EAR, NOSE, and THROAT Flashcards
Newborn with isolated preauricular skin tags
Renal US is not indicated if no other congenital anomalies or risk factors
What is the risk of permanent hearing impairment in a newborn with isolated preauricular skin tags or pits?
5-fold higher compared to the general population
Prior to discharge, newborn hearing screen refers to the right (i.e., did not pass the hearing test in the right ear). Repeat testing also refers to the right. What is the next best step?
Refer for acute brainstem response (ABR) testing
Which antibiotic often used to treat newborn sepsis that may cause ototoxicity?
Gentamicin
Child with acute otitis media or externa and perforation of tympanic membrane—which topical antibiotic drops should be avoided to prevent ototoxicity?
Aminoglycosides
A 12-month-old child with severe bilateral sensorineural hearing loss. What is the best treatment?
Cochlear implant
What is the best audiometric test for an infant 6–9months or for older children with developmental delay?
Visual reinforcement/behavioral audiometry
What is the best audiometric test for a child as young as 2.5years
Play audiometry
What is the best audiometric test for children >4year, and adolescents?
Conventional audiometry: pure-tone, speech
What is the hallmark sign of otitis externa?
Tenderness of the tragus or pinna
Child with persistent purulent otorrhea for more than 2weeks despite treatment with oral and topical antibiotics
Referral to otolaryngologist
Child with persistent otorrhea for more than 6weeks and not responding to oral and topical antibiotics. What is the most frequent cause?
Cholesteatoma (collection of squamous epithelial cells and keratin within the middle ear)
Child presents with persistent ear discharge more than 3months despite the treatment with multiple courses of topical and systemic antibiotics. What is the most common bacteria associated with chronic suppurative otitis media (CSOM)?
Methicillin-resistant Staphylococcus aureus (MRSA) is most common isolate, Pseudomonas is also a common cause
Adolescent is complaining of nasal obstruction, pain, and rhinorrhea after nasal trauma. O/E: intranasal cavity reveals a tense red mass on each side of the nasal septum. What is the next best step?
Prompt drainage of nasal septal hematoma to prevent nasal cartilage ischemia, necrosis, and deformity
Adolescent wrestler with blue swelling and redness in the right ear pinna, occurred during a school match
Auricular (ear pinna) hematoma—urgent aspiration of the hematoma and pressure dressing
A 7-year-old child had tympanostomy tubes placed 4years ago because of acute otitis media with effusion and conductive hearing loss. O/E: you clearly visualize a white tympanostomy tube in the right tympanic membrane. What is the next best step?
Referral to ENT for surgical removal (tympanostomy tubes that remain in place for longer than 3years should be surgically removed)
How long is a tympanostomy tube expected to remain in place?
12–18months
Child has otitis media with effusion (OME) less than 3months
Tympanostomy tube insertion is not indicated
Child has OME lasting 3months with conductive hearing loss
Tympanostomy tube insertion is indicated
Child has recurrent acute otitis media with OME at the time of presentation
Tympanostomy tube insertion is indicated
Child with bilateral or unilateral OME lasting at least 3months together with risk factors for speech, language, or learning problems (e.g., neurodevelopmental disabilities, craniofacial anomalies)
Tympanostomy tube insertion is indicated
A 5-year-old with nasal discharge, congestion, and cough for 10days without improvement
Acute bacterial sinusitis (duration of symptoms)
A 5-year-old with temperature 101.3°F with purulent rhinorrhea for 3days
Acute bacterial sinusitis (severity of symptoms)
A 5-year-old with worsening of nasal congestion or rhinorrhea, cough, and fever after a 3- to 4-day period of improved symptoms
Acute bacterial sinusitis (worsening of symptoms)
Child presents with a 1-week history of fever of 102°F, cough, bilateral purulent nasal discharge, and frontal sinus tenderness
Acute sinusitis First-line treatment: amoxicillin clavulanate for 10–14days
Child presents with nasal congestion, post nasal drip, altered sense of smell, as well as facial pressure for over 3months
Chronic sinusitis
Child with an isolated fracture in the paranasal sinus. What is the best treatment?
1-week course of oral antibiotics and oral analgesics, referral in 1week to ENT or a surgeon specialized in facial trauma
What are the sinus precautions in cases of paranasal sinus fractures?
To avoid swimming, blowing the nose, playing wind instruments, and use of drinking straws
A 6-year-old boy presents with throat pain, fever, headache, and abdominal pain. Rapid antigen detection test for group A Streptococcus is positive. What is the best treatment?
10-day course of oral penicillin V
A 6-year-old boy presents with the third episode of streptococcal pharyngitis in the last 3months. Rapid antigen detection test for group A Streptococcus is positive. He was treated previously with penicillin V and amoxicillin. What is the next best treatment?
Clindamycin for 10days
A 6-year-old boy presents with throat pain, fever, headache, and abdominal pain. Rapid antigen detection test for group A Streptococcus is positive. He had an anaphylactic reaction to penicillin. What is the best treatment?
Clindamycin for 10days
A 6-year-old boy presents with throat pain, fever, headache, and abdominal pain. Rapid antigen detection test for group A Streptococcus is positive. He had a non-anaphylactic reaction to penicillin. What is the best treatment?
Oral cephalosporin for 10days
A 5-year-old boy presents with the insidious onset of fever, sore throat, neck stiffness, tachypnea, drooling, and stridor. Lateral neck radiograph shows thickened prevertebral soft tissues
Retropharyngeal abscess
What is the next best step in the previous case with retropharyngeal abscess?
Airway management, IV fluids, IV antibiotics, emergent ENT consultation
Adolescent female presents with fever, sore throat, difficulty opening her mouth, muffled voice, and dysphagia. She has tender anterior cervical lymphadenopathy. Her right tonsil is erythematous and enlarged, pushing her uvula to the left
Peritonsillar abscesses
What is the next best step in the previous case with peritonsillar abscess?
Needle aspiration of her right tonsil (diagnostic and therapeutic)
A 9-month-old presents with fever, ear tugging, and runny nose. Both tympanic membranes are bulging; this is the first ear infection. What is the first-line treatment?
Amoxicillin 90mg/kg/day for 10days
The same child presents to the office 3weeks later with the same symptoms. Which antibiotic should be used?
Amoxicillin/clavulanate—due to treatment failure within the last 30days
A 2-year-old child presents with fever and purulent conjunctivitis. Physical exam shows bulging of the tympanic membrane. Which antibiotic should be used?
Amoxicillin/clavulanate—likely due to nontypeable Haemophilus influenzae with concurrent bacterial conjunctivitis
Child presents with fever, tenderness, and edema in the postauricular region. Child was diagnosed with otitis media recently, but the parent was not compliant with therapy
Mastoiditis—needs ENT consult and IV antibiotics
Newborn child with severe cyanosis that improves with crying. Nurse attempts to pass a 6 French catheter and is not successful
Bilateral choanal atresia—requires immediate airway, can also be unilateral (less severe) and associated with CHARGE
Child with chronic nasal congestion, mucoid rhinorrhea, and noisy breathing for several months. No history of recurrent serious bacterial infections and normal weight for age. On examining the nasal passages, you note glistening, bluish-gray, grapelike masses bilaterally. What is the next best test?
Sweat chloride test
Children with nasal polyps should be screened for
Cystic fibrosis
The most common cause of epistaxis in a child
Trauma secondary to digital manipulation
A 2-year-old with unilateral rhinorrhea and foul smell from the left nostril. The child is otherwise acting normal?
Foreign body in the nose
Child presents with runny nose, congestion, itchy eyes, sneezing, and darkened skin around the eyes
Allergic rhinitis (under eye circles are called allergic shiners)
What is the most conservative method to control allergic rhinitis symptoms?
To avoid allergic triggers such as pets
Child has a painless blue mass noted on the right lower lip. The child is otherwise healthy, but the mother is concerned
Reassurance unless bothersome, then can consider excision (mucocele)
A 4-year-old girl presents with unilateral cervical lymphadenopathy, mild fevers; she was scratched by her new kitten several weeks ago
Cat scratch fever—Bartonella henselae
What is the most common complication of an adenoidectomy?
Hypernasal speech secondary undiagnosed predisposition to velopharyngeal insufficiency (such as submucosal cleft palate)
