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BDS3 CDS > paediatrics > Flashcards

paediatrics Flashcards

1
Q

what are GDC expectations of registrants in managing cases of acute or neglect in children and vulnerable adults - 3

A

be aware of procedures involved in raising concerns about abuse or neglect

know who to contact for further advice

know how to refer to appropriate authority

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2
Q

what is safeguarding

A

Measures taken to minimise the risks of harm to children.

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3
Q

what is child protection

A

Activity undertaken to protect specific children who are suffering, or are at risk of suffering, significant harm

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4
Q

who are children in need

A

those requiring additional support or services to reach full potential

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5
Q

what is child abuse and neglect

A

anything which those entrusted with care of children do or fail to do which damages the child’s prospect of safe and healthy development

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6
Q

child protection legislation in Scotland

A

GIRFEC
national guidance for CP in Scotland 2014
children and young people act 2014

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7
Q

according to the CYPA 2014, when can information be shared

A

when safety is at risk

when benefit of sharing outweighs the public/individuals interest of keeping confidential

get consent when possible/safe to

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8
Q

what is the UN convection on the rights of child based on

A

needs of child

e.g.
right to be protected from harm
right to a good start in life
right to feel and be secure

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9
Q

big 3 contributing factors of child abuse

A

drugs and alcohol misuse
domestic violence
mental illness

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10
Q

how can a child contribute to child abuse

A

crying
soiling
unwanted pregnancy - forced sex
wrong gender

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11
Q

5 categories of child abuse

A

physical
emotional
neglect
sexual
non-organic - failure to thrive

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12
Q

what makes a child vulnerable- 3

A

under 5
irregular attender - repeatedly DNA, return in pain
medical problems and disabilities

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13
Q

in Scotland how many children are killed by parent/substitute

A

10 PER YEAR

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14
Q

how many children die in the UK as a result of child abuse and neglect

A

1-2 per week

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15
Q

what is the meaning of neglect

A

repeatedly failing to meet a Childs basic needs

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16
Q

what are a Childs needs

A

nutrition
warmth, clothing, shelter
hygiene and health care
stimulation and education
affection

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17
Q

what are the effects of neglect on a Childs needs

A

failure to thrive - short stature

inappropriate clothing - cold or sunburn

dirty - fingernails, head lice, dental caries

developmental delay

withdrawn or attention seeking

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18
Q

why does neglect of neglect occur

A

neglect is less incident focused

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19
Q

what are the long term effects of adults who are neglected as children?

A

greater incidence. of arrest, suicide, depression, diabetes and heart disease

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20
Q

define dental neglect

A

persistent failure to meet a Childs basic oral health needs
likely to result in serious impairment of a Childs oral/general health and

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21
Q

3 reasons other than neglect for obvious dental caries in children

A

inequalities in dental treatment access
individual susceptibility
inequalities in dental health - poverty

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22
Q

what is the effect of severe dental neglect on pt

A

toothache
disturbed sleep
absence from school
difficulty eating

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23
Q

risks associated with dental disease in child

A

bullying
antibiotic resistance
repeated GA
severe infection

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24
Q

after dental problems have been pointed out to parent/substitute, what indicates wilful dental neglect

A

irregular attendance

repeated FTA or late cancellations

returning in pain repeatedly

failure to complete treatment

repeated GA extraction

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25
Q

indicators of dental neglect

A

obvious dental disease
delayed presentation
practical care offered, child hasn’t returned

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26
Q

3 stages of managing dental neglect

A

preventative dental team management
preventative multi-agency management
child protection referral

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27
Q

what is involved in stage 1 of managing dental neglect - preventative dental team management

A

raise concerns with parents
offer support
set targets
record and monitor

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28
Q

what is involved in stage 2 of managing dental neglect - multi agency management

A

lease with other professions to see if concerns shared

agree joint plan of action

letter to HV if child <5 who fail appointments or don’t respond

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29
Q

what is involved in stage 3 of managing dental neglect - CP referral

A

referral to social services
telephone followed up by writing

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30
Q

types of physical abuse

A

over chastisement
acute /compassionate - shaking - remorse
chronic/pathological - no remorse

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31
Q

what percentage of head injuries in first year are non-accidental

A

95%

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32
Q

what percentage of body injuries on a 5 year old in A&E are non-accidental

A

10%

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33
Q

what percentage of childhood burns are non-accidental

A

10-12%

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34
Q

what percentage of head and neck injuries in abuse cases are non-accidental

A

60%

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35
Q

areas on body of non-accidental injuries

A

ears
triangle of safety - ears side of neck and face and shoulder
soft tissues of cheeks
forearms - raised to protect
chest and abdomen
inner arms

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36
Q

where are common areas on body accidentally injured

A

bony prominences - knees, shins, elbows
nose, palms, chin, forehead
match history

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37
Q

which of the following does not raise your concerns of an injury
a. injuries to both sides
b.injuries to soft tissues
c.injuries to bony prominences
d.injuries that don’t fit presentation

A

c. injuries to bony prominences

the rest all elevate concerns

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38
Q

orofacial signs of physical abuse

A

abrasions and lacerations

neck - choke marks

hair pulling

bruising of face and ears - different stages of healing, punch, slap and grip marks

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39
Q

intra oral signs on physical abuse

A

bruises
tooth trauma
renal injury
contusions

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40
Q

medical conditions that may be mistaken for trauma

A

impetigo - cig burns
birth marks or coagulation problems - bruises
facial infection - trauma

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41
Q

what does the SHANARRI model stand for in wellbeing of children

A

safe
healthy
achieving
nurtured
active
respected
responsible
included

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42
Q

what may heighten your suspicions of abuse

A

delay seeking help
story vague and varies
story not compatible with inject
parents mood and behaviour abnormal
Childs interaction with parent abnormal

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43
Q

why is a dentist role so important in preventing death of a child by abuse

A

we may be the first person to notice signs of abuse in children and can get the child out of danger

contribute vital information to save child

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44
Q

which of the following is a dentist not required to do with child abuse
a diagnose
b observe
c record
d communicate
e refer for assessment

A

a diagnose

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45
Q

what orders can be implemented if a child is in immediate danger after a referral

A

child protection order
exclusion order
child assessment order
removal of police or authority of a judicial officer

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46
Q

3 pharmacological behaviour management techniques

A

inhalation sedation NO2
sedation with midazolam
GA

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47
Q

who are pre cooperative patients

A

very young children - communication can’t be established

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48
Q

who are children who lack co-operative ability

A

specific intellectual and LD

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49
Q

what percentage of communication is non-verbal

A

55%

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50
Q

what percentage of communication is words alone

A

7%

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51
Q

define dental anxiety

A

reaction to unknown fear

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52
Q

define dental fear

A

reaction to known fear
fight - flight - freeze

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53
Q

define dental phobia

A

same as dental fear - reaction to known fear
but much stronger response

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54
Q

physiological and somatic sensations of dental fear and anxiety

A

breathlessness
perspiration
palpitations
unease feeling

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55
Q

cognitive features of dental fear and anxiety

A

hypervigilant
interference with concentration
catastrophising

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56
Q

behavioral reactions of pt with dental fear and anxiety

A

avoidance of treatments and appointments
aggression
escape situations

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57
Q

factors affecting child and adolescent anxiety - 3

A

PMH -ve experience
PDH - adverse previous experience
parental anxiety
parental presence
dental staff behaviour

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58
Q

how can you measure dental fear and anxiety

A

MCSADf
modified child dental anxiety scale - faces

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59
Q

non-pharmacological BMT - 5

A

preparatory info - e.g. welcome letters
voice control - young children respond to tone
tell show do
enhanced control - stop signals

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60
Q

describe tell show do technique

A

tell - age appropriate procedure explanation
show - demonstrate procedure
do - perform procedure with minimal delay

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61
Q

describe enhanced control BMT technique and 3 examples

A

allows patient to have control over dentist

stop and go signals
ask patient which tooth they want to start with
structured time

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62
Q

aspects of non-verbal communication used to reduce anxiety

A

happy smiling team
eye contact
gentle pats on shoulder

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63
Q

non-pharmacological BMT - 5

A

distraction
tell show do
enhanced control - stop signals

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64
Q

give an example of a procedure desensitisation would be suitable for in an anxious patient

A

LA

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65
Q

example of topical anaesthetic

A

5% lidocaine
18-20% benzocaine - not for children under 2

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66
Q

non-pharmacological pain control techniques

A

relaxation
distraction
systematic desensitisation

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67
Q

max dose of lidocaine 2%

A

1x2.2ml per 10kg if body weight if fit and well

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68
Q

max dose of articaine 4%

A

0.8x2.2ml cartridge per 10kg of patient

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69
Q

between an upper LA restoration and lower LA restoration, which should you do first

A

upper

70
Q

between an upper and lower tooth, which should be extracted first

A

upper

71
Q

describe positive reinforcement and give an example

A

strengthening of a pattern of desired behaviour - likely to display again in future
e.g. smiles, praise, stickers, child centred phrases

72
Q

what fungal organism oro-facial soft tissue infection

A

candida

73
Q

3 viral orofacial infection examples

A

primary herpes
herpangina
hand foot and mouth

others to note
MMR - measles mumps and rubella
EBV
varicella zoster

74
Q

what virus causes primary herpetic gingivostomatitis

A

herpes simplex virus 1

75
Q

why is there a degree of immunity to herpetic gingivostomatitis in 1st year of life

A

circulating maternal antibodies

76
Q

signs and symptoms of primary herpetic gingivostomatitis

A

fluid filled vesicles - rupture to ulcers on gingivae tongue and mucosa

severe oedematous marginal gingivitis

fever and cervical lymphadenopathy

77
Q

treatment of primary herpetic gingival stomatitis

A

hydration
soft diet
acyclovir if immune compromised

78
Q

which cells does herpetic gingivalstomatitis remain dormant in

A

epithelial

79
Q

triggers of herpes labialis - cold sores

A

sunlight
stress
ill health

80
Q

management of cold sores

A

acyclovir cream

81
Q

which infections are caused by coxsackievirus A

A

herpangina
hand foot and mouth

82
Q

where are vesicles found in the mouth in a pt with herpangina

A

vesicles in tonsil/pharyngeal region

83
Q

what signs will a patient with hand foot and mouth disease display

A

ulcers - gingivae tongue cheek palate

maculopapular rash on hands and feet

84
Q

define oral ulceration

A

localised defect in surface of oral mucosa
epithelium destroyed exposing inflamed connective tissue

85
Q

10 key facts when taking history of an ulcer

A

onset
frequency
site
number
size
duration
exacerbating diet factors
lesions in other area
associated MH
treatment so far - helpful or no

86
Q

give causes of oral ulceration - 5

A

infection - e.g. herpes simplex
immunodeficiency
trauma
vitamin deficiency - iron b12 folate
haematological - leukaemia

87
Q

what is the term for recurrent painful ulceration in oral cavity

A

recurrent apthous stomatitis

88
Q

what is the most common cause of ulcers in children

A

recurrent apthous stomatitis

89
Q

3 causes of RAU

A

GI disease
stress
hormonal disturbance - menstruation

90
Q

investigations for recurrent apthous stomatitis

A

diet diary
FBC
haematinics
coeliac screen

91
Q

what is orofacial granulomatosis

A

chronic inflammatory disorder, unknown cause

92
Q

characteristic pathology of OFG

A

non-caseating giant cell granulomas which result in lymphatic obstruction

93
Q

clinical features of OFG and oral crohns

A

lip swelling
gingival swelling
cobblestone buccal mucosa
peri-oral erythema
linear oral ulceration

94
Q

difference between OFG and oral crohns

A

oral crohns is a manifestation of crohns disease - a chronic inflammatory bowel disease

OFG is a chronic inflammatory condition, unknown aetiology - characterised by non caseating granulomas

95
Q

what is geographic tongue

A

idiopathic
shiny red area with loss of papillae on tongue surrounded by white margins

96
Q

what is a fibroepithelial polyp

A

firm pink lump
cheeks lips or tongue
initiated by minor trauma

97
Q

what is an epulide

A

solid swelling of oral mucosa - benign hyper plastic lesions

98
Q

what are the 3 types of epulide

A

fibrous epulis
pyogenic granuloma
peripheral giant cell granuloma

99
Q

describe a fibrous epulis

A

a pedunculate or sessile mass similar in colour to surrounding gingiva
formed of inflammatory cells and fibrous tissue

cured by removal

100
Q

describe a pyogenic granuloma

A

soft deep red/purple swelling

often ulcerated

vascular proliferation and delicate fibrous stroma - haemorrhage spontaneously and with mild trauma

recur after removing

101
Q

another name for pyogenic granuloma

A

pregnancy epulis

102
Q

describe a giant cell granuloma

A

interproximal

dark red

ulcerated

multinucleate giant cells in a vascular stroma

103
Q

what is a congenital epulis

A

rare benign lesion - occurs in neonates

granular cells covered with epithelium

104
Q

HPV that causes verruca vulgaris

A

2 and 4

105
Q

HPV that causes squamous cell papilloma

A

6 and 11

little cauliflower like growths

106
Q

what is a mucocele

A

bluish soft transparent swelling - blockage of salivary gland
can affect major and minor

107
Q

2 types of mucocelle

A

mucous extraction cyst - secretions rupture - most

mucous retention cyst - secretions retained in expanded duct

108
Q

what is a radula

A

mucocele in FOM

can be minor or ducts of submandibular/sublingual glands

109
Q

why take an ultrasound or MRI for a radula

A

ro exclure plunging renal - extending through FOM into submandibular space

110
Q

what are bohns nodules and what are they remnants of

A

gingival cysts filled with keratin

remnants of dental lamina

111
Q

what are Epstein pearls

A

small cystic lesions found along midline of palate

112
Q

important questions to ask when taking history of TMD

A

symptoms
when it began
times it is worse
exacerbating factors
stress
habits

113
Q

what is the normal extent of jaw opening

A

40-50mm

114
Q

EO exam for TMD

A

palpate MOM for tenderness and hypertrophy

palpate TMJ for tenderness and clicking

assess opening and deviation

115
Q

IO exam for TMD

A

tooth wear

signs of clenching/grinding - tongue scalloped, buccal mucosa ridges

116
Q

management of TMD

A

manage stress

avoid habits

bite raising appliance if nocturnal grinding

avoid wide opening - use fist to support when yawning

soft diet

ibuprofen

117
Q

ratio of Males:Females affected by ASD

A

3:1

118
Q

how does autism affect people

A

spectrum - affects everyone differently

social communication - difficulties verbal and non-verbal, take literally, limited language, may not understand facial expressions

social interaction - can appear withdrawn, may not understand social norm like standing too close

over or under sensitivity to light, sound taste and touch

119
Q

how does autism have an impact clinically

A

routine - upset if changed

limited variety of food - care with diet advice, work on timing>new foods

talk at length on own interests

sensory difficulties - busy waiting rooms, overwhelming, can have underdeveloped or overdeveloped senses

120
Q

features of downs syndrome

A

large tongue
mid face hypoplasia
LD

121
Q

medical problems associated with down syndrome

A

cardiac defects
leukaemia
epilepsy

122
Q

dental features of open bite

A

maxillary hypoplasia

class 3

AOB

hypodontia and microdontia

123
Q

cause of cerebral palsy

A

non progressive lesion of motor pathways in developing brain
brain damage early in development - fatal, birth or first few months

124
Q

how does cerebral palsy affect body

A

delay in motor skills development
poor control over hand/arm
weakness

125
Q

3 main types of cerebral palsy

A

spastic
ataxic
dyskinetic

126
Q

which area of the brain is affected with spastic cerebal palsy and what is the affect

A

cortex - increased muscle tone (stiffness)

127
Q

which area of the brain is affected with ataxic cerbal palsy and what is the affect

A

cerebellum - coordination/balance - unsteady

128
Q

which area of the brain is affected with dyskinetic cerebal palsy and what is the affect

A

basal ganglia - uncontrolled movements

129
Q

diplegia spastic CP meaning

A

muscle stiffness both legs or both arms, arms less affected

130
Q

hemiplegia spastic CP meaning

A

affects only one side persons body - arm more than leg

131
Q

quadriplegia spastic CP meaning

A

all 4 limbs, trunk and face affected - can’t walk

132
Q

give an example of communication aid for visually impaired

A

braille

133
Q

give an example of communication aid for hearing impaired

A

BSL

134
Q

Give an example of communication aid for ASD

A

Makaton

135
Q

what cells are affected by leukaemia

A

WBC - lymphocytes and myeloid cells

136
Q

3/4 of leukaemia cases are acute lymphoblastic leukaemia. describe acute lymphoblastic leukaemia

A

WBC production in bone marrow uncontrolled and cells do not mature

immature dividing cells fill bone marrow and stop it making healthy blood cells

137
Q

how might a leukaemia pt present

A

pallor

bruise and bleed easy as lack of platelets

infection - lack of functioning WBC

138
Q

oral presentation of leukaemia

A

gingival swelling
ulceration
gingival bleeding

139
Q

what category of drugs are used in chemo

A

cytotoxic

140
Q

oral effects of chemotherapy

A

mucositis

infection risk - decreased neutrophils

increased bleeding risk - decreased platelets

141
Q

oral effects of radiotherapy

A

mucositis

taste bud damage

hypo salivation as salivary glands affected leading to caries and infection

ORN risk

142
Q

chemo and radio effect on developing dentition

A

enamel hypoplasia and microdontia

there are more but these are mutual

143
Q

name a syndrome linked to congenital heart defect

A

downs syndrome

144
Q

most common acyanotic congenital cardiac defect

A

ventricular septal defect

145
Q

2 classifications of congenital cardiac defect and what they mean

A

cyanotic - deoxygenated blood can enter systemic circulation

acyanotic - normal levels of oxyhemoglobin in systemic circulation

146
Q

dental implications of congenital heart defect

A

medications - increased bleeding tendency - warfarin or aspirin

GA risk

infective endocarditis

147
Q

which pt are at increased risk of infective endocarditis

A

previous IE
congenital heart disease
valve replacement
hypertrophic cardiomyopathy
valvular disease with stenosis

148
Q

in the dental setting, what poses risk of bacteria to patient at risk of IE

A

invasive procedure

poor OH

dental infection

149
Q

2 examples of non-inherited bleeding disorders

A

chemotherapy induced thrombocytopenia

blood thinning medication - warfarin/aspirin

150
Q

describe primary secondary and tertiary haemostasis

A

primary - vasoconstriction after injury and platelet plug formation

secondary - fibrin formation through coagulation cascade

tertiary - fibrinolysis - formation of plasminogen then plasmin

151
Q

what is the most common inherited bleeding disorder

A

VWD

152
Q

what factors are low in VWD

A

von willebrands factor
factor 8

153
Q

what pattern of inheritance is VWD

A

autisomal dominant

154
Q

what are the functions of VW factor - 3

A

mediates platelet adhesion

mediates lately aggregation

caries factor 8

155
Q

haemophilia A and B can be categorised into mild moderate and severe depending on the level of factor present - what are the levels for each?

A

mild >5%
moderate 1-5%
severe <1%

156
Q

what pattern of inheritance is haemophilia

A

x linked recessive

157
Q

what does x linked recessive mean

A

males who have affected gene are affected

females who have affected gene are carriers

158
Q

which tooth paste might you recommend for a child with sensory impairment

A

oranurse
unflavoured and non foaming

159
Q

causes of gingival overgrowth

A

medication - cyclosporin, phenytoin

systemic and metabolic disease

genetic - hereditary gingival fibromatosis

160
Q

what is periodontitis

A

multifactorial inflammatory disease associated with dysbiotic biofim causing progressive destruction of tooth supporting structures

161
Q

4 main distinguishing factors of perio

A

apical migration of JE
alveolar bone loss
loss of attachment of perio tissues to cementum
JE transforms into pocket epithelium

162
Q

systemic diseases linked to periodontitis in paediatric patients

A

papillon Lefèvre syndrome
neutropenia
downs syndrome

163
Q

features of NP

A

necrosis/ulceration of papilla
PDL loss
rapid bone loss
pseudomembrane formation

164
Q

what is necrotising stomatitis

A

severe inflammatory condition where necrosis extends beyond gingiva to soft tissues leading to bone denudation

165
Q

which BPE code do you always stage and grade

A

4

166
Q

what ages do you only use BPE code 0 1 and 2 for

A

7-11

167
Q

causes of a reduced periotontium

A

recession
crown lengthening surgery

periodontitis - stable

168
Q

non dental biofilm causes of gingivitis

A

trauma - damage to PDL
genetic - hereditary fibromatosis
infective - bacterial, fungal, viral
drug induced - cytotoxic, immunosuppressant
systemic disease

169
Q

microbe associated with NG

A

fusiformspirochateal

170
Q

when do you use BPE codes 0 1 2 only

A

7-11

171
Q

probe for sBPE

A

WHO 621 single black band

172
Q

3 reasons you would refer a perio pt to specialist services

A

stage 2 or 3 not responding to treatment

grad C or stage 4

perio as direct manifestation of systemic disease

BDS3 CDS (11 decks)

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