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pediatric Boards > ENT > Flashcards

ENT Flashcards

0
Q

What antibiotics are ototoxic? What are 2 other medications that cause reversible hearing loss ?

A

Aminoglycosides (gentamicin, tobramycin)

Loop diuretics & salicylate

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1
Q

What is the correct diagnosis and treatment for a 9 y/o male with purulent right ear discharge for several months despite several antibiotics…exam shows retraction of TM and squamous debris?

A

Cholesteatoma - referral to ENT

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2
Q

What diagnosis should you consider in a patient with foul smelling discharge despite treatment of perforated TM?

A

Cholestatoma

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3
Q

What is the most common cause of sudden bilateral sensorineural deafness?

A

Viral labyrinthitis

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4
Q

What are the 4 most common viral causes of sensorineural hearing loss?

A

CMV
Measles
Mumps
Rubella

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5
Q

What is the most common cause of neonatal hearing loss? How can this be prevented

A

Bacterial meningitis - can’t prevent despite treatment with antibiotics

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6
Q

What are the two newborn hearing screens and when should this be performed by?

A

Auditory brainstem response (ABR) and otoacoustic emissions (OAE)

Identification of hearing loss by 3 months with treatment by 6 months

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7
Q

What test is used to detect bilateral hearing loss in infants and toddlers?

A

Visual reinforcement audiometry (VRA)

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8
Q

What is indicated by a flat line (low amplitude) on tympanogram?

A

Stiff membrane or middle ear fluid or obstructed tympanostomy tube

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9
Q

How does tympanometry measure hearing sensitivity?

A

Tympanometry does NOT measure hearing sensitivity (you can have normal tympanogram with sensorineural hearing loss)

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10
Q

What is indicated by a high amplitude line on tympanometry?

A

Hypermobile TM

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11
Q

What is measured by the area under the tympanogram curve? And what does a high volume of this area indicate?

A

The area of the external canal - high volume indicates perforated TM

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12
Q

You are presented with a 4 y/o with chronic drainage through left TM, what is the likely cause and how would you treat?

A

Pseudomonas causing chronic suppurating otitis media

Topical ofloxacin

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13
Q

What diagnosis should you consider in a patient with persistent otitis media despite appropriate antibiotics who presents with headache and vomiting ?

A

Bacterial meningitis

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14
Q

What diagnosis should you consider in a patient with tympanostomy tubes who presents with copious bloody discharge and large red mass in the ear?

A

Tympanostomy tube granuloma

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15
Q

What should you do in a patient with swelling and deformity of the external ear after trauma?

A

Needle aspiration of hematoma

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16
Q

What is the diagnosis and 4 most common cause of postauricular swelling and erythema ?

A

Mastoiditis - strep pneumoniae, h flu, strep pyogenes and staph aureus

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17
Q

How would you confirm diagnosis of mastoiditis? How would you treat?

A

CT and tympanocentesis with culture - IV antibiotics and surgery

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18
Q

What 4 things are associated with nasal polyps and what study should you order in a patient with this finding?

A 
Cystic fibrosis
Asthma 
Chronic allergic rhinitis
Chronic sinusitis
**sweat chloride test**
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19
Q

What diagnosis presents as cyanosis while feeding but resolution with crying? What syndrome is this commonly found in?

A

Choanal atresia - CHARGE syndrome

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20
Q

Which sinuses are present at birth?

A

Maxillary and ethmoid

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21
Q

When are the sphenoid and frontal sinuses developed ?

A

Sphenoid: age 3 - 7 years
Frontal: teen years

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22
Q

What should be done in a patient with fracture of the frontal sinus? Why?

A

Surgery for repair to avoid CNS infection

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23
Q

When is a CT indicated in the diagnosis of sinusitis?

A

Only for chronic recurrent sinusitis

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24
Q

You are presented with a 13 y/o make with recurrent epistaxis. Bleeding is increasing in frequency, severity and duration. What is the next step?

A

CT scan to rule out posterior nasopharyngeal mass such as nasopharyngeal angiofibroma

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25
Q

What clinical finding can differentiate strep pharyngitis from mono?

A

Only mono presents with hepatosplenomegaly

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26
Q

You are presented with a child with high fever, swollen lymph nodes, pharyngitis and hepatomegaly. Strep is positive. Monospot is negative. What is the next step?

A

EBV titers

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27
Q

What would you do for a sexually active teenager who presents with sore throat and erythematous patches of the pharynx?

A

Test for GC pharyngitis and other STD testing

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28
Q

What treatment would you consider for a patient who presents with sore throat and difficulty opening the mouth as well as muffled voice…exam shows swelling around one tonsil and uvula deviation?

A

Needle aspiration plus ampicillin/sulbactam or clinda or augmentin

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29
Q

What is the cause of hypernasal voice after tonsillectomy / adenoidectomy?

A

Velopharyngel insufficiency

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30
Q

What would be the next appropriate step for a patient who presents with high fever, difficulty swallowing and neck hyperextended with drooling? What would you expect to find on imaging?

A

Lateral neck film will show widening of retropharyngeal space and then CT to confirm

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31
Q

What is the appropriate treatment for retropharyngeal abscess?

A

Surgical emergency – needle aspiration under anesthesia plus clindamycin or unasyn

32
Q

How would you differentiate retropharyngeal abscess vs epiglottis?

A

In epiglottitis, children lean forward vs hyperestension of neck which is found in retropharyngeal abscess

33
Q

What should you do for a patient with ankyloglossia?

A

No intervention needed

34
Q

What are the 5 common causes of delayed tooth eruption? After what age is tooth eruption considered delayed?

A 
Hypothyroid
Hypopituitarism
Ectodermal Hypoplasia
Hypohidrosis
Rickets
*delayed if no teeth by 16 months
35
Q

How should you transport an avulsed permanent tooth?

A

In saliva or chilled milk

36
Q

What diagnosis presents in an infant who sleeps with a water filled pacifier who presents with tender red nodules on the cheek who is afebrile with good PO intake and physical shows plaques and nodules? How would you treat?

A

Cold induced panniculitis - no treatment needed

37
Q

What is the gender predisposition em for cleft lip and palate?

A

Cleft lip/palate is more common in boys but cleft palate alone occurs more frequently in girls

38
Q

What is the genetic / environmental cause of cleft lip and palate ?

A

Can occur as single gene defect or in conjunction with other chromosomal abnormalities or from teratogenic exposure

39
Q

What is the first line treatment for dental abscess? Second line?

A

Penicillin

Clindamycin or erythromycin (if PCN allergy)

40
Q

What is the next appropriate step in a patient with croupy cough and X-ray repot of steeple sign?

A

Look at X-ray to r/o foreign body

41
Q

What are the 4 common causes of inspiratory stridor?

A

Paralyzed vocal cords
Adenoid/tonsil enlargement
Laryngomalacia
Pharyngeal or hypopharyngeal mass

42
Q

What is the most common cause of congenital stridor ?

A

Laryngomalacia

43
Q

What is the most likely cause of high pitched inspiratory stridor in a newborn after traumatic birth who has a weak cry?

A

Vocal cord paralysis after recurrent laryngeal nerve injury

44
Q

What diagnosis presents as a newborn with stridor and retractions that is worse with agitation and in the supine position?

A

Laryngomalacia

45
Q

What diagnosis presents as progressive hoarseness without stridor or dysphasia? How would you confirm this diagnosis?

A

Vocal cord nodules

Laryngoscopy

46
Q

What should you do in a patient with symptoms of laryngomalacia who presents with difficulty feeding and failure to thrive?

A

Search for a different cause as laryngomalacia does not present with feeding difficulties

47
Q

What diagnosis presents with difficulty breathing but normal pulse ox and normal physical exam with no response to bronchodilators ?

A

Vocal cord dysfunction

48
Q

What is the clinical difference between laryngomalacia and tracheomalacia?

A

Laryngomalacia presents with inspiratory stridor and improvement during expiration but tracheomalacia presents with expiratory stridor

49
Q

What diagnosis presents with expiratory stridor and feeding difficulties?

A

Vascular ring

50
Q

What two past medical problems can cause symptoms of expiratory stridor later?

A

Chronic ventilation

TE fistula repair

51
Q

What presents as biphasic (inspiratory and expiratory) stridor ?

A

Subglottic stenosis

Epiglottitis (supraglottic stenosis)

52
Q

What is the best appropriate step in a 4 y/o make with inspiratory stridor who is leaning forward and drooling with dysphasia and dysphonia?

A

Evaluation with anesthesiologist prepared for intubation

Third generation cephalosporin

53
Q

What is the classic X-ray appearance in a patient with epiglottitis ?

A

Thumb sign

54
Q

What is the appropriate method to diagnose a vascular ring?

A

Barium swallow

55
Q

What is the appropriate test to diagnose vocal cord function?

A

Flexible nasolaryngoscopy or direct laryngoscopy

CXR and barium swallow

56
Q

How would you diagnose subglottic stenosis ?

A

Direct laryngoscopy and bronchoscopy

57
Q

What diagnosis presents in an 18 month old male with low grade fever and hoarse barking cough with stridor ? What are the most common causes of this condition ?

A

Laryngotracheobronchitis (croup)

RSV, flu or parainfluenza

58
Q

What disease should you consider in a patient who is not immunized and presents with croup?

A

Measles

59
Q

What is the appropriate treatment for croup?

A

Racemic epinephrine
Cool mist
Decadron

60
Q

What is the next step in a patient with viral croup who rapidly deteriorates with toxic appearance and thick purulent secretions who prefers to lay supine?

A

Prepare for intubation &

Broad spectrum antibiotics for Bacterial tracheitis

61
Q

What are the 4 common causes of pseudomembranous croup?

A 
(Aka bacterial tracheitis)
Staph aureus
Moraxella catarrhalis
H. Flu and
Oral anaerobes
62
Q

What diagnosis presents with lateral neck films showing ragged air column and subglottic narrowing?

A

Bacterial tracheitis (aka membranous laryngotracheitis or pseudomembranous croup)

63
Q

What diagnosis presents as recurrent nightly croup without fever or uri symptoms ? How would you treat this condition ?

A

Spasmodic croup (non infectious) - symptomatic treatment plus steroids if needed

64
Q

What is the next step in a patient who you find to have a bifid uvula? What is this finding associated with?

A

Tympanometry

Submucous cleft palate

65
Q

What is the appropriate treatment in a patient with laryngeal papilloma? What is the common cause?

A

Laser excision

HPV (?child abuse)

66
Q

What is the likely diagnosis in a patient with midline neck lesion that moves vertically with swallowing? What is the appropriate treatment?

A

Thyroglossal cyst - do not surgically remove as this is functioning thyroid tissue

67
Q

What diagnosis presents as mobile and tender neck nodes without erythema or warmth?

A

Reactive cervical adenopathy

68
Q

What diagnosis presents as tender, red and warm neck nodes?

A

Lymphadenitis

69
Q

What diagnosis should you consider in a patient with pre-auricular adenopathy and conjunctivitis ?

A

Adenovirus

70
Q

What 2 diagnoses should you consider in a patient with chronic cervical lymphadenopathy?

A

HIV

TB

71
Q

What antibiotics should be started in a patient with bacterial lymphadenopathy ?

A

Unasyn and clinda

72
Q

What diagnosis should you consider in a patient with cervical adenopathy with 5mm PPD finding? How should you treat?

A

Atypical mycobacteria - surgical excision (not needle excision)!

73
Q

What diagnosis should you consider in a patient with chronic adenopathy and hepatomegaly with hx of exposure to farm animals ?

A

Brucellosis

74
Q

What diagnosis presents as an enlarged soft cervical mass that is caused by dilated lymph vessels?

A

Cystic hygroma

75
Q

What diagnosis should you consider in a patient with fever and parotid swelling in a school aged child, there is swelling and erythema inside the mouth but no pus can be expressed with parotid massage and there is no erythema of overlying skin?

A

Viral parotitis

76
Q

What diagnosis presents in a school aged child who is toxic appearing with high temperature and parotid swelling ? What is the most common cause of this ?

A

Bacterial parotitis - staph aureus

77
Q

You are presented with an adopted child from a developing country with 2 weeks parotid swelling resistant to antibiotics. The patient has received multiple vaccines but they are not well documented. What should you consider?

A

HIV ( because you have no parental information and vaccines have been given )

pediatric Boards (23 decks)

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