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200 Cards in this Set
- Front
- Back
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What is the pulp of a tooth?
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THe centre of the tooth and the place where it receives its neuromuscular supply
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What is the portion of the tooth that is normally visible in the oral cavity?
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Coronal portion
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What covers the coronal portion of the tooth?
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Enamel - the hardest substance in the body
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What makes up the normal deciduous teeth?
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10 maxillary
10 mandibular central incisor/lateral incisor/canine/ 2 molars |
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When are all primary teeth present?
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At the age of 3
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What is the normal make-up of the permanent dentition?
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32 teeth
central incisor/lateral incisor/canine/2 pre-molars/3 molars |
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What is the most common numbering system for the permanent dentition?
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Upper right molar = 1
continue to upper left = 16 lower left = #17 lower right = #32 (starting patient "upright") |
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What is Ludwig's angina?
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Infection extending into the sublingual, submaxillary and sub mental space with elevation of the tongue
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How do you localize a tooth with a dental cary?
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Percuss with a tongue depressor
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What is the management of a periodontal abscess?
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Stab incision with draining and insertion of a penrose drain (remove this within 24-48 hours)
Pt should also receive antibiotics - penicillin V or erythromycin for 7-10 days |
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What is truisms?
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Inability to open the mouth because of involuntary muscle spasm
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Does truisms resolve with succinylcholine?
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No, no it is muscular in origin (as opposed to neuromuscular)
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What is the most common organism in Ludwig's angina?
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Hemolytic strep
(but also may have anaerobic, gas-forming bactericides fragilis) |
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What antibiotics should be given in oral infections?
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Pen V 250-500 mg QID (minor)
Pen G 12 million Units q day for serious infections, add clindamycin if there is a preponderance of anaerobes. Erythromycin can be used in penicillin allergic patients |
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What are the characteristics of acute necrotizing ulcerative gingivitis (ANUG)?
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Blunted/ulcerated painful interdental papillae with tray film covering
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what is the treatment for ANUG?
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-Warm saline rinses
-systemic antibiotics - penicillin, erythromycin or tetracycline -3% H202 rinses -document referral to a dentist |
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What are causes of dental pain other than caries?
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-cracked tooth and split root syndrome
-maxillary sinus infection -root canal pain |
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What is acute alveolar osteitis or dry socket syndrome?
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-3-4 days post dental extraction
-++pain and foul smell it results from the premature loss of the blood clot from the socket and results in a localized infection of the socket |
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What is the treatment of acute alveolar osteitis/dry socket syndrome?
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-irrigaiton
-packing with iodoform gauze and medicated dental paste -systemic antibiotics and NSAIDs -nerve block -qday dentist f/u |
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What are the characteristics of TMJ syndrome?
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Unilateral pain, dull, worsening throughout the day and may result in truisms and masseter spasm
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What is the Ellis classification of tooth #?
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Ellis I - enamel
Ellis II - enamel and dentin Ellis III - enamel and dentin and pulp exposure |
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What is the management of tooth #
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Ellis I - reassurance, referral to dentist
Ellis II - apply CaOH paste and dry foil, call dentist (in peds) adults should be seen in 1-2 days Ellis III - immediately notify dents and cover with cotton and dry foil |
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How do you identify pulpal exposure?
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Wipe the tooth clean with gauze, if pink blush or drop of blood then there has been pulp exposed
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What are subluxed teeth?
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Those that are loosened in their sockets
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Ideally, how soon should a tooth be put back in the socket?
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immediately (ideally within 30 min)
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What solutions should you use to store avulsed teeth?
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Ideally the socket or under the tongue or under that parents tongue
-Hank's solution -milk |
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What are signs of inferior rectus or inferior oblique muscle entrapment?
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-Enophthalmos
-ptosis -diplopia -upper cheek anesthesia -limitation of upward gaze |
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What are signs of retrobulbar hemorrhage?
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-proptosis
-limitation of ocular movement -vision loss -increase IOP |
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What is the treatment for a retrobulbar hemorrhage?
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-lateral canthotomy
-acetazolamide (topical) -topical beta blocker -IV mannitol |
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What histological changes does alkali cause?
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liquefactive necrosis
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What histological changes does acid cause?
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coagulation necrosis
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How do you test eye pH?
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Nitrazine paper in the inferior conjunctival fornix
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What should be done for patients who have their eyelids superglued shut?
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May try to separate, if not possible, allow it to dissolve on its own, if lids are inverted, consult optho for surgical options
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What is the treatment for UV keratitis?
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-topical cycloplegics
-topical antibiotics -analgesics (PO) -prevention -consult optho within 24 hours |
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What is a sign of corneal perforation?
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Positive Seidel's test
(leaking aqueous humour seen during fluorescein examination |
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When should a corneal rust ring be removed?
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24 hours after removal of the metallic object
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When should you consult ophtho for a corneal FB?
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-multiple FB
-significant portion of the visual axis affected -deeply embeded -increased risk of perforation |
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What should be done if you suspect an intraocular FB?
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CT scan
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What signs are suggestive of pathology more serious than a subconjunctival hemorrhage?
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-pain
-decreased VA -photophobia |
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What is the treatment for subconjunctival hemorrhage?
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-cold compress for 24 hours
-resolution within 2-3 weeks |
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What is the physical exam finding in an APD?
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Affected pupil paradoxically dilates when you swing the light from the normal eye into it
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What is the management of a hyphema?
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-elevate the HOB to 30-45 degrees
-bed rest -limit eye movement -follow IOP, if increased use topical beta blockers, topical alpha agonists or topical carbonic anhydrase inhibitors |
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What is the main complication of hyphema?
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rebleeding (2-5d after)
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Which patients are at increased risk of hyphema complications?
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Patients with hemoglobinopathies (SCD, thalassemia)
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What is traumatic iridocyclitis?
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Traumatic inflammation and contusion of the iris and ciliary body
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What are signs of traumatic iridocyclitis?
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-ciliary flush
-wbc and rbc in the anterior chamber -flare in the anterior chamber (protein) |
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What is the treatment for traumatic iridocyclitis?
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-cycloplegia (5% homatropine QID) and 1% prednisolone acetate (if no improvement in 5-7d)
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What is traumatic iridodialysis?
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Tearing of the ciliary body from the iris resulting in a secondary pupil
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What is a sign of lens subluxation?
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Trembling or shimmering of the iris with rapid eye movements
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Can succinylcholine be used in patients with penetrating ocular trauma?
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According to Rosens, yes!
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What are signs of vitreous hemorrhage?
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-floaters (dark dots/strands floating)
-decreased red reflex -inability to visualize the fundus on direct ophthalmoscopy |
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What is the treatment for a partial lid laceration?
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Simple interrupted sutures with 6-0 or 7-0 nylon, to be removed in 3-5 days
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What are complex lid lacerations?
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-involving the lid margin
-involving the canalicular system (medial lower lid) -tissue loss -involve the levator or canthal tendons -involve the orbital septum (fat protruding) (there is no subcutaneous fat in the eye lids therefore in there is fat it means that the orbital septum has been perforated) |
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What is the treatment for a superficial conjunctival laceration?
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topical antibiotics
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What is the management of full thickness corneal lacerations?
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Treated the same as a globe rupture
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What is endophthalmitis?
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Infection of the deep parts of the eye, including the anterior and posterior vitreous chamber
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What common pathogens cause endophthalmitis?
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Staph
Strep Bacillus |
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What is sympathetic ophthalmia?
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inflammation occurring in the uninjured eye weeks to months after insult to an injured eye
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What is a good antibiotic choice in uncomplicated bacterial conjunctivitis?
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Polymyxin-trimethoprim (polytrim)
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What is ophthalmia neonatorum?
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Conjunctivitis within the 1st month of life
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What is a pterygium?
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A wedge-shaped conjunctival fibrovascular tissue that extends over the cornea
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What is a pinguecula
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Raised tissue in the conjunctiva adjacent to the cornea
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What is traumatic mydriasis or mitosis?
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Pupillary dilatation ro constriction that persists for days after a trauma. The provider must make sure to r/o cranial nerve palsy prior to making this diagnosis
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What are complications of conjunctivitis?
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keratitis
corneal ulcer corneal perforation |
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What is the treatment for gonococcal conjunctivitis?
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Admission
IV antibiotics saline irrigation ophthalmic antibiotics (erythromycin) |
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What is the treatment for herpes simplex keratitis?
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Trifluridine 1% q 2h for 14-21 days
Prophylactic antibiotics and cycloplegia |
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What is Hutchinson's signs and what is it associated with ?
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A zoster lesion on the tip of the nose - associated with a 76% risk of ocular involvement
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What ophthalmologic problem presents with classic dendritic lesions on the cornea?
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Herpes simplex infection of the eye
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What are common complications of contact lens use?
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-corneal abrasions
-corneal neovascularization -infections with corneal ulcers -reaction to the preservatives -contact lens depositis |
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What is the important pathogen in contact lens wearers?
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pseudomonas
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What is a hordoleum?
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Stye - acute inflammation of the glands of Zeis
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What is a chalazion?
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An obstructed Meibomian gland resulting in lid surface swelling but normal margins
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What is the treatment of hordoleum and chalazion?
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warm compresses 15 min q4-6x/day
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What is dacrocystitis?
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Infection of the lacrimal sac from lacrimal duct obstruction
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What is the treatment of dacrocystitis?
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Topical and oral anti-staph antibiotics, warm compresses and gentle massage
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What is the most common cause of preseptal cellulitis?
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sinusitis
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What are findings of orbital (post-septal) cellulitis?
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-proptosis
-restriction of ocular movement -pain with eye movement -toxicity |
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What antibiotics should be given for pre-septal cellulitis?
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Amoxicillin-clavulanate PO x 10 -14 days
cefuroxime or ceftriaxone IC consider adding vanco to cover MRSA |
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What is normal IOP?
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10-20mmHg
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What is glaucoma?
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An intraocular neuropathy caused by increased IOP
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What is the most common cause of glaucoma?
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Open- angle glaucoma
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What are precipitants of primary angle closure glaucoma?
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Pupillary dilatation
-dimly lit rooms -emotional upset -anticholinergic/sympthomimetic drugs |
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What are symptoms of acute angle closure glaucoma?
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-severe eye pain
-blurred vision -HA -nausea -vomiting -+/- abdo pain |
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What are signs of acute angle closure glaucoma?
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-halo around lights
-conjunctival injection -cloudy cornea -mid position to dilated pupil which is sluggish and fixed -increased intraocular pressure -decreased visual acuity |
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When should IV osmotics be used for the treatment of glaucoma?
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-markedly decreased visual acuity
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What are topical agents used for glaucoma?
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timolol 0.5%
pilocarpine alpha-2 agonists steroid |
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What are IV agents used in glaucoma?
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IV acetazolamide 250-500mg
IV mannitol 1-2g/kg over 45 minutes |
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What is the differential diagnosis of acute visual loss?
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-vascular occlusion
-retinal detachment -vitreous hemorrhage -neurophthalmologic disorders -macular disorder -hysteria |
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What are the signs of CRAO?
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-decreased VA over seconds
-APD -edematous pale retinal with cherry red spots |
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What is the management of CRAO?
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-digital globe massage
-increase CO2 (inhale carbagen or use rebreather) -timolol 0.5% (to decrease IOP) -acetazolamide 500mg PO -optho consult |
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What is the classic appearance of the retinal in CRVO?
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-Dilated veins
-retinal hemorrhages -disk edema "blood and thunder" |
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What 3 mechanisms case retinal detachment?
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-rhegmatogenous (tear or hole in the neural layer)
-exudative (blood or fluid leakage) -tractional - fibrous bond formation |
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What do patients with retinal detachment complain of?
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-flashes of light (traction on the retina)
-floaters (vitreous blood or pigmented debris) -visual loss |
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How does a detached retina appear on fundoscopy?
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Out of focus at the site of detachment
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What is posterior vitreous detachment?
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With aging the vitreous gel pulls away from the retina
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When is posterior vitreous hemorrhage treated?
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If accompanied by a retinal break
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How does vitreous hemorrhage present?
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Floaters or cobwebs in the vision progressing to severe visual loss without pain
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Does vitreous hemorrhage cuase APD?
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Not unless there is a retinal detachment behind the vitreous hemorrhage
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What defines a prechiasmal vision loss?
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Decreased VA or visual field loss in the eye on the affected side
+ APD on side involved -VF defect is in the centre of the VF |
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What are causes of prechiasmal visual loss?
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-optic neuritis
-ischemic optic neuritis -compressive optic neuritis -toxic and metabolic optic neuritis |
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When is posterior vitreous hemorrhage treated?
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If accompanied by a retinal break
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How does vitreous hemorrhage present?
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Floaters or cobwebs in the vision progressing to severe visual loss without pain
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Does vitreous hemorrhage cuase APD?
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Not unless there is a retinal detachment behind the vitreous hemorrhage
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What defines a prechiasmal vision loss?
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Decreased VA or visual field loss in the eye on the affected side
+ APD on side involved -VF defect is in the centre of the VF |
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What are causes of prechiasmal visual loss?
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-optic neuritis
-ischemic optic neuritis -compressive optic neuritis -toxic and metabolic optic neuritis |
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What are symptoms of optic neuritis?
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Progressive visual loss
ocular pain with movement |
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Do patients with optic neuritis have an APD?
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Always
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What % of patients presenting with optic neuritis develop MS within 5 years?
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30
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What causes ischemic optic neuropathy?
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-temporal arteritis
-idiopathic |
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What is the classic defect in chasmal visual loss?
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Bitemporal hemianopsia
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What are common causes of chiasmal visual loss?
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-pituitary tumors
-craniopharyngioma -miningioma |
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When a visual field defect respects the vertical meridian, where must it be?
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chiasmal or post-chiasmal
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What are the most common causes of post-chiasmal visual loss?
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-infarction
-tumor -AVM -migraine |
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What is the classic VF defect in a post-chiasmal lesion?
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homonymous hemianopsia
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What is cortical blindness? What is it commonly mistaken for?
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Visual loss from bilateral occipital infarction.
Functional blindness |
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What is Anton's syndrome?
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Bilateral blindness
Normal pupillary reflexes bilateral occipital lesions denial of blindness |
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What can be done to distinguish organic vs functional visual loss?
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-oppose index fingers
-sign name -place mirror in front and tilt (most patients follow reflection) -optokinetic drum reflex |
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What should be done to differentiate the different types of anisocoria?
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Determine if it increases in light or darkness
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What is Adie's tonic pupils
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Blurred near vision
occurs in young women with decreased DTR. They need cholinergic treatment |
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What are characteristics of 3rd nerve palsy?
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-anisocoria, which increases with light
-other signs of 3rd nerve involvement (ptosis, EOM dysfunction) |
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What should be ruled out in a 3rd nerve palsy?
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-aneurysm
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What is Horner's syndrome?
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Ptosis
Miosis Facial anhydrosis |
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What is a classic finding in Horner's?
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Dilation lag
(requires 15 seconds to dilate fully) |
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Why does increased ICP result in papilledema?
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The subarachnoid space is continuous with the optic nerve sheath
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How is nystagmus named?
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According to the direction of the fast component
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What is the pathological component of nystagmus?
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The slow component
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What are categories of disease that cause nystagmus?
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-toxic exposure
-defective retinal impulses -diseases of the labyrinths or vestibular nuclei -lesions of the brainstem or cerebellum controlling ocular posture |
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What is more concerning binocular or monocular diplopia?
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binocular
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What causes monocular diplopia?
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-refractive error
-dislocated lens -iridodialysis -feigned disease |
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What is the presenting feature of 4th nerve palsy?
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Double vision made worse by downward gaze
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What are causes of 4th nerve palsy?
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Trauma
Vascular disease Aneurysm intracranial tumor myasthenia gravis |
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What do cycloplegics do?
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Block muscarinic receptors resulting in paralysis of the ciliary muscles, this always causes mydriasis
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Are mydriatics and cycloplegics the same?
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No, cycloplegics always result in mydriasis but mydriatics are not all cycloplegics
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When are mydriatics contraindicated?
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-history of glaucoma
-increased intraocular pressure -shallow anterior chamber -ruptured globe -with a lens implant |
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What are RF for OM?
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Male gender
daycare attendance smoking pacifier use family history of middle ear disease |
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What is AOM?
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Signs and Symptoms of infection with evidence of effusion
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What is OME?
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Effusion but no signs or symptoms of infection
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What organisms commonly cause OM
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H influenza
Strep pneumo moraxella catarrhalis |
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What causes bullous myringitis?
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The usual organisms that cause AOM
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What is otitis-conjunctivitis syndrome?
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Purulent conjunctivitis and otitis media caused by HIB
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What is required to make the diagnosis of AOM?
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-history of acute onset
-signs of MEE -signs and symptoms of middle ear inflammation (erythema, otalgia) |
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What is the treatment of AOM with history of failure?
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Clavulin
Cefuroxime ceftriaxone |
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Which patients should have a myringotomy?
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-medical treatment failure
-OME for 4-6 months ->20dB hearing loss |
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What bacterial cause otitis externa?
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pseudomonas aeruginosa
Staph aureus gram negative polymicrobial |
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What is Ramsay Hunt syndrome?
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Herpes zoster oticus
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What should be done for patients with Ramsay Hunt syndrome?
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referral to ENT
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What is the treatment for OE?
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-antibiotic drops
-steroid drops -wick placement for 2-3 days |
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Which patients with OE may benefit from systemic antibiotics?
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-immunocompromised
-DM -HIV -periauricular area/skin affected |
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What is necrotizing otitis externa?
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A particularly aggressive OE
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What are the most common organisms for necrotizing OE?
|
-pseudomonas
(-staph aureus and others have been described) |
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Which CN is most often involved in malignant otitis externa?
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VII
(also may be IX, X, XI, XII, IV, VI) |
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What are complications of malignant otitis externa?
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meningitis
brain abscess sigmoid sinus thrombosis |
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What is the treatment for malignant otitis externa?
|
oral cipro
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What is universally present in mastoiditis?
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-pain
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When should you suspect mastoiditis?
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symptoms of AOM have lasted >2 weeks
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What is specific about hearing loss in conductive hearing loss?
|
individuals hear better in louder environments
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What area most commonly causes anterior epistaxis?
|
Kiesselbach's plexus
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Where does posterior epistaxis come from?
|
the sphenopalatine artery
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What are the most common reasons for epistaxis?
|
URTI with mucosal congestion and vasodilatation
trauma |
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Does HTN cause epistaxis?
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No, but it can worsen the bleeding
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How is persistent epistaxis treated?
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Pledgets soaked in phenylphrine, neosynephrine, cocaine or lidocaine with epinephrine
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When is silver nitrate effective?
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When there is not active bleeding
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Should bot hides of the septum be cauterized?
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No, so as not to cut off blood supply to the septum
|
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How long should anterior packs be left in place?
|
48 hours
|
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What duct is most commonly affected in sialolisthesis?
|
submandibular
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What is the treatment for sialolithiasis?
|
antibiotics (penicillinase -> amoxicilling-clavulanate or clindamycin
-massage -warm compresses -sialogogues (tart candies) |
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What is the 80% rule?
|
In adults 80% of neck masses are neoplastic of which 80% are malignant. In children 80% of neck masses are benign
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What is the difference between dysphagia and odynophagia?
|
dysphagia - difficulty swallowing
odynophagia - pain on swallowing |
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If stridor is present where is the lesion localized?
|
above the larynx
|
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At what size are LN considered abnormal? What are warning signs?
|
>1.5cm
decreased mobility and firmness |
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What is a reasonable strategy for treatment/investigation of neck masses in children?
|
Antibiotics for 2 weeks
-follow up ENT (most are inflammatory) |
|
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What is the most common bacterial cause of pharyngitis in kids?
|
group A beta hemolytic strep
|
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What is the peak age of strep?
|
5-15 years
|
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What is scarlet fever?
|
GABHS associated with sandpaper rash that subsequently desquamates
|
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What is a distinguishing feature of diphtheria?
|
-Gray-green pseudomembrane
-severe inflammation and edema produces bull neck appearance |
|
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What should you know about the mono spot test?
|
It may be falsely negative in up to 10% of patients in the early stages of disease
|
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What are the Centor criteria?
|
-tonsillar exudate
-tender anterior lymphadenopathy or lymphadenitis -absence of cough -history of fever |
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How should the Centor criteria be applied?
|
0-1 - no treatment or testing
2-3 - no treatment but testing 4 - treat empirically |
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Should non-Group A strep be treated?
|
Yes, because it has the same complications as GABHS
|
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Within how long should GABHS be treated to avoid acute rheumatic fever?
|
Within 9 days
|
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What is the treatment for GABHS in adults?
|
Pen V 500mg PO BID x 10 days (pen allergic -> erythromycin)
|
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What is the mainstay of treatment for diphtheria?
|
Antitoxin ***
Isolation Pen G x 5days |
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Why are steroids given in pharyngitis? What is the dose?
|
To decrease the duration of symptoms and alleviate pain
40-60mg Prednisone PO x 1-5d dexamethasone 10mg IM |
|
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What are suppurative complications of GABHS?
|
PTA
-Deep space abscess -suppurative cervical -lymphadenitis -OM -Sinusitis -Meningitis -Mastoiditis -osteomyelitis -empyema |
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What are non-suppurative complications of GABHS?
|
Scarlet fever
PSGN RF non rheumatic perimyocarditis Strep TSS Erythema nodosum |
|
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What is the most commonly isolated bacterial pathogen in adult epiglottitis?
|
H Influenza type B
|
|
|
What are radiologic findings of epiglottitis?
|
-Obliteration of the vallecula
-Swelling of the arytenoids and aryepiglottic folds -Swelling of the pre vertebral and retropharyngeal tissues -ballooning of the hypo pharynx -thumbprint epiglottitis |
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|
What are firstling agents for epiglottitis?
|
Ceftriaxone
Cefotaxime |
|
|
What are the 5 potential communicating spaces in the neck?
|
peritonsillar
parapharyngeal retropharyngeal prevertebral danger |
|
|
What is Ludwig's angina?
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A progressive cellulitis of the floor of the mouth that begins in the submandibular space
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What are causes of Ludwig's angina?
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Dental infection
Mandibular # FB or laceration tongue piercing |
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What is the ideal positioning for a lateral neck X-ray to r/o RPA?
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Lateral, neck extension with full inspiration
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What measurements suggest RPA?
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C2 >7mm
C6 >14mm kids >22mm adults |
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Name the paranasal sinuses?
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-frontal
-sphenoid -ethmoid -maxillary |
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What signs suggest a bacterial origin of sinusitis?
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-Worsening symptoms within 10 days
-double sickening (initial improvement followed by worsening) -more severe presentation |
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What is mucormycosis?
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invasive fungal sinusitis seen in immunocompromised patients.
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Which patients with sinusitis should be treated with antibiotics
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-symptoms and signs for >7d who worsen despite adequate symptomatic treatment
-moderate to severe symptoms including fever and purulent discharge |
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What are possible treatments for sinusitis?
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-Amoxicilin
-high dose amoxicillin -TMP-SMX -axihromycin |
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What are topical decongestants used for the treatment of sinusitis?
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0.5% phenylephrine
0.05% oxymetaxoline HCL (max 3-5 days use) |
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What is the role of CT in the diagnosis of sinusitis?
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it is sensitive but not specific
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