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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
At what age does RPA typically present?
2-4 years
26
How do you diagnose RPA on lateral neck x-ray?
If prevertebral soft tissue is greater than 1/2 width of vertebral body
27
Name 5 symptoms of EoE
- 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
Name 5 causes of vocal cord paralysis
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
What workup is required for vocal cord paralysis?
CXR UGI MRI head and neck CT chest
30
Name 5 conditions that can cause stridor in an infant (inspiratory, biphasic and expiratory)
``` 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
Name 3 differentials for congenital midline neck mass
``` Thyroglossal duct cyst Dermoid cyst Teratoma Cervical cleft Foregut duplication cyst Vascular malformation Plunging ranula ```
32
Name 3 differentials for a lateral neck mass
``` Branchial cleft cyst Laryngocele Fibromatosis Colli (soft tissue mass in SCM) Hemangioma Lymphatic malformation Thymic cyst ```
33
What is the treatment and prognosis of fibromatosis colli?
Physiotherapy 80% complete resolution by age 1 20% require surgery if progress to congenital muscular torticollis
34
How do you diagnose fibromatosis colli?
US
35
Name 5 risk factors for SNHL
``` 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
Without newborn screening, what is the mean age of detection of hearing loss?
18-30 months
37
What audiologic test is used in newborn screening (for patients with NO risk factors)?
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
What audiologic testing can you use in older kids?
Audiogram - Visual reinforced audiometry (8 months to 3 years, can miss unilateral hearing loss) - Play audiometry (3-4 years) - Conventional (4-6 years)
39
What automated audiologic testing (AABR) is used for newborn screening in newborns WITH risk factors?
Auditory brainstem response testing | If positive, refer for diagnostic ABR
40
In tympanometry, what do Type A, Type B, and Type C represent?
Type A-normal Type B-flat (OME) Type C-retraction
41
In a patient with SNHL and delayed walking (18-24 months), what is the cause?
Vestibular dysfunction
42
Name 3 characteristics of SNHL secondary to CMV
High frequency Progressive (in 1st 5 years) Unilateral
43
What investigations should you order for SNHL?
``` 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
Name 4 causes of conductive hearing loss
OME Aural atresia Ossicular chain anomalies Syndromes (e.g. crouzons, MPS, treacher collins)
45
How months after AOM do most effusions clear?
90% cleared after 3 months
46
Name 5 indications for myringotomy tubes
``` 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
How do you manage tube otorrhea?
Ciprodex BID x 7 days | Water precautions
48
Name 10 extracranial complications of AOM
``` TM perforation Mastoiditis Post-auricular abscess Labyrinthitis Labyrthinthine fistula Facial nerve palsy Bezold's abscess Cholesteatoma ```
49
Over what time period do most TM perforations heal?
Within 6 weeks
50
When do you refer perforated TM to ENT?
Otorrhea persistent/visible perf for months after
51
When are perforated TMs typically repaired?
9-10 years of age
52
What is Bezold's abscess?
Abscess in SCM
53
Name 5 intracranial complications of AOM
``` Meningitis Brain abscess SVT Gradenigo's syndrome (petrositis) CSF leak Otic hydrocephalus ```
54
In pneumococcal meningitis with otogenic source, what condition should you look for?
Inner ear dysplasia
55
Name 4 risk factors for developing SNHL after meningitis
``` Raised ICP Seizures S. pneumonaie Low glucose level/high protein in CSF Length of hospital stay ```
56
Name 4 clinical features of Gradenigo Syndrome
Retro-orbital pain Otorrhea Abducens palsy Fever
57
When should you suspect cholesteatoma in a patient with otorrhea?
Unilateral Recurrent Foul smelling Responds to ototopicals but recurs
58
What clue on physical exam is suggestive of a subglottic hemangioma?
Facial hemangioma in beard distribution
59
What is the natural history of laryngomalacia?
Presents in first few days of life Worsens over first 6 months Plateaus from 6-12 months Resolves by 18-24 months
60
What chest x-ray views should you order if you suspect foreign body?
Inspiratory/expiratory views | Right and left lateral decubitus
61
When do you suspect mycobacterial avium adenitis?
Bluish hue | Over partoid or submandibular
62
How do you treat atypical mycobacterium lymphadenitis?
Biaxin x 7 days
63
Name 3 clinical features that suggest laryngomalacia as an etiology of stridor
Worse in supine position Improves when prone Loudest with feeding/sleeping Intermittent low-pitched "wet" inspiratory stridor
64
What are the clinical features of BPPV in young children?
``` Child appears frightened and off balance, often reaching out to steady him or herself Nystagmus Diaphoresis Nausea Vomiting ```
65
What condition is associated with BPPV?
Later develop typical migraine headaches
66
What is cherubism?
- 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
What is Caffey disease? (past question)
- 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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