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
6–9 months or for older children with
developmental delay?
Visual reinforcement/behavioral audiometry
What is the best audiometric test for a child as
young as 2.5 years
Play audiometry
What is the best audiometric test for children
> 4 year, and adolescents?
Conventional audiometry: pure-tone, speech
Child with persistent purulent otorrhea for morecthan 2 weeks despite treatment with oral andctopical antibiotics
Referral to otolaryngologist
What is the hallmark sign of otitis externa?
Tenderness of the tragus or pinna
Child with persistent otorrhea for more than
6 weeks 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 3 months 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 4 years 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 3 years should be surgically
removed)
How long is a tympanostomy tube expected to
remain in place?
12–18 months
Child has otitis media with effusion (OME) less
than 3 months
Tympanostomy tube insertion is not indicated
Child has OME lasting 3 months with conductive
hearing loss
Tympanostomy tube insertion is indicated
Child with bilateral or unilateral OME lasting at
least 3 months together with risk factors for
speech, language, or learning problems (e.g.,
neurodevelopmental disabilities, craniofacial
anomalies)
Tympanostomy tube insertion is indicated
Child has recurrent acute otitis media with OME at the time of presentation
Tympanostomy tube insertion is indicated
A 5-year-old with nasal discharge, congestion, and cough for 10 days without improvement
Acute bacterial sinusitis (duration of symptoms)
A 5-year-old with temperature 101.3 °F with
purulent rhinorrhea for 3 days
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
10–14 days
Child presents with nasal congestion, post nasal
drip, altered sense of smell, as well as facial
pressure for over 3 months
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 1 week 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 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 10 days
A 6-year-old boy presents with the third episode of streptococcal pharyngitis in the last 3 months. 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 10 days
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
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 10 days
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 90 mg/kg/day for 10 days
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
The same child presents to the office 3 weeks later with the same symptoms. Which antibiotic should be used?
Amoxicillin/clavulanate—due to treatment
failure within the last 30 days
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
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
The most common cause of epistaxis in a child
Trauma secondary to digital manipulation
Child presents with runny nose, congestion, itchy eyes, sneezing, and darkened skin around the eyes
Allergic rhinitis (under eye circles are called
allergic shiners)
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)
What is the most conservative method to control allergic rhinitis symptoms?
To avoid allergic triggers such as pets O. I. Naga
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)
