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PNP: Physical Assessment - BK > Nose/Throat > Flashcards

Nose/Throat Flashcards

1
Q

Nose Assessment

External Nose

A
  • Does child have unusual shape
  • Saddle shaped nose
  • Symmetry, size, normal variations, abnormalities
  • Discharge
  • Flaring
  • Allergic crease or nasal pleat
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2
Q

Nose Assessment

Internal Nose

A
  • Septum – central, deviated, intact
  • Patent nares
  • Mucosal edema, erythema, discharge
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3
Q

Physical Assessment of the Nose

A
  • Look at the nose
  • Palpate the soft tissue and ridge of the nose
  • Tilt the child head back
  • Check each nare separately using the otoscope light
    • Note the color of the mucosa
    • Push the tip of the nose upward and hold the light with the other hand
    • You should be able to see up the nose
  • Do not touch the nares
  • Turbinates
    • Equal
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4
Q

Color of Mucosa/Secretions

Red inflamed mucosa

A

Infection

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5
Q

Pale Boggy Mucosa

A

Allergy

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6
Q

Swollen grayish mucosa

A

Chronic rhinitis

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7
Q

Purulent Secretion

A
  • Common with any nasal infections
  • If the secretions are from high up in the nose, may indicate sinus infection
  • Discharge and crusty nose indicates streptococcal infection
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8
Q

Water nasal secretions indicate

A
  • Allergy
  • Common cold
  • Ilicit drug use
  • Rarely skull fracture
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9
Q

Purulent foul smelling secretions

A

Foreign body

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10
Q

NOSE

Toddler, school age child, adolescent

A
  • Foreign bodies
  • Epistaxis
  • Sinusitis/Purulent rhinitis
  • Allergic rhinitis
  • Nasal Polyps
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11
Q

Epistaxis

History and Physical Exam

A
  • History
    • Duration and amount
    • Efforts at home
    • Prior history
    • Medication use
  • Physical Exam
    • Is patient hemodynamically stable
    • Posterior bleeding rare in pediatrics
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12
Q

Epistaxis

Location

A

Typically anterior in origin in childhood

Little’s area = Kiesselbach’s area or plexus

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13
Q

Causes of Epistaxis

A
  • Trauma
    • Digital, foreign body, air pollution
  • Inflammation
    • URI
  • Anatomic
    • Nasal septal deviation
  • Vascular abnormalities
    • Hemangioma
  • Malignant neoplasm
    • Phabdomyosarcoma, lymphoma
  • Platelet dysfunction
    • NSAID use, especially aspirin
    • ITP
    • Leukemia
  • Coagulopathy
    • Von Willebrand disease
    • Hemophilia
    • Liver Disease
  • Benign masses
    • Pyogenic granuloma
    • Papilloma
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14
Q

Management of Epistaxis

A
  • Digital pressure for 10-15 minutes
  • Silver nitrate cautery
  • Topical vasoconstrictors
    • Neo-synephrine
    • Nasal sponge: must be removed in 48 hours
    • Antibiotic RX
    • Nosebleed QR
  • Treatment is use of bactroban tid for one week
  • If posterior bleed must have ENT consult
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15
Q

Nose: Quantifying blood loss

A
  • When mothers/teachers get worried about the amount of blood lost due to nose bleeds, it is helpful to quantify how much blood the child actually lost
  • Blood that would saturate a 4x4 gauze is only about 1 tsp of blood
  • Reassurance
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16
Q

Nose Problems

Nasal

A

Unilateral foul smelling discharge

Can sometime visualize

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17
Q

Nose problems

Allergic Rhinitis

A

Inflammation

Edema

Weeping of nasal mucosa

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18
Q

Assessment following midface trauma

A
  • Observe for deviation of the nasal septum
  • Evaluate the septal hematoma
    • Bulding of nasal septum into the nasal cavity
    • Can deprive cartilage and overlying mucoperichondrium of blood supply
    • Is there any clear fluid leak of CSF as a result of skull fracture through the cribriform plate
  • Do vision screening
    • Do extraocular movements to evaluate for orbital fracture
    • Check for pupil reactivity to light
  • Look in the oral cavity for injury from the trauma
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19
Q

MOUTH and THROAT

Intro

A
  • Defer until last
  • Note the color around the mouth
  • Inspect lips
  • Look for symmetry when open
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20
Q

Angular cheilitis VS. Cheilosis

A
  • Look for angular cheilitis
    • Fissures that occur after exposure to wind, sun
  • Look for cheilosis
    • Occurs with nutritional deficiency
    • Riboflavin deficiency
21
Q

Clinical Eval of the Oral Cavity

Lips, buccal mucosa, gums

A
  • Lips
    • Moist, symmetry, color
    • Mouth breathing
    • Shape of philtrum
  • Buccal mucosa (inside cheek)
    • Color
    • Lesion
  • Gums
    • Color, swelling, bleeding
22
Q

Clinical Eval of the Oral Cavity

Tongue, teeth, palate, pharynx

A
  • Tongue
    • Size
    • Color
    • Mobility
    • Lesions
    • Frenulum
  • Teeth
  • Palate: color, symmetry, closure
  • Pharynx
23
Q

Eval of the Oral Cavity

Assessment tips

A
  • Save the posterior pharynx exam for the last in young children
  • Ask child to open their mouth and show you their teeth (appropriate for older toddler/child)
  • Moisten the tongue blade
  • An alternative is to be flexible and look in the mouth when the child is crying for some other reason!!!
24
Q

Clinical Eval – INSPECTION

A
  • Inspect the teeth
    • Count the number of teeth and note position
    • Note any defects or discolorations
  • Inspect the gums, mucosal surfaces and posterior pharynx
  • Inspect the buccal mucosa and gums looking for ulcers, candida, or trauma
25
Q

How to see the Posterior Pharynx

A
  • You may have to use the tongue blade and gag the child
  • Alternative tricks you can use include asking the child to – roar like a lion; pant like a dog
  • HAH-HAH Test
  • Sing LA-LA-LA
  • Pretending your tongue is stuck down and out
26
Q

Tonsils

A
  • Note tonsillar size
  • Tonsils enlarge to their peak size at 7 and then will disappear slowly behind the tonsillar pillars
27
Q

Tonsil Grading

A
  • Tonsils are +1 if they are visible only slightly beyond the tonsillar pillars
  • Tonsils are +2 if they are midway between tonsillar pillars and uvula
  • Tonsils are +3 if they are nearly touching the uvula
  • Tonsils are +4 if they are touching at midline and occluding view of oropharynx
28
Q

Geographic Tongue

A

Geographic tongue (benign migratory glossitis) is a painless condition characterized by in amed, irregularly shaped areas on the dorsum of the tongue that are devoid of liform papil- lae.

Lesions are red, slightly depressed, and bordered by a whitish band

29
Q

Causes of Painful Mouth Ulcers

A
  • Aphthous ulcers of unknown etiology
  • Immune deficiency
  • Erythema Multiforme
  • Leukemia
  • Folic Acid
  • B 12 deficiency
  • Inflammatory Bowel disease
  • Neutropenia
  • Niacin deficiency
30
Q

Clinical Presentation of Streptococcal Tonsilitis

A
  • Nausea and fever may be the only presenting symptom of strep throat
  • Always examine the throat of a child with abdominal pain especially on the right side since you can get lymphoid tenderness in the right lower quadrant pain
  • Epigastric tenderness and headache is another sign of strep
31
Q

Pastia’s Lines

A

After generalization the rash becomes accentuated in skin folds and creases, and 1 to 3 days after its appearance, petechiae may appear in a linear distribution along the creases, forming Pastia lines

32
Q

Peritonsillar Abscess

A
  • Most common deep infection of neck
  • Typical complication of tonsillitis
    • Extension of infection from tonsil
    • Abscess form between tonsil capsule and superior constructor muscle
    • Obstruction and infection of weber gland
33
Q

Dental Health Assessment: History

A
  • Changes in teeth or mouth
  • Oral hygiene practices (frequency, problems)
  • Use of fluoridated water for drinking or cooking
  • Fluoride use (fluoridated toothpaste, fluoride supplements)
  • Dental sealant use
  • Eating practices
  • Illnesses or infections
  • Medications
  • Physical activity and sports participation
  • Injuries to teeth or mouth
  • Use of tobacco by adolescent
34
Q

Preventative Counseling

A

Dental care/Dental caries

Gingivitis begins in early childhood

9-17% of children aged 3-11 years have gingivitis

If chronic, most common complaint is bleeding gums

35
Q

Caries risk assessment

Low risk

A
  • No carious teeth in past 24 months
  • No enamel demineralization (enamel caries “white-spot lesions”)
  • No visible plaque; no gingivitis
36
Q

Caries Risk Assessment

Moderate

A
  • Carious teeth in the past 24 months
  • 1 area of enamel demineralization (enamel caries “white-spot lesions”)
  • Gingivitis*
37
Q

Caries Risk Assessment

High Risk

A
  • Carious teeth in the past 12 months
  • More than 1 area of enamel demineralization (enamel caries “whitespot lesions”)
  • Visible plaque on anterior (front) teeth
  • Radiographic enamel caries
  • High titers of mutans streptococci
  • Wearing dental or orthodontic appliances†
  • Enamel hypoplasia‡
38
Q

CAT – Environmental

Low Risk

A
  • Optimal systemic and topical fluoride exposure
  • Consumption of simple sugar or foods strongly associated with caries initiation primarily at mealtimes
  • High care giver socioeconomic status
  • Regular use of dental care in an established dental home
39
Q

CAT – Environmental

Moderate

A
  • Suboptimal systemic fluoride exposure with optimal topical exposure
  • Occasional (i.e., 1-2) between-meal exposures to simple sugars or foods strongly associated with caries
  • Midlevel caregiver socioeconomic status (i.e., eligible for school lunch program or SCHIP)
  • Irregular use of dental services
40
Q

CAT – Environmental

HIGH

A
  • Suboptimal topical fluoride exposure
  • Frequent (i.e., 3 or more) between meal exposures to simple sugars or foods strongly associated with caries
  • Low-level caregiver socioeconomic status (i.e., eligible for Medicaid)
  • No usual source of dental care
41
Q

CAT – general health conditions

HIGH

A

Children with special health care needs

Conditions impairing saliva composition/flow

42
Q

Maxillary Sinus

A

Present at birth

Rapid growth from birth to 4 and 6-12

Final growth

43
Q

Frontal Sinus

A

Last sinuses to develop

Begins between 4-8 years of age

Fully until late adolescence

44
Q

Ethmoid

A

Present at birth but not developed

Grow rapidly during the first 4 years

Fully developed by 12 year

45
Q

Sphenoid

A

Undeveloped at birth

Does not begin to grow rapidly until after 5 years of age

Complete between 12-15 years of age.

46
Q

Sleep Problem

A

Must do physical assessment of HEENT

47
Q

NASAL POLYP NEED TO RULE OUT

A

CF

SWEAT TEST

48
Q

STREP – MOUTH

A

PETECHIAE ON PALATE

49
Q

TWO UVULA

A

BIFID UVULA

SUB-MUCOSAL CLEFT

PNP: Physical Assessment - BK (13 decks)

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