ENT

Question 1

Patient with noisy breathing, seems hungry but has difficulty feeding because it seems hard to breath. Sats 92% in RA and RR 46. Physician unable to pass 6F NG via either nare. Dx?

Answer 1

Congenital nasal pyriform aperture stenosis

Dx made with CT scan where pyriform aperture is <11mm. If <5.7mm need surgery.

First line tx conservative: nasal saline, humidification, topical decongestants, nasal corticosteroids, Oral airway, nasal stenting or gavage feeding. If fails then endoscopic surgery via sublabial approach (transnasal approach is for choanal atresia).

Differentiates from choanal atresia in absence of cyanosis (in bilateral) and blockage in anterior rather than posterior aperture but bony or membranous septum.

** Assoc’d with midline dev abnormalities (holoprosencephaly)

Question 2

Normal palatal index

Answer 2

0.3

Question 3

Asymmetric crying facies is hypoplasia or agenesis of

Answer 3

Depressor anguli oris muscle

Question 4

Best method to evaluate vocal cord motion ?

Answer 4

Flexible fiberoptic endoscopy

Can also use direct laryngoscopy

Question 5

Presenting symptom of vocal cord paralysis

Answer 5

High pitched stridor

Question 6

What is the interval for next exam for a pt with low stage rop in zone I?

Answer 6

1 week or less

Question 7

What type of inheritance pattern can be seen in pts with increased risk of hearing loss with amino glycoside use?

Answer 7

Mitochondrial mutation in m.1555A>G

Question 8

Nasal cavity forms from invagination of nasal placodes between which weeks?

Answer 8

3-6 weeks

Nostrils contain an epithelial plug until 24 weeks when resorption occurs

Question 9

What is the embryology of nose development?

Answer 9

Formation of neural tube from ectoderm (3 rd week gestation)

——> Develops into Neural crest cells

-—-> Then Migration of neural crest cells into mesenchyme

Question 10

Skeletal elements of craniofacial region are derived primarily from cranial ___________

Answer 10

Neural crest cells

Muscle from cranial mesoderm and somites

Question 11

Which is the most common nasal mass in neonate?

Answer 11

Nasal dermoid cyst

Manifest was external midline nasal masses with no effect on nasal breathing

External put on nasal dorsum will drain ous or debris

Question 12

Which nasal maldevelopment most likely to be associated with holoprosencephaly?

Answer 12

Pyriform aperture stenosis

Remember if central incisior and this finding think holoprosencephaly

Question 13

What is the threshold of an abnormal newborn hearing screen (ABR and OAE)?

Answer 13

> 35 decibels

Question 14

What does AABR hearing screen measure?

What types of hearing loss are detected?

Answer 14

Detects electric signals from the brain via scalp electrodes when baby is exposed to sound

Conductive
Sensorineural
Neural

Question 15

What does OAE hearing screen measure?

What type of hearing loss is detected?

Answer 15

Measures acoustic ‘feedback’ from cochlear outer hair cells through the ossicles to the tympanic membrane and ear canal

Conductive
Less effective with sensorineural

Question 16

Conductive vs sensorineural hearing loss

Answer 16

Conductive
-Blockage of conduction in the outer or middle ear —> transient (assoc’d with fluid debris) or permanent (anatomical abnormality) conductive hearing loss.

Bone conduction&raquo_space; Air conduction

Sensorineural

• Abnormal dev or damage to cochlear hair cells
• Decreased bone and air conduction

Question 17

Syndromes assoc’d with hearing loss

Answer 17

Alport syndrome 
Pierre Robin sequence 
Waardenburg syndrome 
Treacher Collins 
CHARGE
Klippel Feil
T8
T21
Stickler syndrome

Question 18

Where are dermoid cysts derived from?

Answer 18

Include derivatives from ectoderm (hair follicles and sebaceous/ eccrine glands) fron neural crest mesectoderm

Question 19

What findings lead to diagnosis if Stickler Syndrome ?

Answer 19

Micrognathia

Ocular abnormalities (cataracts)

Question 20

What is the only muscle innervated by thé cervical branch of the facial nerve ?

Answer 20

Platysma muscle

Question 21

Most common cause of bilateral vocal cord paralysis

Answer 21

Idiopathic vocal cord adductor muscle hyperreactivity

Question 22

Most common cause of unilateral vocal cord paralysis

Answer 22

Cardiac surgery

Question 23

Factor that is incorporated in the algorithm to predict threshold ROP

Answer 23

Insulin like growth factor 1

Question 24

Most common cause of vascular ring in neonate?

Answer 24

Doible aortic arch