Ch. 14 HEENT, Dental Flashcards
(182 cards)
1
Q
What is the treatment for septal hematoma?
A
- anesthetize the septum
- make elliptical incision in the mucosa overlying the hematoma (be careful not to incise the cartilage)
- evaluate clot with pressure or suction
- place small penrose drain into the incision
- pack both nostrils
follow up ENT in 48 hrs
2
Q
Why is it important to drain septal hematomas?
A
untreated–» abscess, necrosis, and septal perforation
3
Q
Which muscle is most commonly entrapped in orbital floor fractures?
A
inferior rectus muscle – limits upward gaze
4
Q
What clinical exam can be performed to test for mandibular fracture?
A
Tongue blade test: The ability to maintain the bite on a tongue blade being twisted with enough force that it cracks has a negative predictive value of 95% for mandibular fracture
5
Q
What recommendations should you make after mandibular reductions?
A
Avoid extreme jaw opening for 3 weeks, soft diet, nonsteroidal anti-inflammatory drugs (NSAIDs) for pain, and OMS follow-up in 1-3 days
6
Q
What is a “tripod” fracture of the face?
A
classic fracture pattern involving the zygoma, the lateral orbital wall, and the maxilla
7
Q
Which nerve supplies maxillary teeth?
A
dentoalveolar nerve; can be injured in tripod fractures
8
Q
What are sinus precautions?
A
Avoid:
- blowing your nose
- exercise or bending over, straining, sneezing.
If you have to sneeze, do so with your mouth open.
- avoid straws or suction.
9
Q
What classification system describes mid-face fractures?
A
Le Fort
10
Q
Define Le Fort I
A
Unilateral or bilateral fracture through the inferior maxilla just above the roots of the teeth
11
Q
Define Le Fort II
A
Bilateral pyramidal fracture extending superiorly from the maxilla through the orbital floor and rim, medially through the lacrimal bones, and across the nasal bridge
12
Q
Define Le Fort III
A
Rare injury with fractures spreading laterally from the nasal bridge
through the medial wall, floor, and lateral wall of the orbit and then the zygoma resulting in complete craniofacial dissociation
■ Intranasally, the fracture extends posteriorly to the sphenoid and is frequently
associated with a cerebrospinal fluid (CSF) leak.
13
Q
What is the treatment for Le Fort fractures?
A
- airway protection
- prophylactic abx – augmentin or clindamycin
- urgent OMFS consultation
14
Q
What is the treatment for auricular hematoma?
A
<2cm – needle aspiration
>2cm – I&D
THEN pressure dressing with daily follow-up
15
Q
What are symptoms of vestibular neuritis?
A
Continuous vertigo
+/- hearing loss (if cochlear branch is involved)
16
Q
What causes BPPV?
A
calcium debris (otoconia) within the semicircular canals of the inner ear
17
Q
What causes Menieres?
A
An idiopathic excess of fluid in the endolymphatic spaces of the inner ear
18
Q
What is the classic triad of Menieres?
A
Sensorineural hearing loss, peripheral vertigo, tinnitus
19
Q
What is the treatment for Menieres attacks?
A
Antiemetics, antihistamines (eg, meclizine), and benzodiazepines for acute attacks.
20
Q
What are long term recommendations for patients with Menieres?
A
low-sodium diet,
diuretics,
smoking and caffeine cessation,
and
chemical ablation of vestibular function with aminoglycosides
in extreme cases.
21
Q
What two organisms most commonly cause otitis externa?
A
pseudomonas and staph aureus
22
Q
What is furunculosis of the ear canal?
A
a well-circumscribed infection of the cartilaginous portion
of the external canal caused by S. aureus that requires incision and drainage and oral antibiotics
23
Q
Ramsay-Hunt Syndrome or herpes zoster oticus is due to reactivation of herpes zoster in the ___ ganglion.
A
geniculate
24
Q
What is the treatment for Ramsay Hunt Syndrome?
A
acyclovir or valacyclovir
25
What is the treatment for otitis externa if TM is intact?
PolymyxinB/neomycin/hydrocortisone or
ciprofloxacin/hydrocortisone.
+ topical anesthestics
26
What is the treatment for otitis externa if the TM is perforated?
UTD says topical fluoroquinolone (ciprofloxacin)
27
If you suspect otitis externa but you see granulation tissue at the floor of the canal, what should you be concerned for?
necrotizing (malignant) otitis externa
28
What organism is responsible for necrotizing otitis externa?
pseudomonas aeruginosa
29
What is the treatment for necrotizing otitis externa?
Admission for iV antibiotics (unless nontoxic, then may treat with oral ciprofloxacin for 6-8 weeks with ENT referral)
30
What is bullous myringitis?
AOM with formation of bullae on the TM and medial canal wall
31
What is the treatment for acute otitis media?
>80% of cases resolve spontaneously
- in children >6months okay to do watchful waiting for 48 hours
then Amoxicillin is first line
if tubes then add topical oflaxcin or ciprofloxain (to cover for pseudomonas)
32
In what population is mastoiditis most common?
children <2 years old
33
What is the most common organism attributed to mastoiditis?
s. pneumonia
34
What is the treatment for mastoiditis?
ceftriaxone or clindamycin
+/- surgical drainage
35
What physical exam test can be used to test for conductive hearing loss?
Rinne test
36
What physical exam test can be used to evaluate sensorineural hearing loss?
Weber test
37
What is the treatment for sudden hearing loss?
treat cause, otherwise..
oral steroid for 10-14 days and ENT follow up
38
What is a cholesteatoma?
An accumulation of epithelial cells resulting from chronic Eustachian tube dysfunction or middle ear infection with retraction of the TM that can lead to bone erosion of the middle ear.
39
WHat are the signs/symptoms of cholesteatoma?
Recurrent or persistent purulent otorrhea with hearing loss is common.
■ Whitish mass of epithelial debris may be visible behind the TM.
40
What is the treatment of cholesteatoma?
reverse underlying process-- ie treat infection, improve eustachian tube dysfunction
41
What are examples of Ototoxic agents?
■ Aminoglycosides
■ Loop diuretics
■ Salicylates (usually chronic toxicity)
■ Erythromycin
■ Quinine and related drugs
■ Chemotherapeutics
42
What is the most common cause of TM perforation?
otitis media
43
What is the treatment for TM perforation?
■ Keep ear dry; provide analgesia and topical antibiotic suspension if contaminated
or at risk for contamination.
■ Most (90%) heal within a few months, but should follow-up with ENT.
44
How can lacerations medial to the medial canthus be evaluated for lacrimal system injury?
instill fluorescein into the eye and see if dye is present in the wound
45
For chemical exposures to the eye, how long should you irrigate?
At least 30 minutes; or longer-- use pH paper and irrigate until pH of eye tear is 7.0
46
Are steroids indicated in UV keratitis?
No
47
What is the treatment for chemical eye injuries?
topical steroids (with
ophthalmology consultation),
cycloplegics,
artificial tears, and
antibiotic ointment (eg, erythromycin) along with oral pain medication.
48
What is the treatment for corneal abrasions/injuries?
topical NSAIDs (eg, ketorolac 0.5% qid) or oral analgesics
+
topical antibiotics (eg, erythromycin ointment qid)
if contact wearer --> Levofloxacin (for pseudomonal coverage)
49
What is the treatment after corneal foreign body removal?
topical NSAIDs, oral analgesics, and topical antibiotics
50
What is the treatment for globe rupture
1. shield eye immediately
2. pain control, antiemetics
3. tdap and abx -- Vanc +Ceftazidime
4. Optho consult
51
What do you call a blood collection in the anterior chamber?
hyphema
52
What is the treatment of hyphema?
eye shield, elevate HOB to 30', antiemetics
optho consult -- additional meds per optho ie timolol, systemic glucocorticoids, cyclopentolate, dorzolamide, mannitol, surgery
53
What is iritis and/or iridocyclitis?
inflammation of the iris and ciliary body
54
What are symptoms of iritis?
recent hx of blunt trauma
deep aching eye pain
photophobia
55
What are physical exam findings of iritis?
small, poorly dilating pupil with perilimbal conjunctival injection (ciliary flush)
cell and flare in the anterior chamber on slit lamp exam
56
What is the treatment of iritis?
■ Long-acting mydriatics/cycloplegics (eg, homatropine) for symptom control
and to prevent synechiae
■ Ophthalmology follow-up; generally resolves within 1 week
57
What do you call a fibrovascular proliferation that extends, generally from the nasal side of sclera, onto the cornea?
pterygium
58
What is the treatment for pterygium?
Surgical removal if interfering with vision
59
What are risk factors for pterygiums?
sun exposure (“surfer’s eye”),
low humidity, and dust
60
What do you call a yellowish patch on conjunctiva near limbus that does not grow or extend onto cornea?
Pinguecula
61
What is the difference between a pterygium and pinguecula?
Pterygium extends onto the cornea,
pinguecula does not
62
What is the treatment for pinguecula?
Artificial tears to prevent dryness. Topical steroids if acutely inflamed (pingueculitis)
63
What is the most common cause of viral conjunctivitis?
Adenovirus
64
What do you call inward turning of the eyelid?
entropion
65
In developing countries, what infection may cause a follicular conjunctivitis with entropion?
Trachoma -- chlamydial conjunctivitis (non-sexual serotypes)
66
What do you call conjunctivitis occurring within the first month of life?
Ophthalmia neonatorum
67
What is the most likely etiology of Ophthalmia neonatorum in the first 1-2 days after birth?
chemical causes, from ointment applied postdelivery
68
What is the most likely etiology of Ophthalmia neonatorum in the first 2-5 days after birth?
Gonorrhea
69
What is the most likely etiology of Ophthalmia neonatorum in the first 5-14 days after birth?
chlamydia (most common) - culture to dx
70
What is the most likely etiology of Ophthalmia neonatorum in the first 1-2 weeks after birth?
HSV -- culture to dx
71
What is the treatment for Ophthalmia neonatorum caused by chemicals?
no treatment
72
What is the treatment for Ophthalmia neonatorum caused by Gonorrhea?
saline washes, ceftriazone IM, topical abx drops (eg polymyxin-bacitracin)
also treat for chalmydial infections
73
What is the treatment for Ophthalmia neonatorum caused by Chlamydia?
topical erythromycin ointment and oral erythromycin syrup
74
What is the treatment for Ophthalmia neonatorum caused by HSV?
Acyclovir IV plus vidarabine ointment
75
What is the treatment for corneal ulcers?
topical fluoroquinolone drops (levofloxacin q2h while awake)
pain control with NSAIDs or narcotics
Close optho followup
76
What is the treatment for herpes simplex keratitis?
topical antivirals -- eg trifluridine 1% q2h
**topical steroids are contraindicated
77
Why is prompt diagnosis and emergent ophtho consult important in Herpes Zoster Ophthalmicus?
Corneal involvement may progress to acute necrotizing retinitis and complete vision loss
78
What do you call Vesicular lesions on the tip of the nose indicate herpes zoster involvement
of the nasociliary branch of the trigeminal nerve?
Hutchinson sign -- 76% chance of ocular involvement
79
What is the difference between dendrites and pseudodendrites on fluorescein exam?
dendrites --> HSV
- (have end bulbs)
pseudodendrities --> VZV
80
What do you call chronic eyelid inflammation with acute exacerbations that involves the meiboian glands?
Blepharitis
81
What is the treatment for blepharitis?
warm compresses 15 min QID
82
Hordeolum and chalazion are inflammatory lesions of the ___ glands.
sebaceous -- which includes meibomian gland & gland of Zeis (external)
83
What is another name for a stye?
hordeolum
84
What bacteria is most often implicated in hordeolums/styes?
staph aureus
85
What gland is implicated in hordeolums?
It can be internal, involving the meibomian gland, or external,
involving the gland of Zeis
86
What gland is indicated in chalazions?
meibomian (internal) gland
87
What do you call a CHRONIC granulomatous inflammation of an obstructed meibomian gland that often results from the progression of a hordeolum?
Chalazion
88
What is the treatment for hordeolums/chalazions?
warm compresses
+/- ophtho referral
topical abx NOT warranted
89
What is the treatment of nontoxic patients with preseptal cellulitis?
outpatient with augmentin for 10-14 days and next day follow up
90
What physical exam finding distinguishes orbital cellulitis from periorbital/preseptal cellulitis?
pain with or restriction of extraocular movements
91
How is orbital cellulitis diagnosed?
CT orbits
check IOPs
92
What is the treatment of orbital cellulitis?
■ Blood cultures & broad-spectrum IV antibiotics, including:
vancomycin + ceftriaxone, piperacillin-tazobactam, or ampicillin/sulbactam
■ Emergent ophthalmology consultation, inpatient admission
93
What do you call nasolacrimal duct obstruction?
Dacryostenosis
94
What is the treatment for dacryostenosis?
frequent lacrimal massage
95
What do you call a bacterial infection of the lacrimal SAC due to nasolacrimal duct
obstruction?
Dacryocystitis
96
What organisms are most commonly implicated in dacrycocystitis?
most commonly with S. aureus,
S. epidermis, and alpha-hemolytic streptococci,
97
What is the treatment for dacryocystitis?
warm compresses
+ topical and oral antibiotics
(eg, erythromycin ophthalmic ointment and aumentin, clinda or keflex)
98
What is the treatment for dacryocystitis?
warm compresses
+ topical and oral antibiotics
(eg, erythromycin ophthalmic ointment and augmentin, clinda or keflex)
99
What do you call inflammation of the lacrimal gland?
dacryoadenitis -- tx similar to dacryocystitis
100
What is the leading cause of blindness in the US?
Open angle glaucoma
101
What is the treatment of open angle glaucoma?
topical β-blockers and topical carbonic anhydrase inhibitors (eg, dorzolamide) to temporize prior to ophthalmologic
intervention.
102
What is the tx for acute angle closure glaucoma?
pain + nausea control
β-Blockers: Timolol 0.5% 1 drop once; reduces aqueous humor production,
but is contraindicated in patients with chronic obstructive pulmonary
disorder, asthma, or congestive heart failure
■ Miotic agent: Pilocarpine 1%-2% 1 drop every 15 minutes for 2 doses;
forces pupillary constriction, opening the trabecular meshwork and
increasing outflow
■ α2-Agonist: Apraclonidine 1 drop once; decreases aqueous humor production
and increases outflow
■ Topical steroids may be indicated but should be administered under
the guidance of an ophthalmologist.
103
If patient presents with acute angle closure glaucoma with SEVERE visual deficits or IOP > 50 mm Hg, what medications are indicated?
systemic medications to reduce IOP including:
■ Carbonic anhydrase inhibitor: Acetazolamide 250-500 mg IV; reduces
aqueous humor production; avoid with sulfa allergy.
■ Osmotic agents: Mannitol 1.5 g/kg over 45 minutes; reduces IOP.
104
What is definitive treatment of acute angle closure glaucoma?
Laser iridotomy
105
What is the most common infectious cause of anterior uveitis/iritis in immunocompromised patients?
CMV
106
Besides CMV, what are some other infectious causes of anterior uveitis/iritis in immunocompromised?
■ Reactivation of congenitally acquired toxoplasmosis may be seen in
immunocompetent patients.
■ Syphilis and tuberculosis
107
What are autoimmune causes of anterior uveitis/iritis?
■ Highly associated with HLA-B27–related spondyloarthropathies
(eg, ankylosing spondylitis, reactive arthritis)
■ Also seen with sarcoidosis, inflammatory bowel disease, psoriatic
arthritis, Behçet, etc.
108
How is anterior uveitis/iritis diagnosed?
cell and proteinaceous flare on SLIT lamp exam
PAINFUL + RED eye
109
How is posterior uveitis (choroiditis/chorioretinitis) distinguished from anterior uveitis?
posterior uveitis is WITHOUT pain or redness, but WITH floaters
110
What do you call uveitis seen in patients with a history of contralateral penetrating eye trauma caused by autoimmune response to
retinal antigens?
sympathetic ophthalmia
111
What do you call layering of inflammatory cells in the anterior chamber?
hypopyon
112
What is the treatment of anterior uveitis?
■ Analgesics, mydriatics, and cycloplegics for symptom control and to prevent
synechiae formation
■ Ophthalmology follow-up within 24 hours to rule out infection followed
by initiation of topical steroids
113
What is endophthalmitis?
infection of the anterior, posterior, and vitreous chambers
114
How does endophthalmitis present?
Acute onset red and painful eye with decreased visual acuity and afferent
pupillary defect
115
How is endopthalmitis distinguished from uveitis?
presence of eyelid erythema/edema, proptosis, and often purulent discharge
116
What is the treatment for endophthalmitis?
■ Emergent ophthalmology consult for intravitreal aspiration for culture and
intraocular antibiotics.
■ Hospital admission may be required for adjunctive systemic antibiotics
and close monitoring.
■ Rule out bacteremia in cases with no history of ocular trauma or surgery.
117
How is the timing of surgical repair of retinal detachment determined?
macula is still attached -->> urgent surgery
macula detached -->> repair
is less urgent (5-7 days).
118
What is the diagnosis for an exam with:
Afferent pupillary defect and funduscopic examination showing an edematous pale gray-white retina with a cherry red fovea
Central Retinal Artery Occlusion
EMBOLIC phenomenon
119
What is the initial treatment for central retinal artery occlusion?
Attempt to displace the embolus distally and limit infarct size with digital
ocular massage with direct pressure over the eyelids for 10-15 seconds followed by a sudden release.
120
What are the mainstays of treatment for central retinal artery occlusion?
■ Anterior chamber paracentesis by ophthalmologist to dislodge embolus
■ Carbogen inhalation (95% O2 5% CO2 mix) to vasodilate vessels and
increase retinal artery blood flow
■ Topical timolol or systemic acetazolamide to decrease IOP and
increase the flow gradient
121
What causes Central Retinal Vein Occlusion?
THROMBOTIC disease caused by atherosclerotic build up causing occlusion of the central retinal vein leading to edema, hemorrhage, and vascular leakage
122
What is the fundoscopic exam for CRVO?
disk edema, dilated and tortuous veins, and hemorrhage that may cover the entire fundus giving a “blood and thunder” appearance
123
How is optic neuritis diagnosed?
MRI of brain and orbits with gadolinium
124
Where should you measure optic nerve sheath to evaluate for papilledema?
3 cm posterior to the globe; >5 cm is abnormal
125
Anterior epistaxis results from bleeding from which vessel(s)?
Kiesselbach plexus in the anterior nasal septum-- made up by 5 arteries:
sphenopalatine, greater palatine, anterior and posterior ethmoidal, and superior labial
126
Posterior epistaxis results from bleeding from which vessel(s)?
branches of the sphenopalatine artery
127
Do antihypertensives have any role in management of epistaxis?
NO
128
What is the dispo for patients with anterior nasal packing?
can be safely discharged home with
prophylactic antibiotics and follow-up in 48-72 hours for packing removal
129
What is the dispo for patients with posterior nasal packing?
should remain in place for 72-96 hours and requires hospital admission to a telemetry bed due to risk of respiratory
suppression due to the nasopulmonary reflex as well as bradycardia and
dysrhythmias.
130
What is most commonly the etiology of sinusitis?
90-98% are viral
131
How is viral sinusitis treated?
Acute viral sinusitis should be treated symptomatically with topical decongestants (eg, oxymetazoline) limited to a maximum of 5 days (due to
rebound vasodilation) and sinus self-irrigation.
132
What should be on your differential in patients with initial symptoms of sinusitis that begin to develop black eschars of the face, nasal mucosa, or palate?
rhinocerebral mucormycosis
133
What is the treatment for mucormycosis?
IV amphotericin B and emergent ENT consultation for debridement
134
Which 5 nerves/branches are contained in the cavernous sinus?
cranial nerves III, IV, VI, and the ophthalmic (V1) and maxillary (V2)
branches of the fifth cranial nerve
135
What organism is most commonly implicated in Cavernous Sinus thrombosis?
s aureus
136
How is cavernous sinus thrombosis diagnosed?
Noncontrast head CT is insensitive and diagnosis requires CT venography, or
preferably MR venography.
137
What organisms most commonly cause gingivostomatitis?
Coxsackie virus most commonly, or HSV-1
138
Which viral cause of gingivostomatitis commonly involves that palate and posterior oropharynx?
Coxsackie virus
139
What is the treatment of gingivostomatitis?
Supportive care using oral rinses and topical analgesia with “magic mouthwash” formulation including some combination of topical anesthetic, antihistamine,
and/or antacid (eg, viscous lidocaine/diphenhydramine/magnesiumhydroxide)
140
When should you treat HSV-1 with acyclovir?
immunocompromised patients, healthy patients with frequent outbreaks,
or severe cases of primary infection
141
Characterized by friable gray/white plaques on an erythematous base located on the buccal mucosa, gingiva, tongue, palate, or tonsils
plaques are easily scraped off.
Thrush (candida albicans)
142
How does leukoplakia differ from thrush?
A hyperkeratotic response to oral mucosal irritation manifested
as white patches or plaques that do not scrape off.
143
What is the treatment for thrush?
Topical nystatin swish and swallow (4-6 mL qid) continued for 5-7 days
after lesions disappear
144
Parotitis can occasionally cause palsy of which cranial nerve?
facial nerve due to close proximity
145
The parotid gland drains via ____ duct.
Stenson duct
146
The submandibular gland drains the ____ gland
submandibular
147
What is the treatment for sialolithiasis?
rehydration, moist heat, gentle massage of the affected gland,
and sialogogues (lemon or tart candy to promote secretions)
148
What microbes are implicated in ludwig angina?
Polymicrobial with mixed aerobic and anaerobic oral flora
149
How do you manage Ludwig angina?
■ Airway management is paramount. Early awake fiberoptic nasal or oral
intubation with topical anesthesia is recommended with surgical cricothyrotomy
as a rescue measure.
■ IV antibiotics with ampicillin/sulbactam, penicillin plus metronidazole, or
clindamycin if penicillin allergic.
■ ICU admission and ENT consultation as surgery may be necessary for
patients who do not respond promptly to antibiotics
150
What is Lemierre's syndrome?
internal jugular septic thrombophlebitis
151
What organism most commonly causes Lemierre's Syndrome?
Fusobacterium
necrophorum
152
What are the symptoms of mononucleosis?
fever, creamy or cheesy white tonsillar exudate, posterior cervical LAD, adenopathy, and possible hepatosplenomegaly
153
How is mono diagnosed?
Monospot testing -- for EBV
154
What are the symptoms of pharyngitis caused by diptheria?
fever, malaise, gray or white pharyngeal pseudomembrane
155
If suspicion for diptheria is high, what is the treatment?
antitoxin (horse serum product)
156
What is the Centor criteria?
1 point for each of the following:
- fever
- tonsillar exudates
- tender anterior cervical LAD
- absence of cough
no tx for score of 1
Tx for score of 4
test +/- treat for score 2 or 3
157
What are the 3 options for treatment of Group A Strep pharyngitis?
1. benzathine penicillin 1.2 million units IM once
or
2. Penicillin V 500 mg BID x10 d
or
3. If penicillin allergy, erythromycin or azithromycin for penicillin allergies
158
What are the symptoms of scarlet fever? What organism causes scarlet fever?
Group A strep pharyngitis associated with strawberry tongue and desquamating sandpaper erythematous rash
159
What is the timeline for rheumatic fever as complication of Group A strep?
2-6 weeks following
160
What is the mainstay of treatment for peritonsillar abscess?
drainage via needle aspiration or stab incision and drainage
- may give single dose of dexamethasone to help decrease swelling and pain
PLUS d/c with Abx -- ampicillin/clavulanate or clindamycin
161
What organism is most common cause of epiglottitis?
H. influenzae type b
162
What is the best way to diagnose epiglottitis?
laryngoscopy, preferably with fiberoptic scope in the OR -- showing cherry red epiglottis
lateral soft tissue neck XR has sensitivity of 90% for showing thumbprint sign
163
What is the treatment for epiglottitis?
1. airway management
2. immediate IV antibiotics with ceftriaxone, cefotaxime, or amp/sulbactam
3. emergent ENT consultation
164
How is retropharyngeal abscess diagnosed?
lateral soft tissue neck XR during inspiration shows widening of the prevertebral space
C2: >7mm in adults or children
C6: >14 mm in children, >22mm in adults
then if stable, CT neck with IV contrast may be performed for presurgical planning
165
What is the treatment for retropharyngeal abscess?
1. early airway assessment and management -- awake fiberoptic intubation if necessary
2. high dose IV antibiotics with clindamycin or ampicillin/sulbactam
3. ENT consultation
4. ICU admission
166
What is the most common age to be affected by Croup?
6 months - 3 years (peak 2 years)
(rare beyond 6 years old)
167
What virus most commonly causes croup?
parainfluenza virus
168
How can severity of Croup be scored?
Westley croup score
(mild ≤ 2, moderate 3-7, severe > 7). It uses 5 clinical features:
■ Level of consciousness: Normal = 0, disoriented = 5
■ Cyanosis: None = 0, with agitation = 4, at rest = 5
■ Stridor: None = 0, with agitation = 1, at rest = 2
■ Air entry: Normal = 0, decreased = 1, markedly decreased = 2
■ Retractions: None = 0, mild =1, moderate = 2, severe = 3
169
How does XR play a role in diagnosing Croup?
AP neck XR with "steeple sign"
only useful if diagnosis is in doubt, otherwise diagnosed clinically
170
What is the treatment for Croup?
Dexamethasone 0.6 mg/kg oral/IM/IV
If stridor ->> nebulized racemic epinephrine
171
Can kids who received aerosolized epi be discharged home?
can be safely discharged home if after a 2-4 hour obs period, they are free of stridor and have access to close follow-up care
172
Fistula of which artery is a common cause of tracheostomy hemorrhage (and may be rapidly fatal)?
innominate artery
173
What is the treatment for a bleeding trach?
emergent ENT consultation
+ hemostatic measures:
- hyperinflation of the trach tube cuff
- replacement of the trach tube with cuffed ET tube if source of bleeding is more distal
- digital pressure = most reliable (may require extension of the stoma)
174
What is the diagnosis..
fever, malaise, generalized dental pain
exam: friable gingival inflammation with gingival ulcerations and gray pseudomembrane
necrotizing ulcerative gingivitis
175
What is the treatment for necrotizing ulcerative gingivitis?
Warm saline rinses, oral antibiotics (eg, penicillin or doxycycline), and improved dental hygiene
176
What is the treatment for minimally subluxed teeth?
soft diet for several days
177
What is the treatment for avulsed tooth?
reimplantation -- only of permanent/secondary teeth
178
How should an avulsed tooth be handled?
- touched only by the crown
- gently rinsed with saline or tap water
- transported in hanks solution, milk, or placed under patient or parents tongue (?? lol)
- after reimplantation, tooth should be stabilized with periodontal pack (resin and catalyst mix); update tdap, discharge with abx -- penicillin VK, as well as a liquid diet with dental follow up
179
How many classes of fractured teeth are there?
three: Ellis Class I, II, III
180
What is a class I tooth fracture?
fracture of enamel only
181
What is a class II tooth fracture?
Fracture through enamel and into the dentin, appearing with an ivory-yellow base
182
What is a class III tooth fracture?
Full-thickness fracture through enamel and dentin exposing pulp, identified with a pink blush or a drop of blood over the fracture site
dental emergency!
