ENT

Question 1

Risk factors for hearing loss

Answer 1

ABCD’s
- affected family member
- Bilirubin
- congenital infections (TORCH)
- defects of ENT
- small at birth, low APGARS, NICU

Question 2

Physical Exam findings in AOM

Answer 2

• lack of mobility of TM - most sens/spec for MEE with AOM
• bulging TM = very sens/spec for AOM

Question 3

Risk factors for acute otitis media

Answer 3

• age
• cleft palate/craniofacial abnormalities
• indigenous
• immunoglobulin deficiency/immunosuppressed
• male
• prematurity
• cigarette smoke exposure
• pacifier use
• daycare
• lack of breastfeeding
• CHD/CLD
• Trisomy 21
• household crowding
• family history

Question 4

Duration of Treatment for AOM

Answer 4

• 5 days (BID because 2 ears)
• 10 days if < 2yr, recurrent AOM, failed 1st line, perforated

Question 5

Treatment of AOM + Conjunctivitis

Answer 5

Amox-Clav 7:1 (H. flu or moraxella more likely)

Question 6

Indications to refer for ear tubes

Answer 6

• recurrent AOM with MEE (3-4/season)
• bilateral OME (>3 moths) with CHL
• bilateral or unilateral OME > 3 months with other problems (vestibular, behavioural, discomfort, school performance)
• at risk children
• complications (mastoiditis)
• lack of response to medical therapy
• chronic retraction of TM

Question 7

Indications for T&A

Answer 7

• OSA AHI > 5 and large tonsils
• cor pulmonale
• suspected malignancy
• hemorrhagic tonsillitis
• severe dysphagia
• tonsillar hypertrophy
• recurrent tonsillitis (>/= 7 in 1 year, >/= 5/ year for 2 years, >/= 3/year for 3 years, proven strep)
• tonsilloliths and halitosis

Question 8

Neck mass examination

Answer 8

• thyroglossal duct cyst - moves with tongue, midline
• dermoid cyst - midline, calcification on plain film
• laryngocele - enlarges with valsalva
• hemangioma - mass at birth, grows, then plateaus, bluish
• lymphatic malformation - transilluminates, compressible
• sternocleidomastoid tumour - torticollis
• cervical ribs - harm and immobile, can be bilateral