Clin Med: Ped HEENT

Question 1

High risk for dental caries

Answer 1

• mother/caregiver w/ cavities or low socioeconomic status
• > 3 b/t meal sugary snacks/drinks
• > bed w/ bottle of sugary drink
• white spot lesions or enamel defect
• visible cavities or fillings

Question 2

Moderate risk for dental caries

Answer 2

• special health care needs
• recent immigrant
• plaque

Question 3

Lowers risk of dental caries

Answer 3

• fluoride water/supplements
• daily brushing w/ fluoride toothpaste
• topical fluoride at dentist
• good dental care

Question 4

Otitis Externa Tx

Answer 4

• Irritation w/o infx: OTC acetic acid/ isopropyl alcohol drops
• Infx: Otic suspension +/- ear wick
  –> Neomycin/polymyxin B
  –> Cipro drops
  –> Cipro + Dexamethasone (Ciprodex)
  –> Ofloxacin drops

Question 5

Otitis Media Tx

Answer 5

• APAP/ibuprofen for pain

Abx vs wait & see
- Bulging red TM & looks like infx–> amoxicillin (90mg/kg/day)
–> If Pt has a type 1 sensitivity: Azithromycin
–> 2-3 days after itchy rash Cephalosporin (Cefdinir)

• Look in ear, not quite normal some redness & fluid–> wait & see
• Looks normal, but still pulling on ear–> do nothing (wait & see)

Question 6

Refer child to ENT w/ otitis media if:

Answer 6

> 3 in 6 months
4 in 12 months

Question 7

How to remove small inorganic objects?

Answer 7

irrigation
–> no irrigation if perf TM, vegetable/fruit/plant (can swell) & button batteries

Question 8

How to remove “grabbable” items?

Answer 8

alligator forceps

Question 9

Smooth objects can be removed wtih?

Answer 9

superglue or skin glue

Question 10

How to remove live insects?

Answer 10

• kill by inserting alcohol/mineral oil, or lidocaine then remove

Question 11

Refer child w/ FB to ENT if:

Answer 11

• tried >1 one attempt
• Firm, rounded object w/ smooth surfaces

Question 12

Tympanic membrane perf Tx:

Answer 12

• no H2O in ear, 80% heal on own
  –> May req surg if doesn’t heal spontaneously

Question 13

Describe grade 1 Microtia

Answer 13

ear is smaller, but still looks like an ear b/c most normal features are present

Question 14

Describe grade 2 Microtia

Answer 14

some normal features, but the upper ear is severely deficient
- (+/-) cana

Question 15

Describe grade 3 Microtia

Answer 15

small piece of cartilage is present just above the ear lobe which is displaced upward & forward.
- the canal is almost always absent

Question 16

Describe grade 4 Microtia

Answer 16

• called anotia
• complete absence of ear & canal

Question 17

Aphthous Stomatitis Tx:

Answer 17

• Pain control– Topical anesthetics & coating agents
• dental hygiene:
  –> 2% viscouslidocaine: topical or swish & spit
  –> Diphenhydramineliquid: swish & spit
  –> Simethicone: swish & spit
  –> “Magic Mouthwash”-
  ViscousLidocaine, Maalox,
  Benadryl

Question 18

Hand Foot Mouth Dz Causative agent:

Answer 18

coxsackie virus A16

Question 19

Tonsillitis/Pharyngitis: Mono presentation

Answer 19

• fatigue
• post. cervical lymphadenopathy

Question 20

Tonsillitis/Pharyngitis: GABHS presentation

Answer 20

• fever,
• no cough
• ant. cervical lymphadenopathy

Question 21

Tonsillitis/Pharyngitis: Tx

Answer 21

• Mono- supportive, no sports
• Strep (all weight based dosing)
  –> Benzathine PNG G IM once
  —> PCN VK
  –> Amoxicillin
  –> Azithromycin

Question 22

Tonsillectomy if strep:

Answer 22

• ≥3 episodes in each of 3 years,
• ≥5 episodes in each of 2 years OR
• ≥7 episodes in 1 year

Question 23

Peritonsillar abscess Tx

Answer 23

• PO Abx: Augmentin or Clinda OR
• IV Abx: Unasyn or Clinda
• I&D by ENT

Question 24

Mastoiditis Tx

Answer 24

• IV Abx
  –> Surg if med therapy failure

Question 25

Oral Candidiasis Tx

Answer 25

Nystatin swish & swallow

Question 26

Epiglottis Tx:

Answer 26

• ADMIT
• IV Abx

Question 27

Epistaxis Tx

Answer 27

• oxymetazoline to constrict vessels
• moisturize mucosa w/ saline rinses, humidifier
• Refer to ENT for recurrent/intractable bleeding