Term
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Definition
*Enamel hypoplasia (opacity, discoloration), misshapen due to genetics, infection, malnutrition, trauma and fluorosis
Hypocalcification
Hypodontia (*maxillary permenant lateral incisors)
Oligodontia (multiple teeth missing e.g. Down Sx)
Hyperdontia |
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Term
| Gum disease: gingivitis/Peridontitis |
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Definition
- Check bleeding gums, tooth mobility and severely stained teeth, erythema, abcesses with purulent discharge (if super bad)
- Inflammation of margin of gum line
- Retention of bacterial plaque in crevice around neck of tooth |
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Term
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Definition
- Streptococcus mutans and lactobacilli principle bacteria
- verticle inoculation
- onset 6-30 months
- avg age 2 yrs
- carbs + bacteria = acid environment
- inadequate systemic fluoride puts at risk |
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Term
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Definition
- Leading cause of preventable blindness worldwide
- An opacity of the lens
- Significant when > 3 mm & centrally located
- ½ are idiopathic
- Others are due to congenital infections (rubella), genetic (downs sx) or metabolic dz (galactosemia), teratogens (alcohol or steroids) and ocular disorders
- PE: abnormal RR, asymmetry of the pupils, nystagmus or squinting warrant a referral |
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Term
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Definition
Congenital: occurs in the first 2-3 yrs of life
EXCESSIVE Tearing, photophobia, excessive blinking / blepharospam (eyelid squeezing)
- may be associated w/ port wine stains involving upper and lower eyelids
- Cloudy eyes
Secondary or juvenile:
Acquired obstruction to drainage system
Extreme pain, blurred vision, tunnel vision, erythema in one eye |
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Term
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Definition
<2 yrs
- Leukokoria – whiteness of red reflex
- Strabismus
- Decreased visual acuity |
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Term
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Definition
(Nasolacrimal duct stenosis)
*constant tearing and crusting of the lashes
No erythema of the conjunctivae
Dx may be confirmed by extrusion of mucoid discharge w/ massage of the nasolacrimal duct
Massage 2 to 3 times a day w/ warm water on a soft tissue
Observe for signs of infection – all of a sudden there is a green discharge, or conjunctivae is extremely injected and erythematous
Refer if no resolution – by 1 year, or by 9 months |
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Term
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Definition
An infection or retention cyst of a meibomian gland/deeper than hordeolum
Nontender, firm, discrete swelling with freely movable skin overlying the nodule
Soaks and hygiene |
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Term
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Definition
Infection of sebaceous gland of eyelid
Or other glands
Most common cause is S. Aureus
Tender swollen red furuncle along eyelid margin or internal palpebral conjunctiva
Hygiene, compresses, antibiotic
ERYTHROMYCIN |
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Term
| Opthalmia Neonatorum (5 causes) |
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Definition
- baby conjunctivitis
1. Chemical: 24-72 hours of life
Silver nitrate exposure (prophylaxis GC)
Less common with erythromycin ointment prophylaxis
Non-purulent discharge
2. C. Trachomatis: after 8 days but before 2 weeks
Large round elevations in palpebral conjunctiva (follicular reaction)
Watery discharge
PO EES – oral erythromycin (difficult cuz of SE profile – diarrhea)
3. Pulmonary extension
4. N. Gonorrhoea 2-4 days
IM ceftriaxone
Excessive purulent discharge
Next slide
5. HSV: birth - first few weeks:
antivirals/hospitalization – admit right away, eval right away and treatment
Even if there is a hint of it, admit first, then start antiviral |
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Term
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Definition
Adenovirus – most common cause
**Spring/Fall
Older than 6 years
Itchy red swollen conjunctiva
Hyperemia
Tearing clear discharge = WATERY DISCHARGE
Follicular changes – inner, bottom eyelid
URI symptoms (pharyngitis, fever, malaise
Preauricular nodes with pharyngitis) |
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Term
| Viral Conjunctivitis: Management |
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Definition
- Self-limited, resolves in 7-10 days
- Highly contagious early in the course
- More pronounced photophobia
- Hygiene – wash hands!!!
- Compresses
- Artificial tears
- Prophylactic antibiotics???????????? Because if they have yellow green discharge, probably bacterial
- If concerned re herpetic: refer
- Usually both eyes |
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Term
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Definition
**winter
- erythema, one or both eyes
- preschoolers
- Burning, stinging, itching, foreign body sensation
- Photophobia
- Yellow green discharge – TREAT THEM
- Encrusted and matted eyelashes on awakening – eyes are shut in the morning
- Preauricular lymph node is often swollen and painful, with a history of URI |
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Term
| Bacterial Conjunctivitis - Management |
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Definition
- Broad spectrum
- Ofloxacin-Excellent penetration, tolerability and compliance (EXPENSIVE)!!!!
- Sodium sulfacetamide (burns a little more)
- Polytrim (less irritating) – Haiems preference
- GENTAMICIN (NOT FOR KIDS) – causes severe chemical allergies (hot red eyes) |
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Term
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Definition
- Bacterial infection of the eyelid and surrounding soft tissue
- Mostly in pts < 5 y/o
- S. aureus, s. epidermidis, and s pygoenes
- Simple - May be treated w/ oral antibiotics |
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Term
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Definition
Age: 1 wk to 16 y/o
2:1 male:female
More often in winter months
Associated with paranasal sinus & URI
*** Rhinosinusitis especially ethmoiditis
Mostly unilateral
Staph (MRSA) and Strep (H. flu if unimmunized)
Blurred vision, opthalmoplegia, proptosis, & chemosis (eyeball popping out, paralysis of ocular muscles, eyeball is inflamed) |
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Term
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Definition
tons of wax
- if wax is hard, do hydrogen peroxide w/ water (ear lavage) |
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Term
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Definition
- Retained moisture in the ear (swimming) which changes acidic environment and promotes bacterial and fungal growth
- Chlorine exposure reduces normal floral growth
- Pathogens: Pseudomas aeruginosa and S. aureus
- Pain: worsened by touching the pinna and tragus
- Discharge: purulent exudate
- Edema: intense canal wall inflammation
- Enlarged tender regional lymph nodes |
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Term
| Otitis externa: management |
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Definition
- Remove debris, foreign body
- Topical Ciprofloxacin and ofloxacin are effective against pseudomonas, S. aureus and S. Pneumoniae – 5 drops once a day, some are twice a day (first if covered)
- Those containing steroids may help relieve pain and swelling faster than antibiotic alone |
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Term
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Definition
- OM with Effusion – fluid behind ear
- AOM – acute otitis media
- Persistent OM – been like 6 weeks and kid still has it
- Recurrent OM (>3 DIFFERENT episodes in a 6 month period) |
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Term
| Acute Otitis Media: criteria |
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Definition
1.Acute onset
2.Signs and symptoms of middle ear inflammation
- Pain, Fever, diarrhea, vomiting, (hurts like crazy, they cry in the middle of the night)
Bulging—most predictive of AOM
Diminished, absent or distorted light reflex,
Reduced mobility/Confirmed with pneumatic otoscopy – blows air in ear and should move the TM like a flutter, if not, theres fluid
Color red, yellow or purple
Also audiogram – if flat, it’s not moving, if bell-shaped curve, its okay
3.Middle ear effusion |
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Term
| Acute Otitis Media: Management |
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Definition
Assess pain and treat
Observation without use of antibacterial agents in a healthy child with uncomplicated AOM with good follow up
If you decide to treat,
Amoxicillin 80-90mg/kg/day x 10 days first line drug
(american academy recommendation) – very severe, definite infection
- azithromycin, or bactrim
Give childrens probiotics
Looks really bad and wanna take care of it
If not, 50 mg/kg/day is okay |
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Term
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Definition
Presence of fluid in the middle ear without signs or symptoms of acute ear infection
May occur spontaneously
S/P AOM
Dull, opaque, retraced, airfluid level visible
Can go away by itself maybe 6 weeks
Kid might not have symptoms, leave it alone
- beware hearing loss that can lead to speech and language delays |
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Term
| OM w/ effusion: management |
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Definition
- Watchful waiting for 3 months for kids not at risk
- After 3 months, speech and language and hearing assessment
- Refer with documentation especially if its affecting them a lot or they have speech problems
- No medication documented efficacy |
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Term
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Definition
Group A Beta-Hemolytic Streptocci – look for this one
- Abrupt onset
- Fever, malaise, sore throat, dysphagia
- Nausea, abdominal discomfort, vomiting
- Headache
- Lack of cough
- Petechiae: palate
- Red tonsillopharyngeal tissue
- Exudate
- Tender anterior cervical lymph nodes – HURT LIKE CRAZY
- Scarlatiniform (sandpaper-like) rash with erythrogenic toxin
- Tongue coated red with desquamation of the coating
- “strawberry appearance”
- Rash begins in axilla, groin, neck after 12-48 hours, sandpapery |
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Term
| Strep pharyngitis: diagnosis and tx |
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Definition
Dx -
Throat culture
Rapid strep – if positive, it’s positive, if negative, NOT NECESSARILY negative
Tx -
Supportive care
PenVK <27K 250 tid x 10days
- >27K 500mg tid x 10days |
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Term
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Definition
| More than 10-14 days nasal and postnasal discharge and daytime cough, may be worse at night (cuz of postnasal drip) |
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Term
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Definition
| temperature of 102 degrees and purulent nasal discharge present for 3-4 days. Patient seems ill. |
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Term
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Definition
Positive pain on palpation or percussion over sinuses
Headache
Halitosis
Periorbital swelling
Nasal voice |
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Term
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Definition
- Amoxicillin 45mg/kg in 2 doses or
- Augmentin 80-90mg/dg/d/ in 2 doses for children at high risk, kid isn’t getting over it: daycare, or < 2 years, or those who fail to respond to amox. w/in 72 hrs
Give probiotic – TAKE AT SEPARATE TIMESi |
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Term
| Allergic Rhinitis: Seasonal |
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Definition
| > 2 years, sensitization to pollens, trees, grasses (usually 4-10 y/o) |
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Term
| Allergic Rhinitis: Perennial |
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Definition
| year round -> dust mites, cockroaches, pets, mold, feathers |
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Term
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Definition
- Reduced nasal patency
- Mouth breathing, snoring,
- Pallor and edema of nasal mucosa
- Clear watery to seromucoid discharge
- Nasal crease
- Itching and rubbing of nose
- Cobblestone appearance of pharynx |
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Term
| Allergic Rhinitis: Management |
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Definition
- Intranasal Corticosteroids over 2 yrs old – (FIRST LINE THERAPY) FOLLOW INSTRUCTIONS or else it may hit the side of their nose and cause nosebleeds
- Use 1 to 2 weeks before clinical benefit is seen
- Side effect: local burning, irritation, soreness (if they don’t use it correctly and it hits the side of the nose)
********Flonase, Nasonex for youngest, once daily
- Antihistamine
Especially helpful for seasonal
Relieve itching, sneezing , rhinorrhea and ocular pruritis
Some combine decongestant with antihistamine to relieve nasal obstruction
- avoidance of allergen |
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