HEENT

Question 1

Obtaining a CT of the head would be indicated in which of the following conditions?

a. macrocephaly
b. cephalohematoma
c. craniosynostosis
d. caput succedaneum

Answer 1

a. macrocephaly

Macrocephaly has numerous underlying causes such as hydrocephalus that need to be identified so appropriate treatment can be initiated. A CT scan would be necessary for that identification.
A routine skull x-ray could be used to identify craniosynostosis

Question 2

Patients with cleft lip/palate are more likely to have recurrent ________ in childhood.

Answer 2

recurrent otitis media as well as associated hearing loss

Question 3

In a patient with cleft lip and palate, what is repaired first and at what age?

Answer 3

The lip is repaired first by 2 months of age, palate by 9 to 12 months

Question 4

Patients with cleft lip and palate may need a referral to _____ in the future.

Answer 4

Referral for dental restoration if needed.

Others involved may include: ORL, plastic surgeon, ped dentist, prosthodontist, orthodontist, speech therapist, psychiatrist, social worker and genetic counselors

Question 5

Initial decalcification of enamel appear as what?

Answer 5

Initial decalcification of enamel appear as white spots that turn light brown, progressing to dark brown with the destruction of the tooth.

Question 6

What type of diet would help prevent dental caries?

Answer 6

Well balanced diet with appropriate feeding practices; low sugar and complex carbohydrate consumption

• wean from bottle, pacifier and breast at 1 year of age

Question 7

Topical fluoride varnish should be administered how often?

Answer 7

topical fluoride varnish should be administered every 3 to6 months

Question 8

What differentiates minor apthous ulcers from major apthous ulcers (canker sores)?

Answer 8

The size of the lesions and duration differentiate the two.
Minor: 1 to 5 lesions, 1 cm, lasting 7 to 14 days

Major: 10% of cases; lesions are greater than 1 cm, lasting greater than 6 weeks

Question 9

What would you dx a patient that presents with a single or multipule, small, oval, indurated papules with erythematous halo; develops pale center that erodes into ulcers?

Answer 9

minor or major apthous ulcers (canker sores) depending on the size and duration of the lesions

Question 10

How do you treat apthous ulcers (canker sores)?

Answer 10

canker sores can be treated with oral analgesics

• 6 to 12 years: chloraseptic spray
• greater than 12 years: viscous xylocaine solution, steriod in orabase

You can also use an antibacterial rinse (tetracycline) to shorten the disease course in patients greater than 9 years old.

Question 11

How soon after exposure does a patient begin to experience symptoms?

Answer 11

Illness starts 5 to 10 days after exposure

Question 12

Recovery from HSV takes how long?

Answer 12

Spontaneous recovery in 7 to 10 days

Question 13

Does the initial symptoms of HSV differ from subsequent reoccurrence?

Answer 13

Yes
Initial: includes fever, chills, irritability, tender submandibular adenopathy, ulcerative exanthem of the gingiva and mucous membranes of the mouth, sore throat. Anorexia and mouth pain can lead to dehydration

Recurrent: limimted to a few lesions on the lips- may erupt without sympjtoms but sometimes have prior tingling in lips before blisters appear

Question 14

What are grouped vesicles on erythemaous base; commonly found on mucocutaneous border of lips?

Answer 14

HSV

Question 15

what are vesicles on oral mucousa gingiva, tongue, and lips; ulcers that bleed easily from following vesicle stage; diffuse erythematous, edematous gingiva, especially the interdental papillae

Answer 15

Primary gingivostomatitis in HSV

Question 16

Does management of HSV include abx?

Answer 16

Yes and no
1. Acyclovir may be considered in select patients for primary episodes but is not routinely used; must be started in first 72 hours

2. Treatment is primarily for pain relief (comfort). Once the blisters/vesicles are out, no treatment will hasten resolution.
   - OTC cold sore treatment
   - tylneol or iburpofen
   topical relief with
   occlusive gels

Otherwise, spontaneous recovery within 2 weeks

Question 17

What is a concern of primary HSV?

Answer 17

dehydration

Question 18

Acute viral illness presenting with vesicular exanthem on tongue, gums, palate, oral mucosa; papulovesicular exanthem on hands, feet, and commonly the buttocks in diapered children; less commonly occur on the trunk and extremities

Answer 18

Hand, foot and mouth (coxsackie virus)

Question 19

What seasons is hand, foot and mouth most prevalent and what is its incubation period?

Answer 19

summer and fall; incubation 4 to 6 days with spontaneous resolution in one week

Question 20

What disease has vesicular lesions that appear as blanching red lesions on anterior pillars, palms and soles

Answer 20

HSV

Question 21

What is Herpangina

Answer 21

Herpangina is an acute viral illness presenting with ulceration and inflammation of oral mucosa

Spontaneously resolves in 3 to 5 days

Question 22

What are the most common incidences of herpangina

Answer 22

Coxsackie virus group A more common than coxsackie B viruses and echoviruses