ENT Flashcards

1
Q

What are the indications for tonsillectomy?

A

Recurrent tonsillitis

  • At least 7 episodes in the previous year
  • At least 5 episodes in each of the previous 2 years
  • At least 3 episodes in each of the previous 3 years

OSA

Modifying factors

  • Hospitalizations due to severe symptoms
  • Multiple antibiotic allergies making therapy difficult
  • Recurrent peritonsillar abscess
  • PFAPA
  • Lemierre’s syndrome (internal jugular vein thrombosis) due to tonsillitis
  • Rheumatic heart disease
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2
Q

What is Gradenigo syndrome and a Bezold abscess?

A

Complications of mastoiditis

Gradenigo syndrome = triad of suppurative OM, paralysis or external rectus muscle + pain in ipsilateral orbit

Bezold abscess → complication resulting in neck abscess

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3
Q

What is the treatment for mastoiditis?

A
  • Myringotomy + parenteral antibiotics +/- mastoidectomy if osteitis
  • Antibiotics → Ampicillin or Cefazolin or Cefuroxime
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4
Q

What are the indications for supraglottoplasty in children with laryngomalacia?

A
  • Progressive respiratory distress
  • Cyanosis
  • Cor pulmonale
  • FTT
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5
Q

What test should be done in an older child presenting with vocal cord paralysis?

A

MRI Brain!

Example CNS lesions: chiari malformation, myelomeningocele, hydrocephalus, birth trauma

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6
Q

What are the typical organisms responsible for retropharyngeal abscess?

A

Typically polymicrobial - most common:

  • Gram +: GAS, Streptococcus pyrogens, Staphylococcus aureus
  • Resp anaerobes: Fusobacterium, Bacteroides, Peptostreptococcus
  • Rare: Gram neg (e.g. Haemophilus), TB, Bartonella hensalae
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7
Q

What percentage of children with asymptomatic congenital CMV develop neurological consequences?

A

5-15%

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8
Q

What investigations do you order when congenital CMV is suspected?

A
  • CBC, bili, AST/ALT, CSF + CMV PCR on CSF, HUS and MRI if abnormal or neurologic symptoms, hearing screen, ophtho
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9
Q

What are genetic causes of SNHL loss?

A

Genetic causes make up 50% of SNHL causes

  • SNHL often seen with ear/eye abnormalities, metabolic, MSK, renal and CNS
  • Autosomal dominant: accounts for 10%
    • Most common Waardenburg (type I and II) & brachiootorenal syndromes
  • Autosomal recessive: accounts for 80%
    • Most common: Usher (associated with blindness), Pendred syndrome and the Jervell and Lange-Nielsen syndrome
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10
Q

What are the clinical features suggestive of bacterial sinusitis?

A
  • Persistent URTI (nasal discharge, cough) >10d without improvement
  • OR Severe respiratory sx (w/ T>39) + purulent nasal discharge 3-4 days
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11
Q

What the major symptoms in bacterial sinusitis?

A
  • Purulent anterior nasal discharge
  • Purulent or discoloured posterior nasal discharge
  • Nasal congestion or obstruction
  • Facial congestion or fullness
  • Facial pain or pressure
  • Hyposmia or anosmia
  • Fever (for acute sinusitis only)

“Classic presentation”: prolonged nasal congestion/discharge after URI without improvement for > 10 days OR sudden onset of fever and purulent nasal discharge for > 3 days

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12
Q

What are the common pathogens for cervical adenitis?

A
  • Staph aureus (#1)
  • GAS
  • Anaerobic
  • Nontuberculous mycobacteria
  • Tuberculosis
  • Bartonella
  • Toxoplasmosis
  • Histoplasmosis
  • EBV
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13
Q

What are risk factors for hearing loss in the newborn period?

A

ABCD’s

A = affected family member

B = bilirubin

C = congenital intrauterine infections

D = defects of the ear, nose and throat

S = small at birth (< 1500g), low apgar, NICU

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14
Q

What are findings on lateral soft tissue neck x-ray that is suggestive of RPA?

A
  1. Thickening of prevertebral tissues (greater than half the width of the C2 vertebral body, or >7-mm diameter at C2, or >14-mm diameter at C6)
  2. Locules of gas within the prevertebral tissues
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15
Q

What is the clinical features of acute otitis externa?

A

Rapid onset (within 48h) in past 3wk

  • AND
  1. Symptoms of ear canal inflammation, including
    • Otalgia (often severe), itching or fullness
    • WITH or WITHOUT hearing loss or jaw pain
  • AND
  1. Signs of ear canal inflammation, including
    • Tenderness of the tragus, pinna or both
      • OR
    • Diffuse ear canal edema, erythema, or both
    • WITH to WITHOUT otorrhea, regional lymphadenitis, tympanic membrane erythema, or cellulitis of the pinna and adjacent skin
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16
Q

What are complications of AOMs?

A
  • Extracranial (local/temporal bone)
    • Most heal within 6wk
    • Otic drops (ciprodex) *always use in the setting of a draining ear
    • Repaired 9-10yo
    • Referral: otorrhea is persistent/perf is visible
  • Tympanic membrane perforation
  • Mastoiditis
  • Post-auricular abscess
  • Labyrinthitis, labyrinthine fistula
  • Facial nerve paresis/paralysis
  • Bezold’s Abscess
  • Cholesteatoma
    • Otorrhea → unilateral, foul smelling, persistent/recurrent despite using oto-topicals
  • Intracranial
    • Meninigitis
    • Brain abscess - subdural/epidural
    • Sino-venous thrombosis
    • Gradenigo’s Syndrome (Petrositis)
    • Otic Hydrocephalus
    • CSF leak
17
Q

What are three features of Pierre Robin Sequence?

A
  • Micrognathia
  • Retrognathia
  • Glossoptosis
  • +/- Cleft palate