasal congestion/itching, clear 2. hydration
rhinorrhea, worse in the morning, pale/blue 3. bed rest
turbinates, +/- nasal polyps, +/- eye, ear, throat
involvement; Tx? - ANSWER -dx: allergic
rhinitis Dx? pt w/ sore throat, fever >100.4F/38C,
tx: 1st line intranasal steroids, oral pharyngotonsillar exudates, tender anterior
antihistamines, mast cell stabilizers (cromolyn, cervical LAD, absence of cough and gram stain
nedocromil) showing G+ cocci in chains - ANSWER -
"strep throat" streptococcal pharyngitis (strep
pyogenes)
what are the blood vessels involved in anterior vs
posterior epistaxis? which is MC involved? -
ANSWER -anterior: Kiesselbach's plexus what are the Centor criteria for diagnosing strep
*MC type of epistaxis* throat? - ANSWER -0-1 pts: no abx or
posterior: palatine artery- this one may cause throat Cx (unless 3-14y get Cx anyway)
bleeding in both nares and posterior pharynx 2-3 pts: Cx
4-5 pts: abx
tx for anterior epstaxis? - ANSWER --1st
line is direct pressure 10-15 min in seated what is the tx for strep throat? - ANSWER --
position leaning forward (to reduce vessel 1st line: PCN G or VK; others include: amoxicillin,
pressure) augmentin
-topical decongestants/vasocontrictors: -if PCN allergic = macrolides (azithromycin,
phenylephrine, oxymetazoline (afrin) erythromycin, clarithromycin) or if ADR =
-cauterization: silver nitrate if cannot control cephalosporins or clindamycin
bleeding and site can be seen
-nasal packing: + abx (cephalexin or
clindamycin) to prevent toxic shock syndrome what are some complications from strep throat? -
-adjunct therapy: avoid exercise, spicy foods ANSWER --rheumatic fever (preventable w/
(vasodilation), moisten membranes w/ bacitracin abx)
and humidifiers -glomerulonerphritis (not preventable w/ abx)
-peritonsillar abscess, cellulitis
acute pharyngitis/tonsillitis is MC caused by?
other causes? - ANSWER --viral is MC: peritonsillar abscess is aka _______ that occurs
*adenovirus*, rhinovirus, enterovirus, EBV, RSV, after - ANSWER -quinsy; tonsillitis ->
influenza A/B, herpes zoster cellulitis -> abscess formation
-bacterial: GABHS (strep. pyogenes "strep
throat")
Dx? dysphagia, pharyngitis, muffled "hot potato
voice," drooling, trismus (lock jaw), uvula
Graded A
what is the MC conjunctivitis seen in children? neonatorum; corneal ulceration,
what is the cause? source? - ANSWER - opacification/scarring, visual
viral conjunctivitis; Adenovirus; swimming pools impairment/blindness
Dx? preauricular lymphadenopathy, copious standard prophylaxis given immediately after
watery eye discharge, scanty mucoid discharge, birth to prevent ophthalmia neonatorum (neonatal
usually unilateral with punctate staining on slit conjunctivitis) includes: - ANSWER -
lamp examination; Tx? - ANSWER -dx: erythromycin ointment, tetracycline ointment,
viral conjunctivitis silver nitrate, or povidone-iodine
tx: supportive (cool compresses, artificial tears)
+/- antihistamines for itching (Olopatadine)
if ophthalmia neonatorum (neonatal
conjunctivitis) develops on day 1 after birth what
Dx? bilateral eye itching, tearing, redness, string is the most likely cause? day 2-5? day 5-7? day
discharge, chemosis (conjunctival swelling) with 7-11? - ANSWER -day 1: silver nitrate
cobblestone appearance to inner/upper eyelids; (chemical cause- prophylaxis is what can cause
Tx? - ANSWER -dx: allergic conjunctivitis the condition)
tx: topical antihistamines (H1 blockers) day 2-5: gonococcal
(Olopatadine, Pheniramine/Naphazoline, day 5-7: chlamydia
Emedastine), topical NSAID (ketorolac), topical day 7-11: HSV
corticosteroids (but s/e of long term use =
glaucoma, cataracts, HSV keratitis)
orbital (septal) cellulitis is usually secondary to
_________ infection in most commonly what age
Dx? purulent eye discharge, lid crusting, no group? - ANSWER -sinus; 7-12y; other
visual changes, absence of ciliary injection; Tx? - causes include dental/facial infxns or bacteremia
ANSWER -dx: bacterial conjunctivitis (MC
S. aureus, Strep pneumo, H. influenzae)
tx: topical abx (erythromycin, fluoroquinolones, what is the most common sinus infection (90%)
sulfonamides, aminoglycosides); if contact lens that causes secondary orbital cellulitis? what
wearer cover for pseudomonas w/ organisms are the cause? - ANSWER -
fluoroquinolone or aminoglycoside ethmoid; S. aureus, Strep. pneumo, GABHS
(Strep. pyogenes), H. influenzae
if bacterial conjunctivitis is found to be chlamydia
or gonorrhea what is the tx? - ANSWER - work up/Dx? decreased vision, pain w/ ocular
admit for IV and topical abx (ophtho emergency) movement, proptosis (bulging eye), eyelid
-gonoccoccal: IV ceftriaxone + topical erythema and edema; tx? - ANSWER -dx:
-chlamydia: IV azithromycin orbital cellulitis
work up: CT scan (showing infxn of fat & ocular
muscles) or MRI
neonatal conjunctivitis is aka? if left untreated tx: IV antibiotics (Vanc, Clinda, Cefotaxime,
can develop what? - ANSWER -ophthalmia Ampicillin/Sulbactam)
,PAEA Pediatrics EOR Topics Questions with Answers
Graded A
auricular discharge, pressure/fullness, hearing
usually preserved, pain with tug test and tragus
what is the difference b/t orbital (septal) cellulitis pressure, auditory canal erythema/edema/debris,
and preseptal cellulitis? - ANSWER - recent swimming pool use; MC organisms? Tx? -
preseptal may still have ocular pain, redness and ANSWER -Dx: otitis externa
swelling but NO visual changes or pain w/ ocular MC organisms: *pseudomonas*, proteus, s.
mvmt (hasn't affected the muscles) aureus, s. epidermis, GABHS, anaerobes
(peptostreptococcus), aspergillus
Tx: 1. protect ear against moisture (isopropyl
misalignment of the eyes is aka? when does alcohol and acetic acid) 2.
stable ocular alignment present in infants? - ciprofloxacin/dexamethasone (ofloxacin safe if
ANSWER -strabismus; 2-3 mos there is an associated TM perf) 3.
Aminoglycoside combo (neomycin/polytrim-
B/hydrocortisone -BUT not used if perf suspected
convergent strabismus is aka? divergent bc ototoxic 4. amphotericin B if fungal
strabismus is aka? - ANSWER -
convergent: esotropia (deviated inward "cross
eyed") malignant otitis externa is osteomyelitis at the
divergent: exotropia (deviated ouward) skull base secondary to ___________ infxn; MC
seen in what pt populations; Tx? -
ANSWER -pseudomonas; MC in DM and
a + Hirschberg corneal light reflex test, diplopia, immunocompromised pts; Tx w/ IV Ceftazidime
scotomas (blind spots), or amblyopia (lazy eye) or Piperacillin + FQ or Aminoglycoside
are clinical manifestations of what condition?
what other tests can be performed? -
ANSWER -strabismus; cover-uncover test acute otitis media is an infection of the middle
to determine the angle of strabismus, cover test, ear, temporal bone and mastoid air cells that is
convergence testing MC preceded by - ANSWER -a viral URI
that causes edema of eustachian tube, negative
pressure, transudation of fluid and mucus in
how can strabismus be treated? - middle ear that allows for bacterial growth
ANSWER --patch therapy: normal eye is
covered to stimulate and strengthen the affected
eye what are the 4 MC organisms seen in acute otitis
-eyeglasses media? - ANSWER -*Strep pneumo*, H.
-corrective therapy: if severe or unresponsive to influenza, Moraxella catarrhalis, Strep pyogenes
conservative therapy (same as seen in acute sinusitis)
if not treated before 2 y/o, amblyopia may occur
and cause decreased visual acuity that is not Dx: fever, otalgia, ear tugging in infants,
correctable conductive hearing loss, stuffiness, possible
drainage from ear, bulging/erythematous TM w/
effusion, dec TM mobility on pneumatic otoscopy;
Dx? 1-2 days of ear pain, pruritis in the ear canal, Tx? - ANSWER -dx: acute otitis media
,PAEA Pediatrics EOR Topics Questions with Answers
Graded A
tx: 1st line- amoxicillin, 2nd line- augmentin 2nd Rinne (tuning fork placed on mastoid bone
(amoxicillin-clavulate); if PCN allergy- by ear)
azithromycin, clarithromycin, erythromycin-
sulfisoxazole, trimethoprim/sulfamethoxazole, if
PCN adverse effect but not allergy- ceftriaxone, if a child has conductive hearing loss in their L
cefdinir, cefixine ear what will the Weber and Rinne tests show? -
ANSWER -Weber: lateralizes to L ear
don't forget to treat pain as well (ibuprofen or Rinne: BC > AC
tylenol); can also perform myringotomy (surgical
drainage) to relieve pain
tympanostomy if recurrent >4 times in 1 yr if a child has sensorineural hearing loss in the R
ear what will the Weber and Rinne tests show? -
ANSWER -Weber: lateralizes to L ear (the
if bullae are seen on the TM of a pt with AOM normal one)
what should you suspect? - ANSWER - Rinne: AC > BC (shows normal L ear)
mycoplasma pneumoniae
what are the causes of conductive vs
Dx? deep ear pain (worse at night), fever, sensorineural hearing loss? - ANSWER -
mastoid tenderness and possibly fluctuance conductive: *cerumen impaction* MC, damage to
(abscess), following AOM infxn; complications? - ossicles (otosclerosis, cholesteatoma),
ANSWER --dx: mastoiditis (inflammation of mastoiditis, otitis media
the mastoid air cells of the temporal bone- sensorineural: *presbyacusis* MC (age-related
mastoid and middle ear are connected) hearing loss), chronic loud noise exposure, CNS
-complications: hearing loss, labyrinthitis, vertigo, lesions (acoustic neuroma), labyrinthitis, meniere
CN VII paralysis, brain abscess syndrome
how is mastoiditis diagnosed and treated? - how is cerumen impaction treated? -
ANSWER -dx: by CT scan is 1st line test ANSWER -1. cerumen softening: hydrogen
tx: IV abx (same as w/ AOM- amoxicillin 1st line, peroxide 3% or carbamide peroxide (Debrox)
augmentin 2nd line, azithromycin for allergy to 2. aural toilet: irrigation (as long as no TM perf-
PCN, ceftriaxone for ADR to PCN) + middle H2O must be at body temp to prevent vertigo),
ear/mastoid drainage (myringotomy +/- curette removal, suction
tympanostomy tube placement- can obtain Cx)
if mastoiditis refractory to tx or complicated = Dx? acute ear pain, hearing loss, break in the
mastoidectomy tympanic membrane, +/- conductive hearing loss,
+/- bloody otorrhea, +/- tinnitus & vertigo; Tx? -
ANSWER -dx: tympanic membrane
what are the 2 auditory examination tests (and perforation
what order do you perform them in)? - tx: observation (most heal spontaneously) but
ANSWER -1st Weber (tuning fork placed can do surgical repair; avoid
on top of head) water/moisture/topical aminoglycoside (ototoxic)
, PAEA Pediatrics EOR Topics Questions with Answers
Graded A
in ear tx for acute viral pharyngitis/tonsillitis -
ANSWER -1. fever control: ibuprofen or
tylenol
Dx: sneezing, nasal congestion/itching, clear 2. hydration
rhinorrhea, worse in the morning, pale/blue 3. bed rest
turbinates, +/- nasal polyps, +/- eye, ear, throat
involvement; Tx? - ANSWER -dx: allergic
rhinitis Dx? pt w/ sore throat, fever >100.4F/38C,
tx: 1st line intranasal steroids, oral pharyngotonsillar exudates, tender anterior
antihistamines, mast cell stabilizers (cromolyn, cervical LAD, absence of cough and gram stain
nedocromil) showing G+ cocci in chains - ANSWER -
"strep throat" streptococcal pharyngitis (strep
pyogenes)
what are the blood vessels involved in anterior vs
posterior epistaxis? which is MC involved? -
ANSWER -anterior: Kiesselbach's plexus what are the Centor criteria for diagnosing strep
*MC type of epistaxis* throat? - ANSWER -0-1 pts: no abx or
posterior: palatine artery- this one may cause throat Cx (unless 3-14y get Cx anyway)
bleeding in both nares and posterior pharynx 2-3 pts: Cx
4-5 pts: abx
tx for anterior epstaxis? - ANSWER --1st
line is direct pressure 10-15 min in seated what is the tx for strep throat? - ANSWER --
position leaning forward (to reduce vessel 1st line: PCN G or VK; others include: amoxicillin,
pressure) augmentin
-topical decongestants/vasocontrictors: -if PCN allergic = macrolides (azithromycin,
phenylephrine, oxymetazoline (afrin) erythromycin, clarithromycin) or if ADR =
-cauterization: silver nitrate if cannot control cephalosporins or clindamycin
bleeding and site can be seen
-nasal packing: + abx (cephalexin or
clindamycin) to prevent toxic shock syndrome what are some complications from strep throat? -
-adjunct therapy: avoid exercise, spicy foods ANSWER --rheumatic fever (preventable w/
(vasodilation), moisten membranes w/ bacitracin abx)
and humidifiers -glomerulonerphritis (not preventable w/ abx)
-peritonsillar abscess, cellulitis
acute pharyngitis/tonsillitis is MC caused by?
other causes? - ANSWER --viral is MC: peritonsillar abscess is aka _______ that occurs
*adenovirus*, rhinovirus, enterovirus, EBV, RSV, after - ANSWER -quinsy; tonsillitis ->
influenza A/B, herpes zoster cellulitis -> abscess formation
-bacterial: GABHS (strep. pyogenes "strep
throat")
Dx? dysphagia, pharyngitis, muffled "hot potato
voice," drooling, trismus (lock jaw), uvula
