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FRCPC > ENT > Flashcards

ENT Flashcards

1
Q

What is the pathophysiology of vocal cord dysfunction?

A

Episodic unintentional adduction of the vocal folds on inspiration - plus anterior-superior laryngeal compression during phonation

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2
Q

In a child diagnosed with exercise induced asthma, what features would be consistent with vocal cord dysfunction?

A

Laryngoscopy-vocal cord adduction with inspiration
Truncated inspiratory flow volume loop
Poor response to medications for asthma
Prominent report of stridor at the time of symptoms

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3
Q

What is the treatment of nasal septal hematoma?

A

Refer to ENT

URGENT I&D to avoid cartilage necrosis and saddle nose deformity

Nasal packing +biaxin

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4
Q

How do you remove a nasal foreign body?

A

Positive pressure technique (occlude nostril and blow nose, parent’s kiss)
Direct instrumentation

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5
Q

Indications for ENT referral for nasal foreign body

A

Posterior FBs (ie, not readily visualized by anterior rhinoscopy)

Chronic or impacted FBs

Button batteries which warrant urgent removal

Penetrating or hooked FBs

Any FB that cannot be removed at initial attempt

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6
Q

What is pyriform aperture stenosis?

A

Overfusion of midline
Other midline defecits
Associated with Aperts and Crouzon

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7
Q

How do you establish an airway in choanal atresia?

A

McGovern nipple
Intubation
Dilation
Tracheostomy

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8
Q

How does encephalocele present?

A

Blue, soft, compressible, pulsatile mass in nares
Enlarge with crying
May present with meningitis

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9
Q

Name 3 components of Pierre Robin sequence

A

Retognathia
Glossoptosis (tongue falling back)
High arched palate

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10
Q

How do you distinguish Apert and Crouzons?

A

Syndactyly with Aperts

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11
Q

Name 4 clinical features of Apert syndrome

A 
Bicoronal synostosis 
Maxillary hypoplasia
Hypertelorism
Protruding eyes
Cleft palate
Syndactyly
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12
Q

Name 4 clinical features of Crouzon syndrome

A

Same as Aperts, but less severe, less clefting and no syndactyly

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13
Q

Spot diagnosis: http://www.neurologyindia.com/articles/2010/58/5/images/ni_2010_58_5_815_72206_f1.jpg

A

Pott’s puffy tumour (frontal osteomyelitis)

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14
Q

How does invasive fungal sinusitis present?

A 
Acute sinusitis with fever
Nasal congestion
Purulent nasal discharge, headache
Sinus pain
Nasal ulceration
Periorbital swelling
Facial numbness dipliopia

Suspect in immunocompromised patients and diabetes

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15
Q

Name 4 conditions with nasal polyps

A

Antrochoanal polyp
Wegener’s
CF
PCD

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16
Q

Male, teenager with unilateral epistaxis. Mass in nose. What is the diagnosis?

A

Juvenile nasal angiofibroma

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17
Q

Management of epistaxis

A
  1. Direct compression x 5 minutes, bent forward
  2. Topical vasoconstrictor (e.g. oxymetazoline)
  3. Nasal packing
  4. Cautery with silver nitrate if hemostasis has been achieved
  5. If persistent posterior bleeding, ENT for posterior packing
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18
Q

Name 5 clinical signs of peritonsillar abscess

A

Unilateral tonsil bulge
In palate
Uvula deviated to one side
Trismus***

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19
Q

Name 2 clinical signs of RPA

A

Midline bulge in retropharynx

Torticollis

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20
Q

How do you distinguish button battery from coin on xray?

A

Step deformity

Halo signs

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21
Q

Indications for tonsillectomy

A
  1. Recurrent tonsillitis
    >7 episodes in 1 year
    >5 episodes/yr in each of 2 years
    >3 episodes/yr in each of 3 years

Each episode must have sore throat +one of exudate/adenopathy/swab positive/>T38.3

  1. PFAPA
  2. Peritonsillar abscess
  3. Antibiotics intolerance
  4. OSA
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22
Q

Complications of RPA

A

Airway obstruction
Septicemia
Aspiration pneumonia if the abscess ruptures into the airway
Internal jugular vein thrombosis***can cause H/A
Jugular vein suppurative thrombophlebitis (Lemierre’s syndrome)
Carotid artery rupture [53]
Mediastinitis (suggested by widening of the mediastinum on chest radiograph)
Atlantoaxial dislocation

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23
Q

Name 3 clinical features of Lemierre’s disease

A

Fever
Localized neck/throat pain (antecedent pharyngitis)
Tenderness, swelling induration overlying the jugular vein, over the angle of the jaw or along the sternocleidomastoid muscle (thrombophlebitis of jugular vein)
Respiratory distress (septic pulmonary emboli)

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24
Q

What antibiotics for RPA?

A

Clindamycin

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25
Q

At what age does RPA typically present?

A

2-4 years

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26
Q

How do you diagnose RPA on lateral neck x-ray?

A

If prevertebral soft tissue is greater than 1/2 width of vertebral body

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27
Q

Name 5 symptoms of EoE

A
  • Feeding dysfunction (median age 2.0 years)
  • Vomiting (median age 8.1 years)
  • Abdominal pain (median age 12.0 years)
  • Dysphagia (median age 13.4 years)
  • Food impaction (median age 16.8 years)
  • Gastroesophageal reflux disease-like symptoms/refractory heartburn
  • Associated with atopic disease
28
Q

Name 5 causes of vocal cord paralysis

A

Iatrogenic, most commonly associated with cardiothoracic surgery, thyroidectomy, and tracheoesophageal fistula repair

Idiopathic, probably the result of viral infection and autoimmune disease

Neurologic, including Arnold-Chiari malformation, posterior fossa tumor, meningomyelocele, cerebral agenesis, and hydrocephalus

Breech delivery (stretching of RLN)

Intrathoracic lesions (eg, aberrant great vessels, left heart failure, tumors)

29
Q

What workup is required for vocal cord paralysis?

A

CXR
UGI
MRI head and neck
CT chest

30
Q

Name 5 conditions that can cause stridor in an infant (inspiratory, biphasic and expiratory)

A 
Inspiratory
Laryngomalacia
Vallecular cyst
Saccular cyst
FB
epiglottitis
Biphasic
Subglottic stenosis
Subglottic hemangioma
Larygngeal cleft
Papillomatosis
Bilateral VCP
Expiratory
Complete tracheal ring
Vascular ring
Tracheomalacia
TEF
31
Q

Name 3 differentials for congenital midline neck mass

A 
Thyroglossal duct cyst
Dermoid cyst
Teratoma
Cervical cleft
Foregut duplication cyst
Vascular malformation
Plunging ranula
32
Q

Name 3 differentials for a lateral neck mass

A 
Branchial cleft cyst
Laryngocele
Fibromatosis Colli (soft tissue mass in SCM)
Hemangioma
Lymphatic malformation
Thymic cyst
33
Q

What is the treatment and prognosis of fibromatosis colli?

A

Physiotherapy
80% complete resolution by age 1
20% require surgery if progress to congenital muscular torticollis

34
Q

How do you diagnose fibromatosis colli?

A

US

35
Q

Name 5 risk factors for SNHL

A 
Hereditary SNHL
Congenital infections (TORCH)
Hyperbilirubinemia
Prematurity
Ototoxic medications
Infection (meningitis)
Congenital malformations of inner ear
Perilymph fistula
Tumours (acoustic neuroma)
Trauma
Noise exposure
36
Q

Without newborn screening, what is the mean age of detection of hearing loss?

A

18-30 months

37
Q

What audiologic test is used in newborn screening (for patients with NO risk factors)?

A

Otoacoustic emissions

  • Measures outer hair cell loss
  • Can have false positive in middle ear effusion
  • Does not tell you degree of hearing loss
  • If fail, send for automated auditory brainstem response testing (AABR)
38
Q

What audiologic testing can you use in older kids?

A

Audiogram

  • Visual reinforced audiometry (8 months to 3 years, can miss unilateral hearing loss)
  • Play audiometry (3-4 years)
  • Conventional (4-6 years)
39
Q

What automated audiologic testing (AABR) is used for newborn screening in newborns WITH risk factors?

A

Auditory brainstem response testing

If positive, refer for diagnostic ABR

40
Q

In tympanometry, what do Type A, Type B, and Type C represent?

A

Type A-normal
Type B-flat (OME)
Type C-retraction

41
Q

In a patient with SNHL and delayed walking (18-24 months), what is the cause?

A

Vestibular dysfunction

42
Q

Name 3 characteristics of SNHL secondary to CMV

A

High frequency
Progressive (in 1st 5 years)
Unilateral

43
Q

What investigations should you order for SNHL?

A 
MRI/CT-before cochlear implant
CMV on neonatal blood spot (if >3 weeks, if <3 weeks, can send urine CMV PCR)
Genetic panel
Consider ECG (congenital long QT)
Consider abdominal ultrasound (BOR)
44
Q

Name 4 causes of conductive hearing loss

A

OME
Aural atresia
Ossicular chain anomalies
Syndromes (e.g. crouzons, MPS, treacher collins)

45
Q

How months after AOM do most effusions clear?

A

90% cleared after 3 months

46
Q

Name 5 indications for myringotomy tubes

A 
Recurrent AOM with middle ear effusion
Bilateral OME >3 months with CHL, vestibular, behavioural problems, school performance
Mastoiditis
Chronic retraction of TM
Lack of response to medical therapy
47
Q

How do you manage tube otorrhea?

A

Ciprodex BID x 7 days

Water precautions

48
Q

Name 10 extracranial complications of AOM

A 
TM perforation
Mastoiditis
Post-auricular abscess
Labyrinthitis
Labyrthinthine fistula
Facial nerve palsy
Bezold's abscess
Cholesteatoma
49
Q

Over what time period do most TM perforations heal?

A

Within 6 weeks

50
Q

When do you refer perforated TM to ENT?

A

Otorrhea persistent/visible perf for months after

51
Q

When are perforated TMs typically repaired?

A

9-10 years of age

52
Q

What is Bezold’s abscess?

A

Abscess in SCM

53
Q

Name 5 intracranial complications of AOM

A 
Meningitis
Brain abscess
SVT
Gradenigo's syndrome (petrositis)
CSF leak
Otic hydrocephalus
54
Q

In pneumococcal meningitis with otogenic source, what condition should you look for?

A

Inner ear dysplasia

55
Q

Name 4 risk factors for developing SNHL after meningitis

A 
Raised ICP
Seizures
S. pneumonaie
Low glucose level/high protein in CSF
Length of hospital stay
56
Q

Name 4 clinical features of Gradenigo Syndrome

A

Retro-orbital pain
Otorrhea
Abducens palsy
Fever

57
Q

When should you suspect cholesteatoma in a patient with otorrhea?

A

Unilateral
Recurrent
Foul smelling
Responds to ototopicals but recurs

58
Q

What clue on physical exam is suggestive of a subglottic hemangioma?

A

Facial hemangioma in beard distribution

59
Q

What is the natural history of laryngomalacia?

A

Presents in first few days of life
Worsens over first 6 months
Plateaus from 6-12 months
Resolves by 18-24 months

60
Q

What chest x-ray views should you order if you suspect foreign body?

A

Inspiratory/expiratory views

Right and left lateral decubitus

61
Q

When do you suspect mycobacterial avium adenitis?

A

Bluish hue

Over partoid or submandibular

62
Q

How do you treat atypical mycobacterium lymphadenitis?

A

Biaxin x 7 days

63
Q

Name 3 clinical features that suggest laryngomalacia as an etiology of stridor

A

Worse in supine position
Improves when prone
Loudest with feeding/sleeping
Intermittent low-pitched “wet” inspiratory stridor

64
Q

What are the clinical features of BPPV in young children?

A 
Child appears frightened and off balance, often reaching out to steady him or herself
Nystagmus
Diaphoresis
Nausea
Vomiting
65
Q

What condition is associated with BPPV?

A

Later develop typical migraine headaches

66
Q

What is cherubism?

A
  • AD genetic condition
  • Age 2-5 years
  • Progressive, painless, bilateral, symmetric enlargement of mandible and/or maxilla, from replacement of bone with multilocular cysts
67
Q

What is Caffey disease? (past question)

A
  • Presents with massive subperiosteal new bone formation
  • Usually involves diaphyses of long bones, ribs, mandible***, scapulae, clavicles
  • Fever and pain
  • X-ray: subperiosteal cortical hyperostosis***
  • -Onset around 2 mo → spontaneous resolution by 2 yo

FRCPC (27 decks)

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