PAEA PEDIATRICS EOR EXAM QUESTIONS WITH REVISED 100% SOLUTIONS

PAEA PEDIATRICS EOR EXAM QUESTIONS WITH REVISED 100% SOLUTIONS what is the MC conjunctivitis seen in children? what is the cause? source? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER ophthalmia neonatorum; corneal ulceration, opacification/scarring, visual impairment/blindness standard prophylaxis given immediately after birth to prevent ophthalmia neonatorum (neonatal conjunctivitis) includes: - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER strabismus; 2-3 mos convergent strabismus is aka? divergent strabismus is aka? - ANSWER 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? - ANSWER strabismus; cover-uncover test to determine the angle of strabismus, cover test, convergence testing how can strabismus be treated? - ANSWER -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? - ANSWER 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? - ANSWER 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 - ANSWER 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? - ANSWER *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? - ANSWER dx: acute otitis media tx: 1st line- amoxicillin, 2nd line- augmentin (amoxicillin-clavulate); if PCN allergyazithromycin, 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? - ANSWER mycoplasma pneumoniae Dx? deep ear pain (worse at night), fever, mastoid tenderness and possibly fluctuance (abscess), following AOM infxn; complications? - ANSWER -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? - ANSWER 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)? - ANSWER 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? - ANSWER 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? - ANSWER Weber: lateralizes to L ear (the normal one) Rinne: AC BC (shows normal L ear) what are the causes of conductive vs sensori