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RC Study Cards > ENT/Ophtho/Gen Surg > Flashcards

ENT/Ophtho/Gen Surg Flashcards

1
Q

Describe your approach to a child presenting with confirmed hearing loss.

A
  • Detailed family history
  • Medical evaluation (history, physical examination for associated comorbidities and/or syndromic/nonsyndromic hearing loss)
  • Consultations
    • Paediatric otolaryngologist
    • Paediatric ophthalmology
    • Geneticist
  • Prompt vision assessment to maximize sensory input (and r/o Usher syndrome)
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2
Q

List 4 risk factors for positional plagiocephaly

A
  1. Male sex
  2. Firstborn
  3. Congenital Torticollis
  4. Supeine sleeping position at birth and at six weeks
  5. Exclusive bottle feeding
  6. Awake “tummy time” < 3 X per day
  7. Lower activity level with slower achievement of milestones
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3
Q

Name 2 instances where imaging (x-rays) would be advised in an infant with flattening of his head

A
  1. Craniosynostosis is suspected
  2. Worsening of head shape between 4mo-2yo (when positional plagiocephaly would be expected to improve)
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4
Q

What features would you look for to differentiate craniosynostosis from positional plagiocephaly?

List 3 management strategies for positional plagiocephaly

A
  • Ipsilateral occipitomastoid bossing
  • Posterior displacement of ipsilateral ear

Management strategies

  1. Positioning
    • Head to foot of bed on alternating days
    • Encourage lying on each side in supine position
    • Tummy time (minimum 3 x 10-15min)
  2. Physiotherapy
  3. Moulding therapy
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5
Q

When is moulding therapy considered for the treatment of positional plagiocephaly?

List 3 barriers to use of moulding therapy

A

Severe asymmetry + ≤8 months

  1. Side effects: contact dermatitis, pressure sores, local skin irritation
  2. Cost
  3. Accessibility - only available in select areas
  4. Time: treatment plan usually includes wearing for 23h/day
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6
Q

What vision tests should you ensure you complete to screen vision in these age groups?:

≤3 months

6-12 months

3-18 years

A
  • ≤3 months:
    • Red reflex
    • Complete examination of skin and external eye structures
  • 6-12 months
    • ​As above AND:
      • Corneal light reflex
      • Cover-uncover test
  • 3-18 years:
    • ​As above AND:
      • Visual acuity examination with age-appropriate tool
        • Snellen ≥6yo
        • HOTV ≥3yo
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7
Q

At what age would a child be expected to obtain these milestones?

Face follow

Visual follow

Visual acuity measurable

A
  • Face follow: Birth until 4 weeks
  • Visual follow: 3mo
  • Visual acuity measurable: 3.5y
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8
Q

List 2 causes of amblyopia and their respective management

(reduced vision in the absence of ocular disease)

A
  1. Difference in refractive error (inability to focus the image)
    • Corrective lenses
  2. Strabismus (confusing image = poor aim)
    • Penalization therapy
      • Occlusion (patching)
      • Pharmacologic (cycloplegic drops)
  3. Media opacities (no image = poor clarity)
    • Clear the media - surgery for cataract etc.
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9
Q

List 4 risk factors for acute otitis externa

A
  1. Trauma
  2. Foreign body in the ear
  3. Use of hearing aid
  4. Dermatological conditions
  5. Wearing tight head scarves
  6. Immunocompromise
  7. Chronic otorrhea
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10
Q

What are the elements one needs to consider in order to diagnose acute otitis externa?

A
  1. Rapid onset (usually ≤48h) in the past 3 weeks
  2. Symptoms of ear canal inflammation
    • Otalgia (often severe), itching or fullness
    • +/- hearing loss or jaw pain (TMJ/in ear canal worsened with jaw motion)
  3. Signs of ear canal inflammation (tender tragus, pinna or both) OR diffuse ear canal edema, erythema or both +/- otorrhea, regional lymphadenitis, TM erythema or cellulitis of pinna and adjacent skin
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11
Q

What are the 2 most common pathogens of acute otitis externa?

A
  1. Pseudomonas aeruginosa
  2. Staphylococcus aureus

Other bacteria: gram negative bacteria, Aspergillus, Candida

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12
Q

Describe the management of acute otitis external for both mild-moderate and severe presentations.

What should you consider if there is a lack of response to the management?

A
  • Mild-moderate
    • ​1st line: topical antibiotic +/- topical steroids (7-10d) AND tylenol/NSIDS or oral opioid for analgesia
      • No low pH, corticosporin, gentamicin or neomycin with TM tubes or perforated membranes d/t ototoxicity risk
      • If canal not visualized, an expandable wick can be placed to decrease canal edema and facilitate medication delivery
      • Agents:
        • Polymyxin B-gramicidin (Polysporin) 1-2 drops QID
        • Ciprodex 4 drops QID x 7 days
        • Buro-Sol 2-3 drops TID-QID
  • Severe
    • ​PO antibiotics that cover S aureus and P aeruginosa
      • Ciprofloxacin is a good option

Not responding to treatment

  • Foreign body
  • Non-adherence
  • Alternative diagnosis?
    • Nickel dermatitis (allergic contact dermatitis)
    • viral or fungal infection
    • antimicrobial resistance
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13
Q

What 2 populations are at increased risk for malignant otitis externa?

What are prominent symptoms of malignant otitis externa?

What is the recommended management?

A
  1. Immunodeficiency
  2. Type 1 DM

Prominent symptoms

  • Facial nerve palsy
  • Pain

Risk of invasive infection of cartilage and bone of canal. May require CT/MRI to confirm diagnosis

Treatment

  • Aggressive debridement with systemic antibiotics for Pseudomonas +/- Aspergillus
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14
Q

List 2 recommended preventative measures for acute otitis externa

A
  1. Keep water out of ears (plugs vs positioning, shaking head or hair dryer on low setting)
  2. Avoid cotton swabs (can impact cerumen)
  3. Daily prophylaxis with alcohol or acidic drops durign at-risk activities (not studied)
  4. Hard earplugs shoudl be avoided (can cause trauma)
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15
Q
  1. Orofacial abnormalities (e.g cleft palate)
  2. Indigenous
  3. Frequent contact with other children
  4. FMHx AOM
  5. Prolonged bottle-feeding while lying down
  6. Shorter duration of breastfeeding
  7. Pacifier use
  8. Exposure to cigarette smoke
  9. Household crowding
A

List 4 risk factors for acute otitis media

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16
Q

List 5 extracranial complications associated with acute otitis media

List 5 intracranial complications associated with acute otitis media.

A

Extracranial (local/temporal bone)

  1. Mastoiditis
  2. Meningitis
  3. Labyrinthitis
  4. TM Perforation
    • usually heals in 6wks (repair at 9-10yo if not [when eustachian function improves)
  5. Cholesteatoma
  6. Bezold’s abscess (deep neck abscess)

Intracranial

  1. Meningitis
  2. Gradenigo’s syndrome (CNVII palsy, CNVI palsy can’t move ipsilateral eye outwards - due to petrous bone inflammation/infection)
  3. Cerebral sinus venous thrombosis (transverse, lateral or sigmoid sinuses)
  4. Brain abscess (subdural/epidural)
  5. Otic hydrocephalus
  6. CSF leak
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17
Q

List the 3 most common pathogens of acute otitis media

A
  1. Streptococcus pneumoniae
  2. Moraxella cattarhalis
  3. Haemophilus influenzae

Other common pathogens: Group A Streptococcus

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18
Q

What is a necessary minimal diagnostic criterion for the diagnosis of acute otitis media?

A

A middle ear effusion (MEE)

  • Signs of MEE:
    • Little or no mobility of TM when both positive and negative pressure is applied with pneumatic otoscope)
    • Loss of bony landmarks
    • Presence of air-fluid level
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19
Q

Desribe the management for acute otitis media

What would you prescribe if there had been a recent treatment with amoxcillin within the past month?

A
  • >6 months of age, generally healthy (no craniofacial abnormalities, tubes, recurrent AOM or immunocompromised)
  1. NO MEE/MEE (mild erythematous TM or non-buldging TM)
    • R/A in 24-48h
    • If worsens or no improvement, verify presence of effusion and signs of inflammation
  2. MEE present AND bulging TM
    • Mildly ill
      • Symptoms
        • Alert, responsive, no rigors, responding to antipyretics, mild otalgia but able to sleep
        • <39˚C in absence of antipyretics
        • <48h illness
      • Observe for 24-48h
        • Either:
          • Reassess in 24-48h to document course
          • Have return in 24-48h if no improvement or worsens
          • Provide antimicrobial prescription if no improvement
      • Analgesia
      • If not improved or worsening clinically, PO Amoxicillin
        • <2yo: 10 days
        • ≥2yo: 5 days
    • Moderate-severely ill
      • Either (≥1) of:
        • Irritable, trouble sleeping, poor response to antipyretics, severe otalgia
        • ≥39˚C in absence of antipyretics
        • >48h of symptoms
      • Treat with PO Amoxicililn
        • <2yo: 10 days
        • ≥2yo: 5 days
  3. TM perforated with purulent trainage
    • PO Amoxicillin x 10 days

Antibiotic choice

  • Amoxicillin 75-90mg/kg/day divided BID
  • If allergy: 2nd gen (cefuroxime-axetil) or 3rd gen cephalosporin (cefotaxime)
  • Other considerations: Macrolide (clarithromycin/azithromycin)

Previous Amoxicillin <30 days or relapse of recent infection

  • Clavulin (Amoxicillin/clavulanate)

Failure of oral drugs or Clavulin failed

  • IM Ceftriaxone 50mg/kg/day x 3 days
  • Referral to ENT for tympanocentesis (sample of middle ear fluid)
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20
Q

What should you recommend for the management of a 7mo patient with acute otitis media and purulent conjunctivitis?

A

Otitis-conjunctivitis syndrome

  • PO Antibiotic management
    • Clavulin (Amoxicillin/Clavulanate), or
    • 2nd generation cephalosporin (Cefuroxime-axetil)
  • Obtain bacterial cultures of conjunctival discharge
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21
Q

At what age should childre have a dental home by?

A

12 months

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22
Q

What is the most common causative organism of dental caries?

List 2 ways that topical fluoride prevents caries.

What are risk factors for dental caries?

When should topical fluoride be administered?

A

Streptococcus mutans

Prevention

  • Inhibits plaque
  • Inhibits demineralization
  • Enhances remineralization of enamel

Risk factors for dental caries

  • Populations at risk
    • Indigenous
    • Low-income families
    • Children with special health care needs
    • New immigrants
  • Prolonged use of bottle or training cups with sugar-containing drinks
  • High frequency of sugary snacks per day
  • Environmental tobacco smoke
  • Maternal smoking status

Supplementation Indications

  • Concentration in municipal water supply is <0.3ppm
  • Teeth not brushed at least 2 times a day
  • Dentist/HCP feel child is susceptible to cavities
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23
Q

How much fluoride is in a pea-sized amount of toothpaste?

How much supplemental fluoride should be provided?

What are signs of fluorosis? List 2.

Which teeth are at the greatest risk for fluorosis at 15-24mo?

A

Pea-sized amount = ~0.4mg

  • Supplemental fluoride amount (daily)
    • >6mo-3y = 0.25mg
    • 3-6y = 0.5mg
    • >6y = 1mg

Fluorosis

  • Mottling and pitting of teeth
  • Enamel striations
  • “Snow capped cusps”
  • Chalky-white teeth

Secondary teeth are at greatest risk for fluorosis at 15-24mo

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24
Q

List 4 strategies to decrease incidence of dental caries in Indigenous communities

List 3 examples of primary prevention of dental caries.

A
  1. Promote supervised use of fluoridated toothpaste in all Indigenous (and high-risk children) after 1st tooth erupts twice daily (infants - grain sized; child - pea-sized)
  2. HCPs should perform oral health screening during health assessments and provide referrals PRN to dental health providers
  3. Use motivational interviewing and anticipatory guidance for parents and caregivers of infants and children on oral hygiene and diet
  4. Provide women with preconception and prenatal screening for oral health, anticipatory guidance and referral to dental care PRN
  5. Ensure access to series of fluoride varnish and an assessment to determine need for sealant placement on deep grooves and fissures

Primary prevention

  1. Water fluoridation
  2. Topical fluoride if no fluoridation
  3. Oral health promotion
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25
Q

List 4 indications for tympanostomy tube insertion.

A
  1. Bilateral OME with conductive hearing loss if persisting ≥3mo
  2. Prior to chemotherapy for at-risk AOM groups (most common reason)
  3. Unilateral OME with conductive hearing loss AND concern (behavioural issues, school performance, vestibular symptoms, discomfort)
  4. Recurrent AOM with middle ear effusion (least common reason)
  5. Mastoiditis
  6. Chronic retraction of TM
  7. Lack of response to medical management (i.e. continuous Abx)
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26
Q

What rare condition should you consider with severe unilateral epistaxis?

List 4 management options for epistaxis.

A

Juvenile nasopharyngeal angiofibroma

Management

  • Humidify
  • Lubricate - vaseline
  • Cauterize - silver nitrate
  • Pack
  • Treat underlying coagulopathy
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27
Q

List 3 indications for tonsillectomy

What is Paradise criteria?

A
  • Absolute
    1. OSA (AHI >5) and large tonsils
    2. Cor pulmonale
    3. Suspected malignancy
    4. Hemorrhagic tonsillitis
    5. Severe dysphagia
  • Relative
    1. Tonsillar hypertrophy
    2. Recurrent tonsillitis (Paradise criteria)
    3. Complications of tonsillitis
    4. Tonsilloliths and halitosis

Paradise Criteria

  • Requirements for an episode (≥1 of):
    • Fever >38.3˚C
    • Cervical lymphadenopathy (tender or enlarged [>2cm])
    • Tonsillar or pharyngeal exudates
    • GAS+ Throat Cx
  • ≥7 in 1 year
  • ≥5 in 2 years
  • ≥3 in each of last 3 years
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28
Q

What are the criteria of the Centor score?

When is treatment indicated for acute pharyngitis vs investigations vs reassurance?

A
  • CENTOR (≤3 days of acute pharyngitis)
    • Cough absent
    • Exudate
    • Nodes
    • Temperature
    • OR - young (≥3 to <15yo) OR old (lose a point)
  • Scoring
    • 0-1: reassurance
    • 2-3: throat swab - treat if positive
    • ≥4: throat swab and consider treating
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29
Q

Describe the signs and symptoms of a child with a peritonsillar abscess

A
  • Unilateral tonsil bulge
  • Uvular deviation
  • Trismus
  • Presents in older children/teenagers

Treated with antibiotics and surgical drainage

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30
Q

Describe signs and symptoms in keeping with a retropharyngeal abscess

A
  • Midline bulge in retropharynx
  • Posterior to palate
  • Occurs in younger children

Treatment: antibiotics +/- drainage (if not improving)

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31
Q

Provide 3 possible diagnoses each for inspiratory, expiratory and biphasic stridor

A
  • Inspiratory (Supraglottis)
    • ​Laryngomalacia
    • Foreign body
    • Epiglottitis
    • Vallecular cyst
    • Saccular cyst
  • Expiratory (Trachea/Bronchi)
    • Tracheomalacia
    • Foreign body
    • Tracheoesophageal fistula
    • Complete tracheal rings
  • Biphasic (Vocal cords/Subglottis)
    • Subglottic stenosis
    • Croup
    • Bilateral vocal cord paresis
    • Subglottic hemangioma
    • Laryngeal cleft
    • Croup
    • Foreign body
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32
Q

Provide counselling to the parents of a child with laryngomalacia regarding expected prognosis

A
  • Will worsen until about 6 months
  • Plateaus between 6-12 months
  • Improves 12-18 months (Hamilton Review says 18-24 months)
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33
Q

What is a differential diagnosis for Neck Masses?

A

“COIN”

  • Congenital
    • midline vs lateral
  • Other
    • Inflammatory: Kawasaki, Sarcoidosis
  • Infectious
    • Acute: viral (EBV, CMV), bacterial (GAS/Staph), PFAPA, Lemierre’s syndrome
    • Chronic: HIV lymphadenitis, bacterial (bartonella, TB, atypical mycobacterium, tularemia, syphilis, brucellosis, actinomycosis)
  • Neoplastic
    • Benign
      • Midline
        • Thyroglossal cyst (moves w/tongue protrusion)
        • Dermoid cyst (calcification on plain films)
        • Teratoma
        • Vascular malformation
        • Cervical cleft
        • Ranula
        • Foregut duplication cyst
      • Lateral
        • Branchial cleft cyst (along SCM border)
        • Hemangioma
        • Thymic cyst
        • Laryngocele (enlarges with Valsalva)
        • Vascular malformation
    • Malignant
      • Thyroid
      • Lymphoma
      • Ewing sarcoma
      • Rhabdomyosarcoma
      • Neuroblastoma
      • Salivary gland tumours
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34
Q

In regards to orbital cellulitis:

  1. Where does it usually originate from?
  2. What are 2 features unique it?
  3. What are the 2 most common causal organisms?
  4. What are 2 ophthalmologic complications
A
  1. Usually originates from:
    • Ethmoidal sinusitis
  2. Features unique to it:
    • Proptosis
    • Pain with extraocular movements
    • Restricted ocular motility
  3. Common causal pathogens?
    • Staph aureus
    • Streptococcus pneumoniae
    • GAS
    • Haemophilus influenzae
  4. Ophthalmologic Complications
    • Loss of vision/Blindness
    • Orbital abscess

Treatment: Cefuroxime IV

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35
Q

List 4 causes of ptosis

A
  1. Isolated congenital dystrophy of levator palpebrae superioris muscle
  2. Hemangioma (mechanical ptosis)
  3. Trauma
  4. Muscular dystrophy
  5. Myasthenia gravis
  6. CNIII palsy
  7. Idiopathic
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36
Q

When would you consider referral to ophthalmology for a chalazion?

A

Persistance for >3mo

Aesthetic issue

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37
Q

Why is a dacrocystocele concerning?

A
  • Area for bacteria to proliferate → mucocele
  • Tears go in but can’t get out → expanding → obstruction of respiratory passage → feeding difficulties

= Indications for surgical management

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38
Q

What is a classic finding in congenital Horner’s syndrome?

A

The affected eye’s iris appears lighter in colour than the opposite side

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39
Q

List 4 causes of anisocoria (asymmetric pupils)

A
  1. Physiologic
  2. Pharmacologic
  3. Mechanical (trauma, inflammation)
  4. Horner’s syndrome
  5. CNIII palsy (“down and out”)
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40
Q

List 4 possible diagnosis of a child presenting with leukocoria

A
  1. Retinoblastoma
  2. Cataract
  3. Persistent hyperplastic primary vitreous
  4. Retinopathy of prematurity
  5. Retinal detachment
  6. Retinoschisis
  7. Larval granulomatosis
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41
Q

What cranial nerve palsies are associated with a head tilt?

A

CNIV - usually congenital

CNVI - concern for increased ICP

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42
Q
A

Retinoblastoma

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43
Q
A

Left CN III palsy with ptosis and inability to elevate and adduct the eye

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44
Q
A

Limbal dermoid cyst

=

Goldenhar syndrome

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45
Q
A

Dacrocystocele

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46
Q
A

HSV keratitis

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47
Q
A

Congenital glaucoma

Rt eye hazy and opaque 2˚ corneal edema

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48
Q
A

Coloboma

Associated with CHARGE syndrome

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49
Q
A

Chorioretinitis

Photo of toxoplasmosis

Also see retinitis with rubella, syphilis, zika, CMV

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50
Q
A

Multiple retinal hemorrhages

Non-accidental trauma

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51
Q
A

Acute otitis media

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52
Q
A

Cholesteatoma

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53
Q

What is this?

What test should you consider in this child?

What are sequelae of this condition?

A

Nasal polyps

Sweat chloride

Facial changes → broadened nasal root, prominence of malar areas

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54
Q

What is this diagnosis?

What is the most common cause of this?

A

Pott puffy tumour (osteomyelitis of frontal bone)

Sinusitis

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55
Q
A

Bifid uvula - concern for submucosal cleft

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56
Q
A

Peritonsillar abscess

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57
Q
A

Retropharyngeal abscess

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58
Q

You see an 18mo boy in the clinic due to concerns his eye “didn’t look right” - on examination you note corneal clouding.

What are 3 possible diagoses?

A

STUMPED

  • Sclerocornea
  • Tears in membrane (d/t trauma or congenital glaucoma)
  • Ulcers (infection)
  • Metabolic (e.g MPS)
  • Peters anomaly
  • Edema
  • Dermoid
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59
Q

How should you manage otorrhea associated with tympanostomy tubes?

Which topical drops are safe for use with tympanostomy tubes?

A
  • Uncomplicated acute otorrhea (<4wks)
    • Topical antibiotics x 7-10 days
  • Systemic antibiotics are indicated when:
    • Cellulitis of pinna or adjacent skin present
    • Concurrent bacterial infection present
    • Signs of severe infection exist (high fever, severe otalgia, toxic appearance)
    • Acute otorrhea persists or worsens, despite topical tx
    • Administration of eardrops not possible due to local discomfort or lack of tolerance by child
    • Immunocompromised patient

Topical drops = safe

  • Ofloxacin
  • Ciprofloxacin-dexamethasone
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60
Q

What is the diagnostic crtieria for acute sinusitis?

A
  • Acute sinusitis
    • Either:
      • Persistent symptoms of URTI, including:
        • Nasal discharge AND
        • Cough for ≥10 days without improvement
      • Severe respiratory symptoms, including:
        • Fever ≥39˚C
        • Purulent nasal discharge for 3-4 consecutive days
    • Chronic
      • ​Persistent respiratory symptoms ≤90 days (cough, nasal discharge or nasal congestion)

Management

  • 1st line: Amoxicillin 45mg/kg/day divided BID x 7-10 days for acute, 14 days for chronic
  • If no improvement in 72h or severe sinusitis → high-dose Clavulin
    • If vomiting or poor compliance → IV Ceftriaxone

TMP/SMX + Azithromycin have high rates of resistance

61
Q

List 4 possible complications following tonsillectomy.

A
  1. Throat pain
  2. Postoperative nausea and vomiting
  3. Dehydration
  4. Hemorrhage (↑ if acutely infected at time of surgery)
  5. Speech disorders (velopharyngeal insufficiency [hypernasal voice])
  6. Postobstructive pulmonary edema (seen with severe OSA +/- obesity - treated with PPV/diuresis)
  7. Nasopharyngeal stenosis
62
Q

What is the most common organisms responsible for acute lymphadenitis?

List 4 other infectious causes of this

A

Most common

  • Staphylococcus aureus
  • Group A streptococcus (Streptococcus pyogenes)
  • Anaerobic bacteria

Other infectious causes

  • Unilateral
    • Acute
      • Group B Streptococcus (neonates)
      • Pasturella multocida
      • Gram-negative bacilli
      • Yersinia pestis
      • Tularemia
    • Chronic
      • Nontuberculous mycobacteria
      • Bartonella henselae
      • Toxoplasmosis
      • Tuberculosis
      • Actinomycosis
63
Q

List 2 x-ray findings compatible with retropharyngeal abscess

How do you tell if the lateral film is an adequate view?

A
  • Thickening of prevertebral tissues (greater than half the width of the C2 vertebral body, or >7-mm diameter at C2, or >14-mm diameter at C6)
  • Locules of gas within the prevertebral tissues

Adequate view = neck should be in extension with image captured during inspiration with visualization of the C7/T1 junction

64
Q

List 4 differences between gastroschisis and omphalocele

A
  1. Gastroschisis occurs to the right of umbilicus/omphaocele occurs through umbilicus
  2. Gastroschisis doesn’t involve the peritoneal sac
  3. The bowel is often inflamed with gastroschisis; whereas it is normal in omphaloceles (not exposed to amniotic fluid)
  4. Gastroschisis is not associated with any other system anomalies
  5. Gastroschisis often has prolonged ileus and GI dysfunction, whereas omphalocele has prompt recovery of bowel function
65
Q

What is the most common type of anomaly associated with omphaloceles?

Which is most common of that type of anomaly?

A

Cardiac anomalies

Tetralogy of Fallot

66
Q

What is the most common type of anomaly associated with gastroschisis?

What is the most common complication post-operatively after gastroschisis repair?

A

Intestinal atresia

67
Q

Where is the most common location of intussusception? Most common pathologic lead point?

Name 2 situations where air reduction (air enema) for intussusception would be unsuccessful

List 2 contraindications to air enema.

What is the success rate for this procedure? What is the perforation rate? What is the recurrence rate?

A

Ileocolic (upper invaginates into lower)

Most common pathologic lead point = Meckel’s diverticulum (older child = most likely to have pathologic lead point)

  1. Infants <3mo
  2. >5yo (often have pathological lead point)
  3. When AXR shows signs of intestinal obstruction
  4. Small bowel intussusception

Contraindications

  1. Prolonged intussusception
  2. Signs of shock
  3. Peritoneal irritation
  4. Intestinal perforation or pneumatosis intestinalis

Success rate: 80-95%

Perforation rate: 0.1-0.2%

Recurrence rate: 10%

68
Q

List 2 risk factors for pyloric stenosis

AND 2 associated genetic disorders

What is the characteristic laboratory finding associated with this diagnosis?

A

Risk factors

  • Maternal macrolide administration during pregnancy/breastfeeding
  • First born children
  • Family medical history
  • Male sex
  • B and O blood groups

Genetic disorders

  • Zellweger
  • Cornelia de Lange syndrome
  • Trisomy 18
  • Apert syndrome
  • Smith-Lemli-Opitz syndrome

Lab finding: Hypochloremic metabolic acidosis 2˚ volume contraction from aldosterone; hypokalemia with prolonged emesis

69
Q

What is the most common pathological lead point seen with intussusception?

What is are 2 predisposing factors to intussusception?

A

Meckel’s diverticulum

  1. Recent URTI (adenovirus)
  2. Recent diarrheal illness (enterovirus)
  3. Rotavirus vaccine (1-3 per 100,000) - highest in first week after receiving vaccine (must report all cases occurring within 21 days to Public Health Agency of Canada)
70
Q

Which major anomaly occurs most frequently with esophageal atresia/tracheoesophageal fistula?

What are the main surgical complications seen with this type of repair?

A

Cardiovascular anomalies

(do VACTERL assessment)

  1. Anastomotic leak
  2. Recurrent fistula
71
Q

List 3 possible diagnoses for patient presenting with bilious emesis.

What investigation should you do to work this up?

A
  1. Malrotation
  2. Midgut volvulus
  3. Hirschsprung’s disease
  4. Ileus
  5. Duodenal atresia

Upper GI series with small bowel follow-through

72
Q

In regards to vomiting:

List 4 diagnoses that present with abdominal distension

List 4 diagnoses that DO NOT present with abdominal distension

A

Abdominal Distension

  1. Hirschsprung’s
  2. Volvulus
  3. Meconium ileus
  4. Imperforate anus
  5. Meconium plug
  6. Colonic atresia
  7. Jejunal/ileal atresia
  8. NEC stricture

NO Distension (think proximal obstruction)

  1. Hypertrophic pyloric stenosis
  2. Malrotation
  3. Duodenal atresia
  4. Annular pancreas
  5. Preduodenal portal vein
  6. Antral stenosis
73
Q

Describe the intial management for Hirschsprung’s disease

A
  1. Rectal decompression with saline irrigations
  2. Antibiotics if enterocolitis is present
74
Q

When are inguinal hernias most common?

What side do they more commonly occur on?

What population is more likely to have bilateral inguinal hernias?

When is the risk of incarceration highest?

When should repair occur?

A

Most common: < 1 year

Most common side: Right (60%)

More likely bilateral?: Premature infants

Risk of incarceration highest?: Newborns (8.8%)

When should repair occur?

  • “Soon after diagnosis” median 2 weeks (doubled risk of incarceration if >30 days)
  • If incarcerated (24-48h after reduced)
75
Q

When should you consider referring a hydrocele for repair?

A

If remains present at 1 year

76
Q

When should you refer to Ophtho for bacterial conjunctivitis?

A
  • Not better in 48hr on topic drops
  • Vision loss
  • Severe purulent discharge
  • Corneal involvement
  • Conjunctival scarring
  • SJS
  • HSV
  • Severe photophobia or pain
  • Contact lens involvement
77
Q
A

Ectopia lentis: displacement of the lens from where it is suspended

  • Associated with Marfan syndrome (occurs in about 80% of pts and usually present in about 50% by age 5)
    • Usually displaced superiorly and temporally, usually bilateral and symmetric
  • Associated with homocystinuria (displaced inferiorly and nasally)
  • Also associated with Weill-Marchesani syndrome, Ehlers-Danlos, Sturge-Weber, Crouzon, Klippel-Feil syndromes
78
Q

What is Fuchs heterochromic iridocyclitis?

A

Fuchs heterochromic iridocyclitis:

  • Inflammation of some structures of the front of the eye, including the iris
  • Symptoms include:
    • Atrophy of the iris
    • Loss of pigment in the iris → leads to eye color change
    • Cataracts and inflammation in the eye
    • Sometimes leads to glaucoma, which can cause vision loss if not treated.
79
Q

What investigations should you do for Appendicitis? What is the score for pretest probability?

A
  • History and physical exam
  • CBC + diff
  • Urinalysis
  • b-HCG
  • Imaging:
    • no imaging required if high pretest probability
    • AXR shows fecalith 10-20%
    • US (sens 85% and spec >90%)
    • CT (sens 94% and spec 94%)
  • Alvarado score:
    • Migratory R iliac fossa pain (1)
    • N/V (1)
    • Anorexia (1)
    • Tenderness in R iliac fossa (2)
    • Rebound pain in R iliac fossa (1)
    • Fever (1)
    • Leukocytosis (2)
    • Left shift (1)
  • Interpretation:
    • 5-6 = possible
    • 7-8 = probable
    • >9 = very probable
80
Q

What is the management for perforated appendicitis?

A

Non-operative management approach +/- drainage if abscess or phlegmon (b/c risk of operation high)

  • Pip/tazo or Amp/Gent/Flagyl
  • Continue with IV Abx until afebrile, normal WBC, DAT
  • Usually IR drainage if large abscess (do US in 1 week if no improvement on just IV Abx)
81
Q

What are the presentations of Meckel’s Diverticulum?

A
  • Most common presentation is bleeding (painless, episodic, usually massive LGI bleed with drop in Hb = usually in toddlers and infants)
    • Tc99 scan to detect ectopic gastric mucosa and pre-treat with H2 blocker
    • Usually need some resuscitation due to bleed/anemia
  • Can present with diverticulitis (like appendicitis of the Meckel’s diverticulum) in 20-25% cases

Rule of 2s:

  • 2% of population
  • 2:1 M:F
  • 2-6% symptomatic and usually by age 2
  • within 2 feet of ileocecal valve
  • 2 inches long
  • 2 types of heterotopic mucosa (gastric, pancreatic)
82
Q

What is the initial management in Congenital Diaphragmatic Hernia?

A
  1. NRP for initial steps
    1. If antenatally known, plan to INTUBATE ON FIRST BREATH
  2. NG tube to decompress the stomach
  3. Higher ventilatory pressures (for higher mean airway pressures) to maintain better oxygenation
  4. May need inotropes, iNO for pulmonary HTN
  5. Rule out other abnormalities (ie. cardiac echo, chromosomal anomalies)
  6. if stable over initial 24-48 hrs, may attempt repair but if ECMO needed, usually wait until decannulated before repair
83
Q

List risk factors for congenital SNHL.

A

ABCDs of hearing loss:

A) affected family member

B) Bilirubin (kernicterus)

C) Congenital TORCH infection

D) Defects of ear, nose and throat

S) small at birth (<1500g), low apgars, NICU complications

*only 50% of children with SNHL have risk factors*

84
Q

Foreign body in the airway: when to investigate?

A
  • Bronchoscopy indicated if any 1 of the following:
    • Choking spell/opportunity
      • High density foods (peanut/carrot/apple)
    • Physical exam finding
      • Wheeze
      • Prolonged expiration
      • Decreased breath sounds
    • CXR findings
      • Air trapping
      • Consolidation
      • Should do inspiratory/expiratory views
        • Or Right and left lateral decubitus
85
Q

Give a condition that corresponds to the following eye conditions: a. Coloboma b. Dislocated Lens c. Aniridia- absent iris d. Glaucoma

A

a. Coloboma- defect in iris- CHARGE b. Dislocated Lens- Marfan’s c. Aniridia- absent iris- WAGR (Wilms Tumour-aniridia syndrome) d. Glaucoma- NF1, SWS (Sturge Weber)

86
Q

What underlying diagnosis would you suspect in a child with tearing, photophobia and blepharospasm?

A

Glaucoma (blepharospasm is twitching/contraction of eyelid)

87
Q

21 m with crusty yellow discharge from Left eye and conjunctivitis. Normal visual acuity, no propotosis, no periorbital swelling, normal EOM. You prescribe cipro topical drops. At 36 h exam, unchanged. What is your next step? a. Refer to ophto b. Prescribe IV antibiotic c. Continue and return in 48 h d. Prescribe fucidic acid drops

A

a. Refer to ophto - should see response in 1-2 days - if no response then refer to ophtho *note - fucidic acid is a steroid antibiotic drop - only ophthalmologists should put steroids in eyes!

88
Q

What is the management of bacterial conjunctivitis?

A

warm compresses; topical antibiotics (gent/tobra or cipro)

89
Q

What type of bacteria would you suspect are causing this eye infection and how should it be treated? - significant conjunctival injection, edema (chemoses), gritty sensation, purulence, tenderness on palpation.

A

Neisseria gonorrhea or meningitidis Needs treatment with systemic antibiotics (not topical)

90
Q

Child 3 y/o referred for behaviour problems. Mom concerned because child refuses to wear patch for amblyopia for the past 8 months. What do you do? 1. Refer to social work 2. Immediate referral to ophthalmology for other treatment modalities 3. Refer to ophthalmology once child has started to wear patch again 4. Refer to parenting class through public health to learn skills to make child wear patch

A
  1. Immediate referral to ophthalmology for other treatment modalities Can do chemical patching with atropine drops
91
Q

When would your refer a child with esotropia or exotropia to an ophthalmologist (2 lines)?

A

o Refer if: (goal- normal sight, straight looking eyes, binocular vision) ▪ Decreased visual acuity ▪ Fixed deviation ▪ >4 months of age (strabismus is normal up to 4 months of age)

92
Q

Picture of child. Apparent right esoptropia but normal corneal reflex. What is the diagnosis?

A

pseudostrabismus

93
Q

3 mo Baby with crusty yellow eye discharge, no conjunctivitis, on and off for past 3 months. What is your management? a. Refer to ophto b. Massage tear duct c. Topical abx daily d. Dacryrhinostomy

A

b. Massage tear duct blocked tear duct (nasolacrimal duct obstruction; dacryostenosis) Tx: massage 2-3 times daily; cleanse any discharged liquids with warm water; can use topical antibiotics for mucopurulent drainage but IF red/hot/swollen/tender/febrile needs systemic abx

94
Q

A baby has congenital nasolacrimal duct obstruction (dacrostenosis). What statement is true about this condition? a) it is present at birth b) baby may develop dacrocystitis c) it should be treated with topical antibiotics d) it is always symptomatic at birth

A

b) baby may develop dacrocystitis

95
Q

3mos with Nasolacrimal duct obstruction, what to do: a) observe b) refer to ophtho c) topical abx d) systemic abx

A

a) observe 96% resolve by one year of age

96
Q

Treatment for nasolacrimal duct obstruction? a . Nasolacrimal massage 2 – 3 times per day with cleaning lids with warm water b. 96% resolve by 1 year of age c. Ophthalmology referral during the first 6 months is not necessary unless there are multiple cases of acute dacryocystitis or large congenital mucocele d. Most Ophthalmologist advise referral between 6 – 13 months because during this period simple probing of the duct is curative in 95% e. After 13 months the cure rate with probing alone falls to 75% and silicone intubation of the duct is necessary

A

a . Nasolacrimal massage 2 – 3 times per day with cleaning lids with warm water This is the right “treatment” option, but everything else here is true as well

97
Q

3 causes of leukocoria

A

Leukocoria = white pupillary reflex (white instead of red) - cataract - retinoblastoma - chronic retinal detachment - advanced ROP (cictricial)

98
Q

A child is found to have different sized pupils. The physical exam is otherwise normal. Which statement is true: a. unequal pupils are seen in 25% of normal children - seems most correct b. it is an autosomal recessive trait - autosomal dominant per OMIM c. the larger pupil is abnormal - no could be the larger or the smaller d. the larger pupil will have an abnormal shape - not necessarily, though maybe if associated with coloboma

A

CORRECT: a. unequal pupils are seen in 25% of normal children (anisocoria) b. it is an autosomal recessive trait - autosomal dominant per OMIM c. the larger pupil is abnormal - no could be the larger or the smaller d. the larger pupil will have an abnormal shape - not necessarily, though maybe if associated with coloboma

99
Q

What are pathologic causes of anisocoria? (name 2)

A

Horner syndrome (can be caused by underlying neuroblastoma) congenital iris defects (coloboma, aniridia) medications (topical) - err on the side of referring to ophtho

100
Q

What are features of physiologic/simple anisocoria?

A

less than 0.4mm difference between the sides usually persistent (look back through old photos and see if it has always been there)

101
Q

Which sport is the most common cause of eye injury in Canada: a. baseball b. hockey c. soccer d. golf e. javelin f. basketball

A

b. hockey - then racket sports and baseball

102
Q

Child with hyphema, when is rebleeding most likely to occur a) 24 h b) 4 days c) 1 week d) 2 week

A

b) 4 days Mgmt: head of bed to 30 degrees, bed rest, shield without underlying patch on affected eye, consult ophtho (they will prescribe topical steroids and cycloplegia agent)

103
Q

If there is a hyphema, list 2 steps in your immediate management. What is 1 complication if not treated properly?

A

Bed rest, HOB to 30 degree, Shield (without patch) on affected eye, Cycloplegic agent, topical or systemic steroids, arrange ophtho assessment Complication: loss of vision due to: rebleeding, glaucoma, corneal blood staining

104
Q

Picture of a stye. What is this? How do you treat it?

A

Stye AKA hordeolum - inflammation and infection (staph) of sebaceous glands in the eyelid - treat with warm compresses and consider topical antibiotics - I&D may be needed if no improvement

105
Q

What is a chalazion and how do you treat it?

A

chronic inflammation of sebaceous glands (it is a lipogranuloma) - tx: referral to ophtho for surgical excision

106
Q

Description of an infant with a hemangioma on the eye lid. List 2 thing you would do for immediate management

A
  • evaluation by ophthalmologist for potential for vision compromise - assess for other hemangiomas on face, especially in beard distribution
107
Q

5year old boy, with serous and mucoid discharge from left eye (exact words). No periorbital edema or erythema. Mom and brother had a similar episode a week ago. How do you manage? a. reassure b. start antibiotics drops c. po keflex d. CT orbits

A

a. reassure

108
Q

Contact lens kid on cipro drops. Exam unchanged after 48 hours. Mgt?

A

a) ref to ophtho - with contact lenses should always err on side of sending to ophtho

109
Q

5 yo girl holding 2 month old baby sister who accidentally pokes her eye (corneal abrasion on fluorescein)? List 2 steps in managing.

A
  • topical antibiotic ointment (e.g. erythromycin) 4x/day for 3-5 days - ibuprofen for pain - plan follow-up to ensure resolved symptoms of corneal abrasion: pain, tearing, photophobia, decreased vision
110
Q

Which is true regarding retinal hemorrhages: a. needed to diagnose shaken baby syndrome b. can occur in a vaginal delivery c. do not occur after a C-section d. always associated with trauma e. can occur with CPR

A

b. can occur in a vaginal delivery - yes, 25%, higher if vacuum assisted - 100% will be resolved by 6-8 weeks Can occur with C/S but less likely; CPR is a rare if at all true cause of retinal hemorrhage; can be atraumatic

111
Q

Picture of large confluent round red lesion centrally on fundus with central targetoid pale lesion overlying it, normal optic disc can be seen) Which of the following diagnoses is this fundi consistent with: a. Toxoplasmosis - chorioretinitis b. Shaken baby syndrome - retinal hemorrhage c. Late finding in ROP - tortuous vessels d. Tay-sachs disease - cherry red spots

A

ANSWER: d. Tay-sachs disease - cherry red spots - cherry red spots bright red with lighter halo - T-S is a sphingolipidosis a. Toxoplasmosis - chorioretinitis - darker red with central light spot b. Shaken baby syndrome - retinal hemorrhage c. Late finding in ROP - tortuous vessels

112
Q

You are seeing a 3 year old girl in your Emergency department. Her parents noticed that her right upper eyelid was mildly reddened and swollen before going to bed last night. This morning, she awoke with significant swelling and redness of the right upper and lower eyelids, to the point of being unable to open the eye. She is febrile at 38.6 degrees, but appears otherwise well. Name 4 signs on physical examination that would make you suspect an orbital cellulitis vs. a periorbital cellulitis.

A
  1. change in visual acuity 2. pain with EOM 3. proptosis 4. ophthalmoplegia - weak eye muscle leads to restricted EOM +/- diplopia
113
Q

In a 1 year old child, which sinus would be developed a. Ethmoid b. frontal c. sphenoid

A

a. Ethmoid EMSF - ethmoidal and maxillary sinuses are present at birth but only ethmoidal sinuses are pneumatized - maxillary sinuses pneumatize at age 4 years - sphenoidal sinuses present at 5 years - frontal sinuses begin development at 7-8 years and are not fully developed until adolescence

114
Q

Which is the last sinus to develop: a) frontal b) maxillary c) sphenoidal d) anterior ethmoid e) posterior ethmoid

A

a) frontal EMSF - ethmoidal and maxillary sinuses are present at birth but only ethmoidal sinuses are pneumatized - maxillary sinuses pneumatize at age 4 years - sphenoidal sinuses present at 5 years - frontal sinuses begin development at 7-8 years and are not fully developed until adolescence

115
Q

What is most likely to be associated with hearing loss? a) prematurity b) congenital CMV c) APGARs of 2 at 1 minute d) Sibling with language delay

A

b) congenital CMV most common infectious cause of congenital sensorineural hearing loss (1/100 newborns have congenital CMV and 75% of these have SNHL) - the others are all also risk factors for hearing loss

116
Q

Daycare worker worried about child’s hearing. What would be suggestive on history? a) maternal lasix b) congenital CMV c) history of delayed language in a sibling

A

b) congenital CMV

117
Q

16 month boy has episodes (once weekly) of falling down suddenly and refusing to get up. Remains conscious. Recovers in a few minutes. Sometimes vomits. Eyes are noted to move during the episode. What is his diagnosis (1)? What is one associated condition (1)?

A
  1. benign paroxysmal vertigo (age of onset 2-12 years) 2. associated condition is migraine (it’s a migraine variant)
118
Q

Name 4 perinatal risk factors for the development of sensorineural hearing loss. (may be asked to name 4 non-infectious risk factors in newborn period)

A
  1. TORCH infection 2. low birth weight (<1500g) 3. Hyperbili 4. Apgars 0-4 at 1 minute 5. Ototoxic medications 6. ventilation more than 5 days
119
Q

Which is the most objective test to detect a middle ear effusion: a) otoscopy b) audiometry c) tympanometry d) auditory evoked potentials e) Weber and Rhine tests

A

c) tympanometry - gives info about TM compliance (if the middle ear is filled with fluid the TM will be non compliant)

120
Q

A boy has an acute onset of right ear pain and progressive right facial weakness. On examination his TM is normal, but there is pain with movement of the pinna and vesicles visible in the ear canal. He is afebrile and his cranial nerve examination is normal apart from an inability to wrinkle his forehead, close his eye or smile on the right side. What is your treatment: a. IV cloxacillin b. PO prednisone and PO acyclovir c. Physiotherapy for nerve stimulation d. Tympanocentesis

A

b. PO prednisone and PO acyclovir - remember ocular lubricant to protect cornea, esp at night since eye cannot close - facial nerve travels through middle in ear in up to 50% of people (so any infection or inflammation there causes facial nerve paralysis) - this kid has Ramsay-Hunt syndrome (vesicles in external ear canal and ipsilateral facial nerve palsy)

121
Q

Child had AOM, which is a consequence of withholding treating for 48 hours? a. mastoiditis b. increased duration of fever c. increased pain

A

b. increased duration of fever

122
Q

Give 3 indications for ENT referral for tympanostomy tubes

A
  • OME + hearing loss - OME + ear discomfort - OME + balance issues - recurrent AOM with MEE
123
Q

18 month old child with URTI. He develops higher fever 3 days later, pulling at ear and has erythematous right tympanic membrane, not bulging. Do you treat for AOM? Explain why or why not?

A

No- does not meet criteria Need: Acute onset + MEE + Inflammation *MEE= no movement of TM, loss of bony landmarks, air-fluid level, bulging TM, otorrhea Inflammation= otalgia, erythema

124
Q

2 year old with fever and right ear pain. She was treated with clarithrymycin a few weeks ago for a respiratory infection. ON exam has an otitis media. What are three possible antibiotics for her (3)

A

Amoxicillin Amox-Clav Cefuroxime/ Cefprozil

125
Q

Description of a mom who presents with her child who has otitis media. What are 4 risk factors for otitis media?

A

o Orofacial abnormalities (cleft palate) o Household crowding o Cigarette smoke o Pacifier use o Short duration of breastfeeding o Prolonged bottle feeding lying down o Family history o Aboriginals o Low IgA

126
Q

A 3 year old boy has had 3 episodes of otitis media, 2 episodes of sinusitis, and now presents with bronchiectasis in RML. All of the following investigations are warranted except: a. CT chest b. Alpha-1-antitrypsin level c. Bronchial biopsy d. Immunoglobulins

A

ANSWER: b. Alpha-1-antitrypsin level - respiratory presentation usually in adulthood, kids present with liver disease; respiratory manifestations are emphysema, airflow disease as opposed to recurrent infections a. CT chest - yes for PCD c. Bronchial biopsy - yes for PCD d. Immunoglobulins - yes for immunodeficiency

127
Q

A 6 y/o girl had a nosebleed from 3 days ago. On exam she looks well, VSS, but there is a large clot obstructing her left nostril. What to do: 1. Advise to pinch nose for 10 minutes with future nosebleeds. 2. Remove clot and pack 3. Call ENT for cautery 4. Check coagulation profile 5. Check CBC and platelets

A
  1. Advise to pinch nose for 10 minutes with future nosebleeds.
128
Q

List 4 daytime symptoms of obstructive sleep apnea.

A

Somnolence, headache, mouth breathing, impaired learning

129
Q

Reasons for a tonsillectomy a. One episode of retropharyngeal abscess b. 6 severe tonsillitis episodes this year c. chronic ear effusion for 5 months d. intermittent snoring

A

b. 6 severe tonsillitis episodes this year - recurrent tonsillitis (varying guidelines - anywhere from 3-7 episodes in the preceding year)

130
Q

Kid with exudative pharyngitis. 1y/o. What is most likely dx? a. Viral pharyngitis b. MONO c. Strep

A

a. Viral pharyngitis - viruses most common cause of pharyngitis in N America (adeno, coxsackie A) - GAS is uncommon before 2 years - most kids under 4 with EBV mono are asymptomatic

131
Q

What are the indications for tonsillectomy?

A
  • Absolute o Acute airway obstruction +/- cor pulmonale o Suspected malignancy, TB, Atypical Mycobacteria, fungal, actinymycosis o Acute hemorrhage - Relative ● sleep apnea ● chronic nasal obstruction/ mouth breathing ● speech abnormalities ▪ Recurrent tonsillitis (7 in 1 year, 5 in 2, 3 in 3)
132
Q

What condition is a bifid uvula associated with. (1)

A
  • Loeys-Dietz Syndrome
133
Q

15 yo male with severe retropharyngeal abscess, requiring surgical decompression. On day 3, he has new onset headache. What is the most likely cause? a) meningitis b) jugular thrombosis c) migraine

A

b) jugular thrombosis - he has a cerebral venosinous thrombosis (most commonly caused by head and neck infections) which can present with headache

134
Q

Picture of lateral neck xray (++ prevertebral soft tissue swelling), febrile with difficulty opening the mouth. Presents with neck pain, what is the dx? a. bacterial trachieitis b. peritonsillar abscess c. retropharyngeal abscess d. epiglottis

A

b. peritonsillar abscess

135
Q

Patient with trismus and torticollis. Most likely diagnosis? a. Bacterial tracheitis b. Peritonsillar abscess c. Retropharyngeal abscess d. Epiglottitis

A

b. Peritonsillar abscess (classic to have trismus) c. Retropharyngeal abscess (more torticollis, 1/3 of RPAs have trismus)

136
Q

What is most associated with neck pain and trismus?

A

Peritonsillar abscess (could also be retropharyngeal abscess depending on i they gave other info)

137
Q

Kid with pain with movement both directions. Supple neck, slight red throat otherwise normal oral pharynx. Drooling. a. Peritonsillar abscess b. Retropharyngeal abscess c. Mono d. Urti

A

b. Retropharyngeal abscess

138
Q

A 9 year old presents with his third episode of stridor. He is otherwise well. Which of the following investigations would you do? a) CXR b) lateral soft tissue of the neck c) MRI d) bronchoscopy e) culture of his oropharyngeal secretions

A

b) lateral soft tissue of the neck note that direct observation by laryngoscopy is generally needed for diagnosis

139
Q

Child with severe stridor. There is no improvement with 2 rounds of racemic epinephrine and dexamethasone. What should be done next? a) Heliox b) Intubate c) Humidified air

A

b) Intubate - this could be epiglottitis - will not respond to racemic epi and corticosteroids - need to establish an airway (symptoms should improve immediately after intubation) - heliox may have benefit for severe croup when facing impending intubation but not definitive

140
Q

8 week old presents with concerns of persistent noisy breathing and episodes where breathing stops. On exam is alert and well with stridor. What is the most likely diagnosis (1)? What one physical exam manouver will help clarify the diagnosis (1)?

A
  1. laryngomalacia 2. put them prone (symptoms should improve; and will worsen when supine)
141
Q

What are paradoxical vocal cord movements?

A

inappropriate closing of cords during inspiration (and sometimes expiration); causes intermittent wheeze or stridor with activity that does not respond to asthma treatment

142
Q

Picture of a swollen red midline neck mass What do you do? a. IV ABx b. Incision and drainage c. Surgical excision d. Ultrasound

A

d. Ultrasound Suspect infected thyroglossal duct cyst Tx: keflex, amox-clav or clinda (IV cefazolin and clinda if severe) *no surgery until infection resolves - can seed cells and have recurrence

143
Q

2 differential diagnoses for congenital torticollis other than sternocleidomastoid tumor.

A
  • muscular torticollis - unilateral absence of sternocleidomastoid - craniocervical vertebral anomalies
144
Q

Child with large port wine stain in a distribution of the 1st trigeminal nerve. What do you work him up for? a. optic glioma b. cerebral arteriovenous malformation c. glaucoma d. liver disease

A

c. glaucoma (worried about Sturge Weber) Re: b. cerebral arteriovenous malformation (no its leptomeningeal capillary venous malformation= angiomas)

145
Q

Trismus is most often associated with: a) hypercalcemia b) epiglottitis c) peritonsillar abscess d) retropharyngeal abscess

A

c) peritonsillar abscess

146
Q

A 15 year old presents with a fleshy mass under his tongue. You think that it is a ranula. Best management: a. no treatment b. I&D c. refer to surgeon d. antibiotics

A

c. refer to surgeon Ranula: cyst associated with sublingual salivary gland - cyst should be surgically excised

147
Q

14 year old girl with symptoms of obstructive sleep apnea and BMI > 95th percentile. Which of the following tests is MOST likely to reveal an underlying sequelae of her disease? a) Echocardiography b) Electrocardiogram c) Creatinine d) Fundoscopy

A

a) Echocardiography (pulmonary HTN, LV hypertrophy, cor pulmonale)

148
Q

Patient with new trach. In respiratory distress with clear chest, indrawing, cyanosis. a.) What do you think is going on? b.) List 3 steps for initial management?

A

a.) What do you think is going on? Obstruction (or decannulation) b) 1. Suction 2. Oxygen 3. Emergency Trach Change

149
Q

A 3 month old child had a TEF repaired in the first few weeks of life. He now presents in your office with stridor. List 3 causes of his stridor.

A
  • Tracheomalacia - GERD with laryngospasm - Anastomotic stricture (tracheal) - Vocal Cord Paralysis

RC Study Cards (23 decks)

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