ENT + Ophthalmo

Question 1

Type of tympanogram for hearing loss

Answer 1

Type B

Question 2

When should OME resolve?

Answer 2

90% resolve within 3 months

Question 3

When should someone get ear tubes

Answer 3

• recurrent AOM with middle ear effusion
  
  • 4x/6m or 6x/12m
• bilateral OME (>3 mos) with CHL
• unilat/bilat OME (>3 mos) with other problems (vestibular, behavioural problems, discomfort, school performance)
• at-risk children
• other uncommon indication
  
  • complications of AOM (i.e. mastoiditis)
  • lack of response to medical therapy
• chronic retraction of TM

Question 4

Extracranial Complications of AOM?

Answer 4

• TM Perforation
• mastoiditis
• post-auricular abscess
• labyrinthitis
• labyrinthine fistula
• facial nerve paresis/paralysis
• Bezold’s Abscess
• cholesteatoma

Question 5

What are char’s of a cholesteatoma:

Answer 5

older 
persistent/recurrent
stinks like pseudomonas
unilaterral
responds to steroid drops but recurs

Question 6

What are intracranial complications of AOM?

Answer 6

meningitis
brain abscess 
subdural/epidural
sino-venous thrombosis
Gradenigo’s Syndrome (Petrositis)
otic Hydrocephalus
CSF Leak

Question 7

How to tx epistaxis?

Answer 7

humidify 
lubrificate 
cauterize 
ant and post pack
treat underlying coagulopathy

Question 8

Red flags for periorbital cellulitis?

Answer 8

Proptosis 
Diplopia
Altered Vision 
Severe Pain / HA 
Altered LOC

Question 9

Complications of OSA?

Answer 9

Poor school performance
Daytime somnolence
Eneurusis
ADHD
FTT
Cor pulmonale

Question 10

Indications for T&A?

Answer 10

absolute:
OSA (AHI>5/hr) and large tonsils
Cor pulmonale
suspected malignancy 
hemorrhagic tonsillitis 
severe dysphagia

relative:
tonsillar hypertrophy
recurrent tonsillitis
7 episodes in the previous year, or
5 episodes in each of the previous 2 yr, or
3 episodes in each of the previous 3 yr
complications of tonsillitis 
tonsilloliths and halitosis

Question 11

Peritonsillar abscess

• characteristics + age
• invest
• tx

Answer 11

unilateral tonsil bulge in palate
uvular deviation
trismus
older children/teenagers

invest
none

treatment

• antibiotics
• surgical drainage

Question 12

Retropharyngeal abscess

• characteristics + age
• invest
• tx

Answer 12

midline bulge in retropharynx
posterior to palate
younger children
limited lateral ROM neck torticollis

invest:
lat xray - prevertebral bulge
CT to confirm

treatment

• antibiotics
• +/- drainage

Question 13

What test to screen for hearing in infants?

If fail, next step?

Answer 13

otoacoustic emissions (OAE)

auditory brainstem response (ABR)

Question 14

Midline Neck Mass Ddx?

Answer 14

Thyroglossal duct cyst 
Dermoid cyst 
Teratoma 
Cervical Cleft
Foregut duplication cyst 
Ranula Vascular Malformation

Question 15

Lateral Neck Mass Ddx?

Answer 15

Branchial cleft cyst 
Fibromatosis Colli 
Hemangioma 
Thymic cyst
Vascular malformation 
Laryngocele

Question 16

Most common midline nasal mass

Answer 16

Dermoid cyst

Question 17

CHARGE?

Answer 17

Coloboma
Heart defect
Atresia chonae
Retarded growth/development
Genital / urinary anomalies
Ear anomalies/deafness

Question 18

Thrombosis of IJ?

Answer 18

Lemierre syndrome

from deep neck infections

Question 19

Nerves of Eye movement?

Answer 19

CN3
SO4
LR6

Question 20

Eyelid nerves

Answer 20

CN3&raquo_space;> Sympathetic

Question 21

Horner syndrome?

Answer 21

ptosis
miosis (small pupil)
anhydrosis

Question 22

Cause of periorbital/preseptal cellulitis vs orbital cellulitis

Answer 22

Periorbital - scratch/bite

Orbital - sinusitis

Question 23

Signs of Orbital cellulitis

Answer 23

Red eye
Proptosis
Pain/limited EOM
RAPD possible
UNWELL

Question 24

Treatment for orbital cellulitis

Answer 24

IV abx

- cefuroxime, ceftriaxone/vanco

Question 25

congenital nasolacrimal duct obstruction?
name and tx
complications?

Answer 25

Dacryostenosis
Crigler massage

Dacryocystocele
Dacryocystitis
Urgent Ophthalmo referral

Question 26

Keratitis

Answer 26

Pain
White spot on cornea
vision loss

Question 27

How to screen for uveitis In JIA?

Answer 27

Slit lamp

Question 28

Who to screen for ROP?

When?

Answer 28

EITHER

<31wga
or
< 1250g

At 31cga if born <27wga
At 4weeks old

Question 29

What do you see in ROP on fundoscopy?

Answer 29

Dilated tortuous vessels

Demarcation line

Question 30

Strabismus definition?

where is the problem?

Answer 30

Ocular misalignment of any kind

Problem usually in the BRAIN

Question 31

Amblyopia definition?

where is the problem?

Answer 31

Functional loss of visual acuity
(even when all eye problems have been fixed)

Problem is in the BRAIN

Question 32

Indications for surgical intervention with laryngomalacia?

Answer 32

FTT
Apnea
Cyanosis
Rapidly worsening stridor

Question 33

Most common cause of lung absess

Answer 33

Aspiration pneumonia

Question 34

Vocal cord paralysis - PFT

Answer 34

spirometric lung function testing reveals truncated and inconsistent inspiratory and expiratory flow-volume loops,

Question 35

Order of development of sinuses?

Answer 35

Ethmoid > Maxillary >Sphenoid > Frontal

Question 36

pseudomembrane keratoconjunctivis

Answer 36

Adenovirus keratoconjunctivitis

Question 37

condition assoc w bifid uvula

Answer 37

Submucosal cleft palate

DiGeorge

Question 38

When to refer to ophthalmologist for dacryostenosis/blocked nasolacrimal duct

Answer 38

1 year

Question 39

How long is strabismus normal for?

Answer 39

Strabismus is normal until 3-4 months

After 6 months - refer

Question 40

What is one investigation that she should have done before T&A surgery?

Answer 40

Echo- to rule out cor pulmonale

Risk of post obstructive pulmonary edema

Question 41

Hyphema - list 2 steps in immediate management

What is the big risk?

Answer 41

Refer to optho
Head elevated
Limited activity
No ASA, ibuprofen

Rebleeding in 3-5 days

Question 42

Gradenigo’s Syndrome

Answer 42

complication of mastoiditis or AOM

fever
retroorbital pain
abduncens palsy

tx: IV ceftriaxone and flagyl