ENT 2

Question 1

What causes inspiratory stridor?

Answer 1

Pharynx and supraglottis

Question 2

What causes biphasic stridor?

Answer 2

Glottis, subglottis, cervical trachea

Question 3

What causes expiratory stridor?

Answer 3

Thoracic trachea and bronchi

Question 4

What are the features of laryngomalacia?

Answer 4

Common (75%) cause of stridor
Inspiratory stridor, worse with feed, prone position, agitation 
Folded epiglottis (omega shape)

Question 5

What is the management for laryngomalacia?

Answer 5

Self-resolving for most (18-24 months)

Supraglottoplasty for some

Question 6

What are the types of vocal cord motion impairment?

Answer 6

Usually presents at birth
Unilateral (iatrogenic), weak/breathy cry
Bilateral (idiopathic/Arnod Chary), respiratory distress
Bilateral: 50% need tracheostomy, 50% recover

Question 7

What is subglottic stenosis?

Answer 7

Narrowing of dubglottic airway
Cricoid area narrowest point of airway, only complete ring
Congenital
Acquired: mechanical trauma (intubation) or infection
Biphasic stridor- exercise induced
endoscopic, reconstruction of airway or tracheostomy

Question 8

What are haemangiomas?

Answer 8

Infantile benign vascular tumours 
Rapid growth first 6 months followed by involution (70% by age 7)
Cutaneous or extra-cutaneous 
Cause problems when in subglottis 
Biphasic stridor and airway compromise

Question 9

What is the treatment for haemonagiomas?

Answer 9

Propanolol or surgical treatment

Question 10

What is recurrent respiratory papillomatosis?

Answer 10

HPV 6 and 11
Vertical transmission
Risk factors:First child, vaginal delivery, young mother
Husky voice and airway obstruction over time

Question 11

What is the treatment for recurrent respiratory papillomatosis?

Answer 11

Repeated debulking

Rarely malignant transformation

Question 12

What are the characteristics of inhaled foreign bodies?

Answer 12

6/12-4 year old, M>F (2-1)
Leading cause fo death in 1-3 year old
CXR may or may not be helpful
Rigid bronchoscopy

Question 13

What can obstructive sleep apnoea lead to?

Answer 13

Cognitive defects
Behavioural abnormalities 
Lower QOL
Impulsivity, hyperactivity
Cardiovascular implicatiosn
Poor growth usually thin

Question 14

What causes OSA?

Answer 14

Large tonsils and adenoids make airflow more difficult

Question 15

What special circumstances do some doctors reserve sleep studies for?

Answer 15

obesity, Down’s, craniofacial abnormalities, neuromuscular, sickle, MPS, when need for surgery is uncertain, or if there is discordance between tonsil size and history

Question 16

What are the types of sleep studies?

Answer 16

Simplest= home oximetry: useful screening but might miss mild OSA. Measures HR and O2 sats
Most comprehensive= Polysomnography: gold standard but limited availability, expensive, and needs hospital stay. Use in complex conditions. Measures HR, sats, CO2, EEG, airflow sensors, chest/abdo sensors.

Question 17

What is the treatment for OSA?

Answer 17

Conservative, 40% resolves in 7 months
Adenotonsillectomy: majority improve, but persistent OSA in some (20% depending on how hard you look)
CPAP: difficult if large adenoid/tonsil blocks airway
Nasal steroid spray (mild OSA)
Airway/craniofacial surgery depending on pathology

Question 18

What is chronic lymphadenpathy?

Answer 18

Usually benign/reactive
if history of malignancy, node >2cm, supraclavicular, getting bigger, fixed/hard node
Give antibiotics & review in 2 weeks
Bx if getting bigger
Non-tuberculous mycobacteria: well child with violet skin colour over cold abscess, usually submandibular area
Rx: abx or nil as settles spontaneously over 1-2 years

Question 19

What are typical reactive lymph nodes?

Answer 19

Size <1 cm
Fluctuates in size, worse with URTI
Clear source of infection eg scalp disease, tonsillitis
Jugulodigastic area
Well child, no other nodes or B symptoms
Offer reassurance and conservative management / monitoring