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Pediatrics > ENT > Flashcards

ENT Flashcards

1
Q

Discuss the differential for otalgia

A

Primary: CN8 has no pain fibres so should not be painful
- auricle: hematoma, laceration, perichondritis (infection of pinna), herpes zoster (Ramsay-Hunt syndrome)
- External auditory canal: acute otitis external, malignant otitis externa, foreign body, cerumen impaction
- Middle ear: acute/chronic otitis media, myringitis (infection of tympanic membrane), mastoiditis, choleastoma
Secondary otalgia: referred pain from CN5, 7, 9, 10 and C2 and C3
- infection: tonsilitis
- trauma
- TMJ syndrome
- dental pain
- glossopharyngeal neoplasm

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2
Q

Discuss the presentation and management of TMJ

A 
Presentation:
- referred otalgia
- pain in TMJ area
- clicking, popping of joint
- restricted jaw opening
- headache, neck pain
Management:
- soft food
- avoid grinding teeth
- no gum
- NSAIDs
- occlusal dental splint
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3
Q

Name of of the triangles in the neck and important structures within

A

Submental: Bilateral anterior digastrics and hyoid bone
- submental lymph nodes
- myohyoid muscle
Submandibular: anterior and posterior digastric and mandible
- submandibular gland
- facial artery and vein
- mandibular branch of facial nerve
- hypoglossal nerve
Muscular: Median line, omohyoid, sternocleidomastoid
- thyroid gland
- larynx
- strap muscles
Carotid: omohyoid, sternocleidomastoid, posterior digastric
- Carotid artery and its division into the internal and external carotid
- internal jugular vein
- Vagus nerve
- Ansa cervicalis
Posterior cervical: sternocleidomastoid, trapezius, clavicle
- External jugular vein
- Phrenic nerve
- Accessory nerve
- Roots of brachial plexus
- ansa cervicalis

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4
Q

Name the divisions of the External Carotid Artery

A 
Some Anatomists Like Freaking Out Poor Medical Students
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular 
Maxillary
Superficial temporal
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5
Q

Name the Levels of the neck

A 
Submental - I (Ia and Ib)
Submandibular - II (IIa and IIb)
Middle sternocleidomastoid - III
Inferior sternocleidomastoid - IV
Posterior cervical - V
Muscular - VI
Supraclavicular
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6
Q

List the differential for a midline neck mass

A 
Congenital:
- Thyroglossal duct cyst
- Dermoid 
- Teratoma
- Thymic cyst
- Vascular tumours and malformations
Inflammatory/Infectious:
- lymphadenitis
- thyroiditis
Neoplastic
- thyroid
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7
Q

List the differential for a lateral neck mass

A 
Congenital:
- Brachial cleft cyst
- pre-auricular pit/sinus/cyst
- vascular malformation
- pseudotumour of infancy
- thymic cyst
Infectious:
- lymphadenitis: viral, bacterial, infectious mononucleosis, atypical mycobacterium, cat-scratch disease
- infection of congenital mass
- deep neck space infection
- parotitis
Inflammatory:
- Kawasaki
- Sarcoidosis
Neoplastic:
Benign: vascular tumour, teratoma, dermoid, lipoma, nerve tumour
Malignant: lymphoma, rhabdomyosarcoma, thyroid
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8
Q

List the most common brachial cleft cyst?

A

Second brachial cleft

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9
Q

Discuss the presentation and treatment of a first brachial cleft cyst

A

Presentation:
- Cyst or draining sinus that is anterior to the ear
- can extend over parotid or angle of mandible
- tract can extend into external auditory canal
Treatment:
- surgical excision with careful dissection of facial nerve

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10
Q

iscuss the presentation and management of a second brachial cleft cyst

A 
Location: 
- Cyst located along anterior border of middle to lower third of SCM
- tract extends along carotid sheath -> between divisions of carotid -> terminating in tonsillar fossa
Presentation: 
- cyst with clear or mucoid drainage
Investigations: 
- ultrasound and then CT
Treatment: 
- surgical excision
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11
Q

Discuss the presentation and management of pseudotumour of infancy

A 
- Intra-uterine trauma to the neck resulting in hematoma and subsequent fibrosis
Presentation: 
- firm, round mass along SCM that presents in 2-3 weeks of life
- possible torticollis
Investigations:
- ultrasound
- FNA
Treatment:
- physiotherapy
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12
Q

Discuss the presentation and management of a lymphatic malformation of the neck

A

Presentation: soft, mobile, painless, cystic mass in posterior triangle. Grow with infant growth
Investigations: MRI
Treatment: bleomycin

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13
Q

Discuss the presentation and management of infantile hemangioma

A

Presentation: soft, mobile, bluish/red masses. Must discuss risk of airway hemangioma. Most improve within 5-7 years
Treatment: Propanolol

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14
Q

What are the most likely organisms for acute suppurative lymphadenitis?

A

Staph aureus

Group A beta-hemolytic strep

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15
Q

What inflammatory neck lesion presents in an asymptomatic child in the submandibular region of the neck?

A

Atypical mycobacterium

Concern with surgery is mandibular branch of facial nerve

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16
Q

Discuss the presentation and management of a thyroglossal duct cyst

A

Demographics:
- Children 2-10 years old
Presentation:
- soft, smooth, painless cyst at the level of the hyoid
- Elevates with swallowing
Investigations:
- ultrasound (must ensure normal thyroid is present)
Treatment:
- Sistrunk procedure (remove cyst and hyoid bone)

17
Q

Discuss the presentation and management of malignant otitis externa

A

Develops from otitis externa where pseudomonas extends through haversion canals into the skull causing osteomyelitis
Presentation:
- otitis externa with granulation tissue
- CNVII palsy
Treatment:
- topical ciprodex
- long term IV 3rd generation cephalosporin

18
Q

List the indications for tympanostomy tubes with acute otitis media

A

Recurrent (>=4 in 6 months or >=6 in 12 months)
Language delay
Febrile seizures

19
Q

List some of the complications of acute otitis media

A

Perforated tympanic membrane -> squamous epithelium invaginate and shed kerratin -> form epithelial cyst cholesteatoma -> activates osteoclasts -> erodes ossicles and nerves

20
Q

List the indications for tympanostomy tubes for chronic otitis media with effusion (>3 mont

A

Bilateral COME with hearing loss >30dB for >3 months
Any language or speech delay
Unilateral COME with hearing loss >30dB for >6 months

21
Q

What are the different forms of hearing loss and how are they detected?

A

Conductive hearing loss: air-bone gap where bone is better than air
Sensorineural hearing loss: decrease in both air and bone conduction, especially in higher frequencies
Mixed: both

22
Q

List the differential and pertinent signs for sensorineural hearing loss

A

Presbycusis: bilateral high frequency hearing loss, age-related
Noise-related: bilateral, acute with temporal shift, chronic have 4kHz decrease in hearing
Meniere’s disease: unilateral low frequency hearing loss, tinnitus, episodic vertigo, sensation of fullness
Vestibular Schwannoma: unilateral hearing loss, tinnitus, vertigo
Ototoxicity: Aminoglycosides, Erythromycin, Furosemide, Cisplatin, Quinone
Sudden Sensorineural Hearing Loss: Occur over 3 days, >30dB loss in 3 consecutive frequencies

23
Q

List the common typanometry findings

A

Type A: Normal
Type Ad: flaccid tympanic membrane (dislocation of ossicle) - increased
Type As: stiff tympanic membrane or ossicle - decreased
Type B: fluid or mass in middle ear - flat with no peak
Type C: Eustachian tube dysfunction - negative peak pressure

24
Q

List the differential for conductive hearing loss

A 
Intact tympanic membrane:
- Otosclerosis
- Ossicular dysfunction
- Trauma
- acute otitis media
- Middle ear effusion
Perforated tympanic membrane:
- trauma
25
Q

Discuss the presentation and management of BPPV

A

Symptoms:
- episodic vertigo lasting seconds to minutes
- aggravated with head motion
Signs:
- positive Dix-Hallpike
- rotatory nystagmus with reversibility and latency
Treatment:
- Epley maneuver to remove cupololithiasis from posterior semicircular canal

26
Q

Discuss the presentation and management of Meniere’s disease

A 
Symptoms: 
- severe episodic vertigo lasting hours to days
- sensation of fullness
- tinnitus
- ataxia
- nystagmus
Signs: 
- unilateral low frequency hearing loss
- decreased vestibular activity
Treatment: 
- lifestyle: smoking cessation, decreased salt intake
- Medications: hydrochlorothiazide, antihistamine
- Surgery
27
Q

Discuss the presentation and management of vestibular neuritis

A 
Symptoms: 
- antecedent URTI
- vertigo lasting days to weeks
- nausea/vomiting
Signs: 
- ataxia
- nystagmus
- decreased vestibular activity
Treatment: 
- self-limiting in 3-6 weeks
- methylprednisone 100mg PO daily tapered to 10mg PO daily over 3 weeks
- gravol, ondansetron
28
Q

List the two main arteries and their divisions within the nose

A 
Internal carotid:
- anterior ethmoidal
- posterior ethmoidal 
External carotid
- sphenopalantine
- greater palantine
- superior labial
29
Q

List the differential for causes of epistaxis

A 
Local:
- trauma
- inflammatory: allergy, infection
- neoplasm
- foreign body
- medication: steroid, cocaine
- idiopathic
Systemic
- medication: anticoagulant
- vascular: congenital
- cardiovascular: hypertension
30
Q

Discuss the presentation and management of anterior epistaxis

A 
Pathophysiology: bleeding from Kiesselbech’s plexus
Presentation: blood out of nose first then oropharynx, can visualize bleeding with anterior rhinoscopy
Treatment:
- Trotter method
- silver nitrate coagulation
- Surgicel
- Anterior nasal packing
- Surgery
31
Q

Discuss the presentation and management of posterior epistaxis

A

Location: sphenopalantine artery
Presentation: bleeding into the oropharynx and then anterior nose, not visualized on anterior rhinoscopy
Treatment: posterior nasal pack, embolization, surger

32
Q

Differentiate between anterior nasal packing and posterior nasal packing

A

Anterior:
- apply nasal tampon with Otrixin in nose horizontal to palate OR
- use Vaseline gauze inserting from inferior to superior compressing down after each pass
- tape string on outside cheek to avoid aspiration
- Packing remains for 2-3 days as outpatient and have MD remove
- post-removal use nasal saline spray (hydrasense) and vaseline q12h for 2 weeks
Posterior:
- insert Foley into nostril and inflate balloon in oropharynx and pull back
- proceed with nasal packing technique
- treat as inpatient with continuous cardiac monitorin

33
Q

List some complications of anterior and posterior packing for epistaxis

A
  • Toxic shock syndrome (prevented with Amoxicillin or Cephalexin)
  • sinusitis (prevented with Amoxicillin or Cephalexin)
  • nasal trauma or synechiae
  • alar necrosis
  • aspiration of packing material
34
Q

What is Samter’s Triad?

A

Asthma
Nasal polyps
Sensitivity to NSAIDs

35
Q

Discuss the presentation and management of chronic sinusitis

A

Definition: chronic sinusitis with or without nasal polyp
Symptoms:
- CPODS (C for congestion)
Treatment:
- With nasal polyp: topical intransal corticosteroid and antibiotic, surgery
- Without nasal polyp: topical intranasal corticosteroid spray with irrigation, 2nd-line long term antibiotics (clarithromycin)

36
Q

Discuss the treatment of a tympanic membrane perforation

A

Most will heal spontaneously
Must avoid ototoxic antibiotic ear drops and water in ear
antibiotics only if signs of infection (otalgia, otorrhea) - amoxicillin, Septra
Surgery if persists >2 months or have conductive hearing loss

37
Q

What are some of the reversible risk factors for COME?

A 
Sleeping with a bottle
Smoking or wood burning stove in household
Cat
Daycare with >=6 kids
Pacifier

Pediatrics (18 decks)

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