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Pediatric Board Prep > ENT & Ophtho > Flashcards

ENT & Ophtho Flashcards

1
Q

A pt presenting with respiratory distress, drooling, torticollis and limited ROM of neck following a URI most likely suffers from….

A

Retropharyngeal abscess

preferred dx w/ CT with contrast if stable

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2
Q

An infant presenting with excessive tearing, photophobia, and blepharospasm (abnormal contraction of eyelid muscle) most likely suffers from …

A

Infantile Glaucoma

(can have corneal enlargement/ edema, abnormal red reflex)

(needs immediate Ophtho eval)

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3
Q

What is the most appropriate treatment for newborn with bilateral choanal atresia?

A

place an oral airway

followed by surgical correction of nasal patency

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4
Q

What is the best management for a cholesteatoma (abnormal growth of desquamated squamous epithelium & kertain in the middle ear) especially after recurrent otitis media?

A

surgical excision

complications of cholesteatoma including ossicle destruction, abscess formation, meningitis, cranial nerve palsies

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5
Q

What is the most likely diagnosis for a pt presenting with a firm, nontender nodular mass of the upper or lower eyelid without the presence of drainage/ pus?

A

Chalazion

tx with surgical excision is does not resolve or distorts vision

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6
Q

What is the best treatment for chronic sinusitis?

A

2-4 weeks of antibiotics

cough upon lying down & awakening, halitosis, nasal congestion

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7
Q

What is the most likely diagnosis for a discrete, cystic mass overlying the anterior margin of the right sternocleidomastoid muscle?

A

Branchial cleft cyst

can become seconardily infected at which time should be surgical removed

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8
Q

What is the characteristic sign of a retropharyngeal abscess (respiratory distress, fever, stiff/ hyperextended neck, drooling, soft palate injury, sore throat, difficulty speaking, torticollis) on lateral neck Xray?

A

widened retropharyngeal space with anterior airway displacement on lateral neck film

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9
Q

What is the characteristic sign of epiglottis on on lateral neck Xray?

A 
Thumbprint sign
(thickened radio-opaque epiglottis on Xray)
(definitive diagnosis is with direct visualization of cherry red epiglottis)
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10
Q

What imaging finding is consistently found in patients with orbital cellulitis (red painful swollen eye, limited EOM, proptosis)?

A

CT scan shows acute sinusitis (usually opacification of ethmoid sinuses)

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11
Q

what is the best initial treatment for orbital cellulitis?

A

IV ceftriaxone/ unasyn and vancomycin

Staph. Strep, rhinosinusitis organisms

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12
Q

What are the most common organisms to cause chronic rhinosinusitis (inflammation of the sinuses for > 12 weeks, facial pain, tenderness, mucopurulent nasal discharge, cough, fever, hailtosis) ? (4)

A
  1. Staph Aureus
  2. fungi
  3. gram negative bacilli
  4. anaerobes
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13
Q

What tympanogram is consistent with eustacian tube dysfunction?

A

Type C

peak is shifted to left due to negative pressure in middle ear

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14
Q

What tympanogram is consistent with middle ear effusion or perforated eardrum?

A 
Type B
(poorly defined peak suggesting poorly mobile ear drum)
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15
Q

What is the expected number of viral URIs in a pediatric patient?

A

3-8 episodes a year

daycare increases episodes

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16
Q

What is the best treatment for retropharyngeal abscess?

A

IV unasyn (amp sub) or Clindamycin

IV until afebrile and clinically improved; then oral for completion of 14 days

17
Q

What is the most common complication of acute URI?

A

otitis media

18
Q

what is the treatment for an auricular hematoma (tender, fluctuant, swollen hematoma in the anterior superior auricle following external ear trauma)?

A

drainage followed by pressure dressing of auricle

complication of cartilage necrosis due to interrupted blood supply

19
Q

What are possible causes of sensorineural hearing loss in neonate? (6)

A
  1. Aminoglycoside
  2. loop diuretics (furosemide)
  3. Salicylate toxicity
  4. congenital CMV
  5. Congenital Rubella
  6. Congenital Toxoplasmosis
20
Q

What is the most common cause for development of obstructive sleep apnea in children?

A

tonsillar and adenoid hypertrophy

21
Q

What is the most likely diagnosis of a patient with ill appearance, fever, severe dysphagia, trismus (difficulty opening mouth), stiff neck, respiratory distress (leaning forward to breath), and symmetrical, indurated, tender and tense submandibular swelling with crepitus?

A

Ludwig angina
(rapidly spreading, bilateral poly microbial cellulitis of submandibular and sublingual spaces as complication of infected molar)
(dx w/ CT scan)
(tx w/ amp/sulb or clindamycin)

22
Q

What is the most likely diagnosis for a patient presenting with unilateral ear pain, fever, postauricular tenderness/ erythema/ swelling, and displaced auricle?

A

Mastoiditis
(CT shows clouding of middle ear & mastoid, loss of definition of bony septae & coalescence of mastoid air cells)
(tx: IV abx & myringotomy or mastoidectomy if severe)

23
Q

What is the likely diagnosis for a child 6-24 months old presenting with intermittent/ asymmetric horizontal nystagmus, head nodding and torticollis with normal brain MRI & EEG?

A

Spasmus nutans (acquired nystagmus)

  • resolves in months to years
  • need to rule out space occupying lesion, drug ingestion & CNS infection
24
Q

What is the most likely diagnosis for pt presenting with fever, sore throat, dysphagia, trismus, asymmetric tonsillar swelling and deviation of uvula?

A

Peritonsillar abscess

(ENT consult for possible drainage and IV antibiotics

25
Q

What is the normal tympanogram for a pediatric patient?

A

well defined peak with compliance pressures between +50 and -150 mmH2O and peak compliance between 0.2-1.8

26
Q

What is the best initial treatment for dacryostenosis (congential nasolacrimal duct obstruction)?

A

gentle massage 3-4 times daily

-usually resolves by 6 months; if not refer to ENT for lacrimal duct probing

27
Q

What are risk factors for retinopathy of prematurity? (5)

A
  1. elevated arterial oxygen tension exposure
  2. low birth weight
  3. low gestational age
  4. surfactant therapy
  5. prolonged assisted ventilation
28
Q

What is the most likely cause of leukocoria (white pupillary light reflex)?

A

Retinoblastoma

29
Q

What is the most likely diagnosis of a pt presenting with prolonged ear drainage with visualization of whitish-gray cystic like mass in the posterior-superior quadrant of eardrum?

A

Cholesteatoma

30
Q

When should you refer to ENT for possible cholesteatoma? (3)

A
  1. whitish-gray mass behind intact TM
  2. drainage > 2 weeks despite appropriate tx
  3. new-onset hearing loss in previously operated ear
31
Q

What is the major complication of strabismus (intermittent or continuous misalignment of one or both eyes)?

A

loss of visual acuity
(tx with patching better eye)

(esotropia- inward deviation of eye towards nose is most common form of strabismus)

32
Q

What is the most likely diagnosis if pt presents with limited vertical gaze, lower lid ecchymosis, nosebleed, orbital emphysema (crepitus), diplopia, and hypesthesia (decreased sensation) of ipsilateral cheeck & upper lip after eye injury?

A

Orbital floor fracture

dx: CT of orbit
(tx: immediate ophtho consult- surgery if EOM entrapment or nasal decongestants & ice packs)

33
Q

What are the clinical features associated with CHARGE syndrome?

A

C: coloboma (keyhole liek defet of pupil &irirs w/ nystagmus
H: heart defect (usually septal or conotruncal)
A: atresia of chonae (nasal passage)
R: retarded growth
G: genital anomalies
E: ear anomalies

34
Q

What is the most common cause of unilateral foul smelling nasal discharge?

A

Foreign body

35
Q

What is the best initial treatment for simple corneal abrasions?

A

topical antibiotic ointment and oral analgesia with recheck in 1-2 days
-can use topical anesthetic in office for pain but not sent home with it

36
Q

What is a common ENT manifestation of cystic fibrosis?

A

nasal polpys (glistening grayish masses between the nasal turbinates and septum)

37
Q

What is the most common cause of otitis externa (unilateral ear pain exacerbated by movement of pinna & tragus, usually after swimming?

A

Pseudomonas aeruginosa

Pediatric Board Prep (26 decks)

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