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Question 1

Pharyngitis due to group A streptococcus is common in children over

Answer 1

3 years of age, especially young school-aged children. Asymptomatic infection and pharyngeal carrier states may approach 15% - 50% of children during school outbreaks.

Question 2

Suppurative complications of streptococcal pharyngitis include

Answer 2

cervical adenitis, peritonsillar abscess, sinusitis, otitis media, and less frequently, mastoiditis. Disseminated disease (pneumonia, meningitis, joint or bone infection) is rare. Prompt treatment with antibiotics can prevent these complications.

Question 3

Nonsuppurative complications of group A streptococcal infection are

Answer 3

acute rheumatic fever and acute glomerulonephritis.

Question 4

_____ occurs after pharyngitis but not skin infections and can be prevented in virtually all cases if antibiotics are begun within a week of onset of symptoms.

Answer 4

Acute rheumatic fever

Question 5

______ occurs after either pharyngitis or skin infection with group A streptococcus, and antibiotic treatment may not prevent this complication.

Answer 5

Acute glomerulonephritis. Most patients (90%-95%) will recover completely with supportive care. The occurrence of acute glomerulonephritis is related to the prevalence of nephrogenic serotypes (1, 6, and 12) of group A streptococcus in the community.

Question 6

Summary of indications for tympanostomy tubes:

Answer 6

Refractory infection with moderate to severe symptoms
Unresponsiveness to at least 2 antibiotics
Hearing loss of 20 - 30 dB or worse with effusion = 3 months
Impending or actual complications (mastoiditis, labyrinthitis, etc.)
Persistent infections (4 - 6 months)
Advanced middle ear disease (e.g., cholesteatoma)
Craniofacial anomalies that predispose to middle ear dysfunction

Question 7

Hearing impairment is a risk factor for ________ , particularly if it occurs early in life.

Answer 7

impaired speech and language development

Question 8

Palpable cervical adenopathy is frequently encountered in otherwise healthy children. Infectious cervical ____ from viral or bacterial infections and is the most common cause of pediatric neck masses found.

Answer 8

adenitis

Question 9

_____ presents with solitary or multiple painful ulcerations occurring on the labial, buccal, or lingual mucosa

Answer 9

Aphthous stomatitis

Question 10

_____ is caused by transient atrophy of the filiform papillae and surface epithelium of the tongue. The patient may note mild burning or irritation.

Answer 10

Benign migratory glossitis, or geographic tongue. Treatment consists of reassurance as to the benign nature of the condition.

Question 11

_____ may also be seen in up to 50% of patients with geographic tongue and presents as deep, fissured grooves on the dorsal tongue.

Answer 11

Scrotal tongue

Question 12

_____ is a mucous retention cyst that is blue, painless, fluctuant and tense. They are typically found on the lips, tongue, and palate

Answer 12

A mucocele

Question 13

_____ typically causes white, curd-like plaques on the tongue, buccal, and gingival mucosa.

Answer 13

Thrush, caused by candidal species,

Question 14

_____ is the most common cause of stomatitis in children 1-3 years of age. Symptoms may appear abruptly, with high fever, drooling, fetid breath, and refusal to eat, as noted in the above vignette. However, the fever may precede the oral lesions by 2-3 days and presage to a more insidious onset of the disease. The tongue, cheeks, and gingiva are most commonly affected, but the entire oral cavity may be involved. These areas can present with ulcers that are yellowish-gray in color, and the gingiva may be quite friable.

Answer 14

Herpetic gingivostomatitis, caused by herpes simplex virus type 1.
Drooling may be present secondary to the pain associated with chewing and swallowing, and dehydration is a real concern in the management of the patient. Cervical and submaxillary adenitis is common. The acute phase may last up to 1-2 weeks. Treatment consists of measures to relieve the pain and facilitate the intake of fluids for adequate hydration.

Question 15

Approximately 50% of babies with choanal atresia have other anomalies, the most frequent of which is the

Answer 15

CHARGE association (Coloboma, Heart defects, Atresia choanae, Retardation of growth and development, Genitourinary anomalies, and Ear anomalies, including deafness)

Question 16

______ is an uncommon disorder presenting with respiratory distress after birth. Symptoms may mimic those of choanal atresia.

Answer 16

Congenital nasal pyriform aperture stenosis. The narrowing of the nasal pyriform aperture is thought to be due to bony overgrowth of the nasal processes of the maxillae during fetal development. High resolution CT scan done with thin contiguous axial section slices in the plane of the hard palate will provide anatomic detail.

Question 17

Otitis externa is an inflammation of the external ear canal. The most common pathogen is

Answer 17

Pseudomonas aeruginosa, followed by Staphylococcus aureus and strepococcus. It can also be caused by fungi, trauma, or dermatologic conditions like eczema.

Question 18

Teething or the eruption of primary teeth in the infant usually starts around 6 months of age. Though teething has been blamed for multiple symptoms and behaviors, including fever, pain, irritability, sleep problems, mouthing/biting, drooling, red cheeks, decreased oral intake, gum inflammation, runny nose, and diarrhea, recent cohort studies found many of these to be weak - if any - associations. Symptoms seen most consistently were

Answer 18

biting/mouthing, drooling, gum rubbing, and irritability. Many studies also reported decreased appetite for solids and mild temperature elevation (

Question 19

Nosebleeds are fairly common in children and are usually associated with trauma (nose-picking), mucosal friability due to upper respiratory tract infection, and mucosal drying related to environmental conditions. Most episodes are self-limited and require simple measures, such as stopping the bleeding with pressure application (pinching) and comfort care. Recurrent nosebleeds are rarely noted to be due to an underlying anatomic or hematologic abnormality. Patients who require further evaluation are those who:

Answer 19

have very frequent nosebleeds
have bleeding that is difficult to control or localize
have a positive family history of bleeding disorder
have other signs suggestive of a bleeding disorder

Nasopharyngoscopy helps identify the site and direct treatment.

Question 20

The epiglottis in children is more anteriorly and superiorly placed than that in adults, sits at a greater angle to the trachea, and is more floppy and omega-shaped than the more rigid and U-shaped epiglottis of the adult. Consequently, inflammation and swelling of the epiglottis is more likely to cause acute upper airway obstruction in children than in adults.

Answer 20

The etiologic agents, including Haemophilus influenzae (even in the era of prevalent Haemophilus influenzae B immunization), Streptococcus pneumonia, and Neisseria meningitides, are causative agents in both adults and children.

Question 21

Children may occasionally experience hemorrhage from recurrent tonsillitis or tonsilar hyperplasia. This is an absolute indication

Answer 21

for tonsillectomy, if this bleeding is recurrent and causes anemia.

Question 22

After failing a course of high-dose amoxicillin/clavulanate for Acute Ottitis Media, the most appropriate treatment would be a t

Answer 22

hree day course of parenteral ceftriaxone due to its superior efficacy against S pneumoniae compared to other oral antibacterials.

Question 23

Patient has continued obstructive symptoms despite having undergone adenotonsillectomy. His obesity continues to put him at risk for OSA and will take time to resolve as he loses weight slowly over time. In the meantime, he will benefit from the institution of non-invasive positive pressure support at night during sleep. The optimal level of pressure settings varies from patient to patient, and therefore a titration study done during a ___ can help identify the appropriate level of support for each patient.

Answer 23

nocturnal polysomnography. During this study, the patient is started on minimal settings of positive pressure and his respiratory parameters are monitored. The lowest settings that can help maintain adequate oxygenation and normal CO2 levels overnight with no desaturations are the ones that are selected for the patient.

Question 24

child has the classic findings of Kawasaki Disease, and this diagnosis has to be made on the basis of this combination of clinical findings. Along with presence of fever of 5 days’ duration, presence of any 4 of the following is considered diagnostic for Kawasaki Disease:

Answer 24

Edema and redness of hands and feet
Polymorphic rash
Bilateral painless conjunctival injection without exudates
Lips and oral cavity showing fissured and cracked lips, strawberry tongue or erythema of oral and pharyngeal mucosa
Unilateral cervical lymphadenopathy (>1.5cm diameter)

Question 25

case description is suggestive of acute bacterial sinusitis that is associated with persistent symptoms (>10 days), later onset of fever, and purulent nasal discharge and headaches. He requires initiation of therapy with

Answer 25

antibiotics, but his repeated vomiting may not allow him to keep the doses down; therefore, treatment with an initial parenteral antibiotic followed by an oral antibiotic is recommended.