PANCE Prep- EENT Flashcards
What is the number 1 chronic disease in children?
ECC
*greater than asthma
Components of ECC prevention:
- strengthen enamel- via fluoride (possible supp. after 6months)
- reduce oral sugars
- reduce transmission of Strep mutans- dont share utensils and binkys
- manual removal of biofilm.
sucking becomes non-nutritive at age __. Consequences of prolonged sucking habits results in:
6 months
*stop definitely by age 3
malocclusions
- Increased overjet
- anterior open bite
White curd-like plaques initially beginning on the buccal and/or labial mucosa and spreading to the tongue and finally to the lips that can be scraped but not off easily (leave behind erythema/bleeds if scraped)
oral candidiasis (thrush)
- normal until age 2, after consider immunocompromised states
- Remember to examine the diaper area as the fungus is swallowed and then excreted in the stool and often the infant has a candidial diaper dermatitis as well, which will also need treatment.
DX: clinical or KOB smear: budding yeast/pseudohyphae
Tx:
- vNystatin suspension orally for up to 4 weeks.
- Clean bottle nipples and pacifiers in the dishwasher cycle.
- Breastfeeding moms should apply a small amount of the Nystatin suspension to their nipples to prevent re-infection to the infant
- If treatment fails, consider oral Diflucan for 7 days.
a LOW GRADE fever, rhinorrhea and the vesicular/ulcerative lesion on the buccal, pharyngeal and/or labial mucosa
herpangina (caused by cocksackie virus)
Tx: supportive and encourage hydration
- oral ibuprofen dosed at 10mg/kg/dose given every 6hours until the symptoms are resolved- usually in 3-5 days.
- 3:1 mouth solution, KBX or magic mouthwash (20cc each of the following: 1. Benadryl-controls inflammation, 2. Maalox or Kaopectate- band-aid to keep salivary enzymes from irritating the lesions, and may or may not include viscous 3. lidocaine- numbing)
- good hand-washing to prevent spread
*highly contagious, mostly to young children, as adults likely have been infected before and have immunity.
- HIGH GRADE fever, often lasting 7-10 days, vesicles and ulcers to pharyngeal, buccal, labial mucosa, and gingival mucosa
- vesicular lesions may spread onto the skin around the mouth and nose
- Cervical lymphadenopathy*
herpetic gingivostomatitis- caused by HSVI
(herpetic whitlow if on fingers- minimally painful)
Tx: self-limited
- oral ibuprofen 7 days around the clock*
- KBX if appropriate
- +/- oral acyclovir if sx present <72 hours.
- encourage hydration (oral sores and high fever)
- Educate: herpes viruses all have the ability for recurrence, usually during times of illness or after sun exposure- usually consists of a solitary or possibly a few lip or lower face vesicular lesions, commonly known as a “cold sore” or “fever blister”. The recurrence is never as severe as the initial infection
Blisters superimposed on eczema rash on hands from sucking
eczema herpeticum
Tx: requires admission for IV anti-viral drugs due to the possibility of disseminated HSV infection
*if a child with HSV 1 infection should have a seizure, it is important to consider the complication of herpetic encephalitis or meningitis and the child will need appropriate work-up.
Areas of normal rough-appearing tongue mucosa with patches that appear denuded, smooth and shiny
-commonly after a viral illness, some medications, stress, and sensitizing foods such as citrus and tomatoes
Benign glossitis
Tx: benign and no tx needed
1. Reassurance
Tx of Apthous ulcers
- self-limiting in 7-10 days
2. OTC Zilactin or Orabase
Fluid-filled cysts on the labial or buccal mucosa, which develop following trauma
Mucocele
Tx: benign- often don’t need tx
*oral surgeon can remove if large enough to interfere with chewing
lingual frenum is attached very close to the tip of the tongue. This does not allow full mobility of the tongue, resulting in feeding problems and later speech problems
ankyloglossia (tongue-tied)
Tx:
referred to an ENT or oral surgeon for consideration of a frenectomy,
Differentiate between:
- Bohn’s nodules
- Dental lamina cysts
- Epstein Pearls
- Bohn’s nodules: occur along the buccal or lingual sides of the mandibular or maxillary gingival ridges as well as the hard palate
- Dental lamina cysts: occur also along the mandibular and maxillary gingival ridges, but are more cystic in appearance
- Epstein Pearls: occur only in the midline of the hard palate
Tx: self-limiting- resolve in a few weeks
Describe the different classes of tooth fractures
Class I: fx of enamel
Class II: fx of enamel + dentin (yellow)
Class III: fx of enamel + dentin + pulp (red)
Class IV: involves root
Tx: (both primary and secondary teeth)
Class I-II: DDS referral in 2-3 days
Class III-IV: immediate DDS referral
Dental Displacements:
___- tooth has been traumatically removed from socket
___- tooth has been pulled down in the socket
___- tooth has been pushed into the socket
___- tooth has been moved laterally in the socket
Avulsion- tooth has been traumatically removed from socket
Extrusion- tooth has been pulled down in the socket
Intrusion- tooth has been pushed into the socket
Luxation- tooth has been moved laterally in the socket
tx: immediate DDS referral (primary and secondary)
Tx of teeth avulsions
Primary- immediate DDS referral and DO NOT reinsert tooth
Secondary: immediate DDS referral and don’t touch or scrub root. Rinse and re-insert if <60 min. Can store in milk/saline
Tx of tongue and lip lacerations
Tongue: could suture but difficult- rinse their mouth with salt water after eating and expect closure by secondary intention in about a week
Lip: suture esp. if vermillion portion involved- oral antibiotic prophylaxis for in-to-out lac (higher risk to develop infection in the wound) Any mucosal laceration left open will need to be rinsed with salt water after eating
Tx of commissure burns
- dentist immediately so they can be fitted with a commissure splint which prevents the mucosal layers from touching together and healing with a fusion of the corner of the mouth
- PCP debridement
- oral prophylaxis Abx
- Tetanus immunization
When do you start performing different eye exams?
birth: red reflex, corneal light reflex (Hirschberg’s test), pupillary response to light
Age 2: cover/uncover
age 3: visual acuity (tumbling E then shapes in kindergarten and then typical Snellen)
*20/20 is not attained in children until age 6 years, so usually no need to refer unless they are 20/40 or a 2-line chart difference between eyes.
*the visual cortex of the brain is developing until ~9yo, so any visual deficit, whatever the cause, could cause the visual cortex to not develop properly which is an uncorrectable condition beyond the age of 9 years, even if the underlying disorder is identified and treated
when does conjugate gaze develope
5 months
Tx for horeolums and chalazions
Chalazions: steroid eye drops +/- surgery
Internal and external hordeolums: warm compresses to unplug the gland and antibiotic eye drops for the infection. Expect resolution within 2-3 days
Eye discharge in a neonate is most commonly caused by ___ and is treated with ___
chlamydia (erythromycin eye ointment) or gonorrhea (IV abx)
*culture eye discharge + gram stain
OR
dacryostenosis (message inner canthus, should resolve at 4-6 months, if not by 6 months refer to ophthalmology for tear duct probing)
Tx of allergic, viral and bacterial conjunctivitis
Allergic: antihistamine eye drops (Patanol or Pataday (QD formula), or Naphcon and Ketotifen which are OTC)
Viral: nothing (tx w/ abx drops for 2/2 bacterial infection)
Bacterial: abx eye drops (Polytrim, Vigamox or Ocuflox, and erythromycin ointment in infants)
Dx and Tx of corneal abrasion
Dx: woods lamp w/ fluoroscein stain
Tx:
- Cylogel for pain or Tylenol #3
- Abx eye drops (Polytrim, Vigamox or Ocuflox)
- return in 1 day as the corneal abrasion should heal overnight, and needs to be rechecked. If not healed, refer to ophthalmology for a slit lamp exam in case a FB or more extensive damage is present
* if pt wears contact lens, tx w/ aminoglycoside eye drop or fluoroquinolone (Ciprofloxacin)***
Tx of periorbital cellulitis and orbital cellulitis
periorbital: outpt augmentinor cephalosporins and close f/u
orbital (septal): IV abx (cefotaxime or ceftriaxone and clindamycin) and surgical debridement