Exam 1 Flashcards
(99 cards)
1
Q
hematoma (eruption)
A
swelling of clotted blood within gingiva (gums); most common during eruption of first molar
2
Q
bacteria that causes dental caries
A
strep mutans
3
Q
candidasis
A
caused by yeast; white curd-like plaques initially beginning on the buccal and/or labial mucosa and spreading to the tongue and finally to the lips
Tx: nystatin fir up to 4 wks (baby’s mouth, mom’s nips), clean bottle nipples/pacifiers (dishwasher), oral Diflucan for 7 days (if nystatin does not work)
4
Q
herpangina
A
caused by cocksackie virus
Sx: children <6 y/o (usually <3), low grade fever, rhinorrhea, vesicular/ulcerative lesions on the buccal, pharyngeal and/or labial (inside lining of lips) mucosa
Tx: oral discomfort (Ibuprofen, KBX, OTC orabase); resolves in 3 days
5
Q
herpetic gingivostomatitis
A
caused by herpes simplex virus 1 (HSV)
Sx: children < 8 y/o, usually very high fever (often lasting 7-10 days), vesicles and ulcers to pharyngeal, buccal and labial mucosa and most important: the gingival mucosa
Tx: oral acyclovir, oral discomfort (Ibuprofen, KBX), hydration
- lasts 7 days
Caution: eczema herpeticum, herpetic meningitis ro encephalitis
6
Q
glossitis
A
benign condition on surface of child’s tongue
Tx: none
7
Q
apthous ulcers
A
known as “canker sores”, common after minor oral mucosa trauma; resolve in 7-10 days
Tx: none (avoid irritation), OTC orabase/Zilactin
8
Q
mucocele
A
fluid-filled cysts on the labial or buccal mucosa, which develop following trauma
Tx: none, remove if interferes with chewing
9
Q
ankyloglossia
A
lingual frenulum is attached very close to the tip of the tongue - does not allow full mobility of the tongue
Tx: EMT referral for frenectomy
10
Q
Epstein’s pearls
A
whitish marks on midline of hard palate
Tx: none, will resolve in few wks
Bohn’s nodules: nodules on gingival ridges and hard palate
Dental lamina cyst: cyst along mandibular and maxillary gingival ridges
11
Q
“danger zone” for infection on face
A
triangle made of maxilla (upper jaw bone) to corners of eye
- area drains to brain
- admit for IV (systemic ABX) if infection in this area
12
Q
red reflex - ddx for abnormal
A
cataracts refractor error retinoblastoma strabismus OM conjunctivitis
13
Q
Hirschberg’s test (corneal light reflex) - ddx for abnormal
A
strabismus refractory error glaucoma (congenital) conjunctivitis (bacterial/allergy) trauma botulism
14
Q
cover / uncover - ddx for abnormal
A
amblyopia strabismus hemangioma (large eyelid) neoplasm refractive error glaucoma (congenital) cataract disorder neglect
15
Q
visual acuity - ddx for abnormal
A
vital sign of eye!
conjuntivitis sinusitis trauma (FB or corneal abrasion) refractory error uveitis orbital cellulitis
16
Q
following eye conditions = urgent ophthalmology consult or referral
A
congenital cataracts
corneal ulcer
periorbital cellulitis (danger triangle) - augmenten if reliable historian and EOM intact
orbital cellulitis (danger triangle) - IV ABX
17
Q
strabismus - treatment
A
patch or cyclopegic drops in good eye
surgery if not corrected
18
Q
amblyopia - treatment
A
correct underlying issue (strabismus, refractive error, neoplasm, hemangioma) before age 6
patch or cyclopegic drops in good eye
19
Q
dacrynostenosis - treatment
A
blocked tear duct
massage inner canthus of eye several times/day - should resolve in 4-6 months
ABX eye drops if purulent
referral to ENT for probing at 6mo
20
Q
hordeolum - treatment
A
infected gland on eyelid
warm compress
ABX eyedrops
resolve in 2-3 days
21
Q
chalazion
A
chronic (hardened) hordeolum
steroid eye drops - ophthalmologist referral
22
Q
antihistamine - rx and OTC eye drops
A
Rx: Patanol or Pataday
OTC: Naphcon and Ketotifen
Indication: allergic conjunctivitis
23
Q
antibiotic eye drops - rx
A
Polytrim, Vigamox, Ocuflox
24
Q
antibiotic ointment - for kids <1
A
erythromycin
25
herpetic conjunctivitis
HSV infection of eye
eyelid swelling, pain, photophobia, dendrite formation on cornea (see w/ fluorescein stain)
26
red flags in history and exam of the eye
eye pain
photophobia
trauma
vision loss (vital sign of eye)
27
red flag of eye trauma - ddx
- corneal abrasion/ulcer
- endopthalmitis
- periorbital cellulitis
- orbital cellulits
28
red flag of photophobia
herpetic conjunctivitis
uveitis
endopthalmitis
note:
conjunctivitis (minor)
blepharitis
29
red flags for eye pain
```
herpetic conjunctivitis
uveitis
endopthalmitis
keratitis
orbital cellulitis
```
30
red flags for vision loss
trauma (FB, corneal abrasion)
uveitis
endopthalmitis
orbital cellulitis
31
allergic conjunctivitis (ss, exam, tx, ed)
ss: bilateral, chemosis, cobblestoning on palprebral conjunctiva
pe: other allergic findings (boggy nasal turbinates, stringy/clear mucous)
tx: antihistamine: Patanol, PAtaday
ed: avoid allergen, itching, touching eyes
rtc: pain, photophobia, worsening of sxs, vision loss
32
bacterial conjunctivitis (ss, exam, tx, ed)
ss: purulent d/c, sig. erythema, swelling of eye lid, w/o pain
- lack of allergic and viral sx
tx: ABX eye drop (Polytram), erythromycin (<1)
ed: hand washing key, tx both eyes if spreads, should resolve in 24 h, return to school 24 h
rtc: pain, photophobia, worsening of sxs, vision loss
33
viral conjunctivitis (ss, exam, tx, ed)
ss: current URI, erythema w/ or w/o watery d/c
tx: ABX eye drop (Polytram), erythromycin (<1) - self-limiting
ed: hand washing key, tx both eyes if spreads, any purulent d/c resolve in 24 h, return to school
rtc: pain, photophobia, worsening of sxs, vision loss
34
corneal abrasion
assess: very painful, contact lens wearer, small pupil - lack of response, seen w/ fluorescein stain and tangential lighting and slit lamp
manage: ABX (polytrim), RTC 1 day (resolve), no contacts 24 hrs
35
corneal ulcer
assess: very painful, contact lens wearer, seen w/ tangential lighting and slit lamp (possibly w/ fluorescein stain) (ulcerative/whitish)
manage: urgent ophthalmic referral
36
ocular trauma
rule out hyphema or open globe (total thickness of eye wall) injury (urgent referral)
hyphema: concern for glaucoma
trauma: concern for retinal detachment
Note: do not do fluorescein stain until r/o open globe
Note: always look for fractures or other signs of ocular trauma
37
peri-orbital cellulitis
cause: secondary to skin disruption (insect bite, scratch)
exam: erythematous, edematous, warm eyelids with a fever; often can see small trauma; normal EOM
manage: outpatient Augmentin w/ strict monitoring and RTO precautions since in danger triangle
- fever, worsens, confusion, inc. HR or RR, SOB, fainting, pale skin
38
orbital cellulitis
cause: spread from sinusitis (from orbital bone) or eye trauma
exam: erythematous, edematous, warm eyelids with a fever; chemises of conjunctiva, proptosis (eye pops out), abnormal EOM
manage: admit for CT scan and IV ABX
39
rhinitis: most common causes
viral rhinitis
allergic rhinitis ("hay fever")
bacterial sinusitis
40
viral rhinitis (ss, tx)
ss: frequent rhinorrhea with periods of resolution (even brief); yellow-green nasal discharge common around days 3-4, 7-14 days
tx: supportive care
- nasal irrigation q few hrs
- honey for cough (not <1)
- humidifier
41
allergic rhinitis (ss, tx)
clear, thin rhinorrhea, nasal congestion, sneezing, pruritus of eyes, nose, ears and palate; post-nasal drip causes cough and hoarseness
• PE: pale pink/bluish gray, swollen boggy nasal turbinates w/ clear, watery secretion; dark periorbital areas, swollen eyelids, conjunctival injection
• Sxs: more constant, seasonal, crease on bridge of nose (“nasal salute”)
• Often accompanied by other atopic diseases: asthma, eczema
tx: intranasal steroids or systemic antihistamine
42
bacterial sinusitis
longer than 10 days (but < month), fever, purulent discharge worsening
- unlikely in children since have later sinus development
tx: Amox 80/90 mg/kg/day BID x 10 days
- supportive care
43
why do we treat group A strep with ABX (even when many have in system)
to avoid complications of post-streptococcal glomerulonephritis or rheumatic fever
44
treatment for GAS carrier
Augmentin/clindamycin – associated with GAS eradication
o Be clear that you are not treating illness today
o Have pt RTC in 2 weeks for GAS culture to see if eradication worked or to prove carrier status
45
GAS - treatment
If score indicates tx:
PCN (including amoxicillin, ampicillin), cephalosporins, and macrolides for 10 days
- Stress the importance of completing the entire regimen
- patients can return to school once they complete 24 hours of treatment
46
sore throat - ddx
viral pharyngitis, sinusitis, GAS pharyngitis / scarlet fever, GAS carrier status, mononucleosis, abscess
47
rapid strep test - validity
```
low sensitivity (30% false negatives) - treat and send for culture
- only do rapid strep for score of 6!!
```
48
peritonsillar abscess - sxs
sore throat, fever, difficulty swallowing, hot potato voice
deviated uvula, bulging soft palate
Note: emergent ENT (life threatening due to airway obstruction)
49
retropharyngeal abscess
sore throat, fever, difficulty swallowing, stiff neck, lateral neck flexion
Note: emergent ENT (life threatening due to airway obstruction)
50
obstructive sleep apnea (ss, risk factors, management)
ss:
- Habitual snoring
- Episodes of arrested breathing/choking during sleep
- Behavior/learning problems including ADHD
- Nocturnal enuresis (inability to control urine)
risk factors:
- Adenotonsillar hypertrophy
- Obesity (BMI>97%)
- Family hx
- Cranial facial malformations
manage:
- sleep study (EEG and resp. effort) and ENT if pos.
- directly to ENT
- tonsillectomy/adenoidectomy
- CPAP machine
51
child with fever OR rhinorrhea OR conjunctivitis
ALWAYS look in ears!
52
most common cause of conductive hearing loss in children
otitis media with effusion (unresolved)
| - why so important to have pt f/u in 4 weeks (and until resolved or refer to ENT)
53
acute otitis media - key history questions
breastfeeding
smoke exposure
family history
vaccines: Prevnar and Hib
54
acute otitis media - treatment
ABX if needed
- f/u if no improve in 2-3 d - change ABX (resistance)
Watchful waiting
- f/u if sx do not resolve in 2-3 days
- safety net Rx (avoid 2nd appt.)
Everyone dx with AOM
- follow-up in 4 weeks to see if otitis medial w/ effusion resolved
55
acute otitis media - rules for ABX treatment
fever (>102.2 F / 39 C) w/ otalgia
bilateral involvement 6-23 mo.
if sxs persist for 2-3 days after seen
56
AOM - 4 week follow-up
checking for resolution of otitis media with effusion
- can use light reflex (present if effusion gone)
- can use pneumatic otoscope
- can use tympanogram
57
ddx for ear pain
```
AOM
OM w/ effusion
mastoiditis
foreign body
otitis externa
```
58
tympanogram
provides acoustic measurements of TM middle ear system using sound energy
correlates well with presence or absence of middle ear effusion
sharp peak = normal TM mobility (lack of effusion)
59
Amoxicillin dosing
80-90 mg/kg/day divided BID
- this is high dose Amox
- max: 3g/day
Note: same dosing for Augmentin
60
mastoiditis
emergent complication of AOM (mastoid air cells infected) – keep on Ddx
• Infection in facial area of concern for meningitis and brain abscess
• Emergent referral to ENT or admit if ill appearing in office
61
AOM - most common bacteria
Streptococcus Pneumoniae: PEN (Amox)
Resistant Strep. Pneumo or other organisms: Augmentin
62
antibiotics used for common HEENT pathologies
1st line: high dose Amoxicillin
- 80-90 mg/kg/day (BID) x 10 days
2nd line: Augmentin (high dose Amox w/ clavulanic acid)
- if had AMOX in past 30 days
- if resistant strain (beta-lactamase)
3rd line: cephalosporins (Rocephin, IM daily for 3 days)
- for PEN allergy (no urticaria or anaphylaxis)
4th line: macrolides (azithromycin)
- if hx of anaphylaxis or urticaria with PEN
63
key vaccinations for HEENT issues in PEDS
Prevnar (pneumococcal conjugate vaccine (PCV)) - vaccine against strep pneumoniae
Hib: Haemophilus influenzae type b
64
tonsilar grading
```
1+ = just visible
4+ = touching
```
65
What treatment does every draining ear get?
ear drops - ABX (anti-bacterial) and steroid (anti-inflammatory)
66
pre-auricular pits - findings and tx
small hole in front of crus of helix - developmental anomaly
tx: nothing unless infected (then referral to ENT for surgical removal of sinus)
67
auricular hematoma - findings and tx
fluid (blood) fills space in Y of anti-helix of ear; caused by trauma to pinna (wrestler's ear)
tx: referral to ENT for draining and pressure dressing
68
perichondritis - findings and tx
inflammation of cartilage of ear (often from peircings in cartilage)
tx: oral or IV ABX w/ good cartilage penetration
69
otitis external - findings and tx
inflammation and exudation in external auditory canal in absence of other disorders (OM or mastoiditis)
- pain, tenderness (w/ pinna mov't and chewing), DRAINAGE
- no fever or hearing loss
- occurs in summer months (“swimmers ear”)
- can be bacterial or fungal
tx: topical drops (ABX ro corticosteroid) for every draining ear
- anti-fungal drops if fungal infection
70
granulomas - findings and tx
salmon-colored tissue in middle ear (defected skin cells filled w/ blood vessels)
tx: Cipro X (topical ABX and steroid drop)
- if granulation does not go away = ENT referral
71
exostosis - findings and tx
benign bony growths (caused by cold water exposure) – hard and painful on palpation w/ probe (can be multiple)
- surfers/kayakers ear
Tx: nothing (surgical intervention if traps wax)
72
osteomas - findings and tx
benign tumor that will continue growing – soft and non-painful on palpation w/ probe (single lesion, reddish)
Tx: refer to ENT for removal – can cause problems if touches TM or occludes canal impeding on epithelial migration
73
tympanosclerosis - findings, tx, potential complications
findings: calcified mass (scar plaque), bright white w/ distinct edges, surrounded by normal TM on all borders, TM mobility intact
tx: nothing
comp: rule out cholesteatoma
74
TM perforations - findings, tx, potential complications
findings: hole in TM, shiny middle ear mucosa visible through the perforation (liquid)
tx: spontaneous healing likely; use drops if draining; avoid swimming or altitude
comp: refer to ENT if:
- not healing in 2 weeks
- signs of infection
- vertiginous after injury (spinning sensation)
75
TM retractions - findings, tx, potential complications
cause: Eustachian tube dysfunction and middle ear gases resorb
findings: TM retracts (visualize bony landmarks)
tx: ENT referral for possibly PE tubes to releve pressure
comp:
- pressure on ossicles (ear bones) and lead to bony erosion and conductive hearing loss
- hearing worsens suddenly (loss of connection b/t incus and stapes)
- can result in cholesteatoma
76
cholesteatoma - findings, tx, potential complications
cause: trapped epithelium cannot properly migrate out of ear canal (inflammation present, drainage can occur from infected debris)
- primary and secondary (see retractions)
- congenital (no retractions)
- hearing loss slight to moderate
- located in antero-superior quad (light area where should be darkest)
findings: yellowish or whitish mass behind TM w/ or w/o retractions (does not follow rules for tympanosclerosis)
tx: immediate referral to ENT
comp:
- pressure and enzymes cause erosion of bones involved in hearing
- can grow into ear canal, facial nerve (paralysis), brain (life-threatening)
77
TM perforations - documentation
important to document quadrant and percentage perforated so tracking of healing is possible
- refer to ENT if not healed in 2 weeks (or making progress)
78
mastoiditis - clinical presentation
complication of OM - inflammation and destruction of mastoid air cells result in infection of bone (osteitis) and mastoid abscess formation
findings: in addition to OM signs...
- posterior auricular tenderness, swelling, erythema
- pinna is displaced downward and outward
79
indications for ENT referral
Pre-auricular pit: only if infected
Auricular hemotoma: always
Granuloma: if not resolved by ear drops (steroid and ABX)
Osteoma: always for removal
TM perforations:
- If not healing in 2+ weeks
- If accompanied by spinning sensation or infection
TM retractions: always
Cholesteatoma: always (surgery)
Mastoiditis: always (danger triangle)
80
children with expected hearing loss - risks and signs
Perform objective screens: newborn, 4, 5, 6, 8, 10, 12, 15, 18 (annually but q 6 mo if high risk)
- Typanometry performed in physicians office and helps to dx and manage OM w/ effusion
Know risks: family hx, in utero infection (CHARGE association), low birth weight, low APGAR scores, parent concern, bacterial meningitis, head trauma, syndrome with known association to SNHL or CHL, recurrent or persistent OM w/ effusion
Know signs: delayed speech and language development (extensive language by age 3-4 y/o), below par performance, poor behavior, inattention in school
81
children with expected hearing loss - management
Refer for full developmental and speech and language evaluation (audiology and speech evaluation)
If audiology and speech evaluation abnormal, refer to otolaryngology, genetics, ENT, speech referral for diagnostic testing
Repeat auditory testing as necessary to monitor
82
type of hearing old associated with otitis media w/ effusion
conductive hearing loss
83
hearing loss treatments
CHL: surgical correction or getting rid of effusion → ENT
SNHL: hearing aides
Congenital/prelingual onset deafness (infants, young child): multichannel cochlear implants
- note: risk of pneumococcal meningitis (must be vaccinated with PCV13)
84
cochlear implants - which vaccine must be given first
PCV13 - risk of pneumococcal meningitis
85
early childhood caries (ECC)
caries (repaired or not) or missing teeth from caries in children < 6 y/o
#1 chronic disease in children
86
complications of herpetic gingivostomatits
herpetic whitlow: vesicular lesions spread to hands - looks bad, but no big deal
eczema herpeticum: admission for IV anti-viral drugs (disseminated HSV)
herpetic encephalitis or meningitis (child with HSV has seizure): ER or admit for lumbar puncture
Note: seizure could be from high fever
87
fever - DDx (HEENT)
```
herpetic gingivostomastitis
viral sinusitis
rhinosinusitis
GAS pharyngitis
bacterial sinusitis
acute otitis media
otitis conjunctivitis syndrome
peritonsilar or retropharyngeal abscess
peri oribital or orbital cellulits
```
88
checking for dehydration - children
```
wet diapers / urination
color of urine
tongue blade on buccal mucosa
cap refill
skin turgor
```
89
tooth fractures - things to keep in mind
aspiration of tooth (CRX)
intrusion injury (vs. avulsion)
facial cellulitis can occur if infection gets into tooth root and spreads
- maxilla: danger triangle (admit for IV ABX)
- mandible: outpatient tx w. PEN
90
what should you do if you suspect an intrusion injury or Class 4 fracture
send to dentist for DENTAL x-ray
91
maxillary lip laceration - do you need IV ABX b/c danger triangle
no, due to high blood flow to lips / mouth
92
acute uveitis
inflammation fo uvea (pigmented layer b/t retina and sclera.cornea) - includes iris, ciliary body, and choroid
- associated with JIA
- erythema, ciliary flush (redness around iris), irregular pupil, poor vision, photophobia, pain, hypopyon
93
choanal atresia
bony or membranous septum b/t nose and pharynx
- CHARGE association
- can be unilateral or bilateral
- most common congenital anomaly of nose
think of (along with viral rhinitis, bacterial sinusitis, and foreign body) w/ purulent d/c
94
pt with swollen eyelid
must do EOM exam to rule out orbital cellulitis
95
PCP role in retinopathy of premature infant
follow-up on ophthalmology recheck
| document discussions about importance of continued follow-up ( every 1-2 weeks)
96
purulent nasal discharge - Ddx
viral rhinitis (rhino-sinusitis)
bacterial sinusitis
foreign body
choanal atresia
97
clinical sxs of AOM
1. moderate to severe TM bulging OR
2. new onset otorhea OR
3. mild TM bulging + <48 hr ear pain/evidence of discomfort
98
clinical manifestations of AOM
ear pain, strabismus, abnormal eye mov/t, diarrhea, hearing loss, fever w/o a source
99
population at inc. risk of developing persistent middle ear effusion resulting in conductive hearing loss
children <2
| special circumstances: cleft palate, down syndrome, sinus disease, allergies
