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PNP: Physical Assessment > Nose, Throat, Mouth > Flashcards

Nose, Throat, Mouth Flashcards

1
Q

External Nose Assessment (6)

A
  1. Does child have unusual shape
  2. Saddle shaped nose
  3. Symmetry, size, normal variations, abnormalities
  4. Discharge
  5. Flaring
  6. Allergic crease or nasal pleat
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2
Q

Internal Nose Assessment (3)

A
  1. Septum—central, deviated, intact
  2. Patent nares
  3. Mucosal edema, erythema or discharge
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3
Q

Physical Assessment of the Nose (9)

A
  1. Look at the nose
  2. Palpate the soft tissue and ridge of the nose
  3. Tilt the child head back..
  4. Check each nare separately using the
    otoscope light
  5. Note the color of the mucosa
  6. Push the tip of the nose upward and hold the light with other hand
  7. You should be able to see up the nose
  8. Do not touch the nares.
  9. Check that turbinates are equal

Never leave speculum on!

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4
Q

Nasal Fractures and Hematoma

A

In children, there is only a loose attachment of the upper lateral cartilages to the nasal bones, so it is possible to develop hematomas in this area as well. Untreated hematomas cause pressure necrosis to the septal cartilage, leading to a saddlenose deformity

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5
Q

Red inflamed nasal mucosa…

A

Infection

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6
Q

Pale boggy nasal mucosa…

A

Allergy

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7
Q

Swollen grayish nasal mucosa…

A

Chronic rhinitis

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8
Q

Purulent secretion nasal mucosa…(5)

A
  1. Common with any nasal infections
  2. If the secretions are from high up the nose, may indicate sinus infection
  3. Discharge and crusty nose indicates streptococal infection.
  4. Water nasal secretions indicate
    - Allergy
    - Common cold
    - Illicit drug use
    - Rarely skull fracture
  5. Purulent foul smelling secretion suggestion foreign body
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9
Q

Common Nasal Problems (5)

A
  1. Foreign bodies
  2. Epistaxis
  3. Sinusitis/purulent rhinitis
  4. Allergic rhinitis
  5. Nasal polyps
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10
Q

History of epistaxis (4)

A
  1. Duration and amount
  2. Efforts at home
  3. Prior history
  4. Medication use
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11
Q

Physical of epistaxis (3)

A
  1. Is patient hemodynamically stable
  2. Posterior bleeding rare in pediatrics
  3. Typically anterior in origin in childhood
    A. Little’s area
    B. Kiesselbach’s area or plexus
    *Look at kiesselbach’s plexus; picking nose will cause scratch of those vessels and then bleeding
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12
Q

Trauma causes of epistaxis (3)

A
  1. Digital
  2. Foreign body
  3. Air pollution
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13
Q

Inflammation cause of epistaxis

A

URI

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14
Q

Anatomic cause of epistaxis

A

Nasal septal deviation

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15
Q

Vascular abnormality leading to epistaxis

A

Hemangioma

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16
Q

Malignant Neoplasm causing epistaxis (2)

A
  1. Rhabdomyosarcoma

2. Lymphoma

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17
Q

Platelet dysfunction leading to epistaxis (3)

A
  1. NSAID use, especially aspirin
  2. ITP
  3. Leukemia
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18
Q

Coagulopathy cause of epistaxis (3)

A
  1. Von Willebrand disease
  2. Hemophilia
  3. Liver disease
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19
Q

Benign mass cause of epistaxis (2)

A
  1. Pyogenic granuloma

2. papilloma

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20
Q

Management of Epistaxis (5)

A
  1. Digital pressure for l0 to l5 minutes
  2. Silver nitrate cautery
  3. Topical vasoconstrictors
    - - Neo-Synephrine
    - - Nasalsponge:mustberemovedin48hours
    - - AntibioticRX
    - - NosebleedQR
  4. Treatment is use of Bactroban tid for one week
  5. If posterior bleed must have ENT consult
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21
Q

Nose Bleed Amount (2)

A
  1. 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.
  2. Blood that would saturate a 4*4 gauze is only about 1 tsp of blood. This helps to reassure them that their child is okay.
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22
Q

Allergic Rhinitis Signs (3)

A
  1. Inflammation
  2. Edema
  3. Weepingofnasal mucosa
23
Q

Nasal Foreign Body Signs (2)

A
  1. Unilateralfoul smelling discharge

2. Can sometimes visualize the object

24
Q

Nasal polyps

A

Nasal polyps are seen in children with cystic fibrosis; if you see stringy secretions, think about allergies first, but if there are nasal polyps do sweat test to check for cystic fibrosis

If nasal polyp is blocking the turbinate, the patient will complain of feeling unable to breath through the nose

25
Q

Assessment Following Midface Trauma (4)

A
  1. Observe for deviation of the nasal septum.
  2. Evaluate the septal hematoma
    - - bulging 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.
  3. Do vision screening
    - - Do extraocular movement to evaluate for orbital fracture
    - - Check for pupil reactivity to light.
  4. Look in the oral cavity for any injury from the trauma.
26
Q

Mouth and Throat Assessment

A
  1. Defer until last
  2. Note color around the mouth
  3. Inspect lips
  4. Look for symmetry when open
27
Q

Angular cheilitis vs. cheilosis

A

Look for angular cheilitis: Fissures that occur after exposure to wind, sun
*Angular cheilitis usually from strep or candidiasis

Look for cheilosis: Occurs with nutritional deficiency
*Vitamin deficiencies can cause angular cheilosis

28
Q

Clinical Evaluation of the Lips (3)

A
  1. Moist, symmetry, color
  2. Mouth breathing
  3. Shape of philtrum
29
Q

Clinical Evaluation of Buccal Mucosa

A

Color and lesion

30
Q

Clinical Evaluation of Gums

A

Color, swelling, bleeding

31
Q

Clinical evaluation of the tongue (5)

A
  1. Size
  2. Color
  3. Mobility
  4. Lesions
  5. Frenulum
32
Q

Clinical Evaluation of Oral Cavity (8)

A
  1. Save the posterior pharynx exam for the very last in young children
  2. Ask child to open their mouth and show you their teeth (appropriate for an older toddler/child).
  3. Moisten the tongue blade
  4. An alternative is to be flexible and look in the mouth
    when the child is crying for some other reason!!! !
  5. Inspect the teeth
    - -Count the number of teeth and note position
    - -Note any defects or discolorations
  6. Inspect gums, mucosal surfaces and posterior
    pharynx
  7. Inspect the buccal mucosal and gums looking for ulcers, candida or trauma
  8. To see the posterior pharynx, you may have to use the tongue blade and gag the child.
33
Q

Tonsil Evaluation

A

Note tonsillar size; Tonsils enlarge to their peak size at 7 and than will disappear slowly behind the tonsillar pillars
*By the time puberty is hit, tonsils start to get smaller

34
Q

Tonsil Grading (1-4)

A
  1. Tonsils are +1 if they are visible only slightly beyond the tonsillar pillars
  2. Tonsils are +2 if they are midway between tonsillar pillars and uvula
  3. Tonsils are +3 if they are nearly touching the uvula
  4. Tonsils are +4 if they are touching at midline and occluding view of oropharynx
35
Q

Causes of Painful Mouth Ulcers (9)

A
  1. Aphthous ulcers of unknown etiology
  2. Immune deficiency
  3. Erythema Multiforme
  4. Leukemia
  5. Folic Acid
  6. B 12 deficiency
  7. Inflammatory Bowel disease
  8. Neutropenia
  9. Niacin deficiency
36
Q

Bifid Uvula

A

double or notched (bifid) uvula that, when present, serves as a clue to the existence of the palatal abnormality, but may also be asymptomatic

*More common in Caucasians

37
Q

Clinical Presentations of Strep Tonsilitis (4)

A
  1. Nausea and fever may be the only presenting symptom of strep throat
    * Strep pharyngitis presents with a lot of systemic symptoms; may even look like appendicitis due to right sided pain can have hives, headache, vomiting, etc.
  2. 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
  3. Epigastric tenderness and headache is another sign of strep
  4. May have petechiae on the palate
38
Q

Scarlet Fever

A

Strep can secrete a toxin that causes scarlet fever (an exotoxin); will see rash on skin as a result
Scarlet fever isn’t more serious than strep throat; it is just a different stereotype in the same family of strep

39
Q

Clinical Evaluation of Peritonsillar abscess (4)

A
  1. Most common deep infection of neck
  2. Typical complication of tonsillitis
    - Extension of infection from tonsil
    - Abscess form between tonsil capsule and superior constructor muscle
    - Obstruction and infection of weber gland
40
Q

Evolution of how the mouth looks with strep (Day 1-4)

A

Day 1: My throat hurts

Day 2: Fever

Day 3: begin to see the bulge starting to form (tonsilar abcess) on the side

Day 4: fiery red color of tonsils
*May get worse before getting bettter

41
Q

Dental Health Assessment: History (11)

A
  1. Changes in the teeth or the mouth
  2. Oral hygiene practices (frequency, problems)
  3. Use of fluoridated water for drinking or cooking
  4. Fluoride use (fluoridated toothpaste, fluoride
    supplements)
  5. Dental sealant use
  6. Eating practices
  7. Illnesses or infections
  8. Medications
  9. Physical activity and sports participation
  10. Injuries to the teeth or the mouth
  11. Use of tobacco by adolescent
42
Q

Dental Care (2)

A
  1. Gingivitis begins in early childhood -9-17% of children
    aged 3-11 years have gingivitis
  2. If chronic, most common complaint is bleeding gums
43
Q

Low risk for Dental Caries (3)

A
  1. No carious teeth in past 24 months
  2. No enamel demineralization (enamel caries white-spot lesions )
  3. No visible plaque; no gingivitis
44
Q

Moderate risk for Dental Caries (3)

A
  1. Carious teeth in the past 24 months
  2. 1 area of enamel demineralization (enamel caries white-spot lesions )
  3. Gingivitis
45
Q

High Risk for Dental Caries (8)

A
  1. Carious teeth in the past 12 months
  2. More than 1 area of enamel demineralization (enamel caries white- spot lesions )
  3. Visible plaque on anterior (front) teeth Radiographic enamel caries
  4. High titers of mutans streptococci
  5. Wearing dental or orthodontic appliances
  6. Enamel hypoplasia
  7. Children with special health care needs
  8. Conditions impairing saliva compositio n/flow
46
Q

Environmental Characteristics Low Risk for Dental Caries (4)

A
  1. Optimal systemic and topical fluoride exposure
  2. Consumption of simple sugar or foods strongly associated with caries initiation primarily at mealtimes
  3. High care giver socioeconomic status
  4. Regular use of dental care in an established dental home
47
Q

Environmental Characteristics Moderate Risk for Dental Caries (3)

A
  1. Suboptimal systemic fluoride exposure with optimal topical exposure
  2. Occasional (i.e., 1-2) between-meal exposures to simple sugars or foods strongly associated with caries
  3. Midlevel caregiver socioeconomic status (i.e., eligible for school lunch program or SCHIP) Irregular use of dental services
48
Q

Environmental Characteristics High Risk for Dental Caries (4)

A
  1. Suboptimal topical fluoride exposure
  2. Frequent (i.e., 3 or more) between- meal exposures to simple sugars or foods strongly associated with caries
  3. Low-level caregiver socioeconomic status (i.e., eligible for Medicaid)
  4. No usual source of dental care
49
Q

Dental Diseases (6)

A
  1. A tooth surface without caries.
  2. The first signs of demineralization, a small “white spot” has been formed (initial caries, incipient caries). It is not yet a cavity, the surface is still hard. It is not calculated as “D” (Decayed) according to WHO criteria. With proper measures, the caries process can be halted here and even reversed.
  3. The enamel surface has broken down. We have got a “lesion” with a soft floor. It is now calculated as a “D” tooth or surface.
  4. A filling has been made, but as can be seen, the demineralization has not been stopped and the lesion is surrounding the filling.
  5. The demineralization proceeds and undermines the tooth.
  6. The tooth has fractured - an effect of a process which could have been stopped at an
    early stage!
50
Q

Maxillary Sinuses (3)

A
  1. Present at birth
  2. Rapid growth from birth to 4 and 6-12
  3. Final growth
51
Q

Frontal Sinuses

A

Last sinuses to develop, begins between 4-8 years of
age
*Fully there until late adolescence

52
Q

Ethmoid Sinuses (3)

A
  1. Present at birth but not developed
  2. Grow rapidly during the first 4 years
  3. Fully developed by 12 year
53
Q

Sphenoid Sinuses (3)

A
  1. Undeveloped at birth
  2. Does not begin to grow rapidly until after 5 years of
    age
  3. Complete between 12-15 years of age.

PNP: Physical Assessment (21 decks)

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