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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
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)
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
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

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
36
Q

When would you consider referral to ophthalmology for a chalazion?

A

Persistance for >3mo

Aesthetic issue

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

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

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”)
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
41
Q

What cranial nerve palsies are associated with a head tilt?

A

CNIV - usually congenital

CNVI - concern for increased ICP

42
Q
A

Retinoblastoma

43
Q
A

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

44
Q
A

Limbal dermoid cyst

=

Goldenhar syndrome

45
Q
A

Dacrocystocele

46
Q
A

HSV keratitis

47
Q
A

Congenital glaucoma

Rt eye hazy and opaque 2˚ corneal edema

48
Q
A

Coloboma

Associated with CHARGE syndrome

49
Q
A

Chorioretinitis

Photo of toxoplasmosis

Also see retinitis with rubella, syphilis, zika, CMV

50
Q
A

Multiple retinal hemorrhages

Non-accidental trauma

51
Q
A

Acute otitis media

52
Q
A

Cholesteatoma

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

54
Q

What is this diagnosis?

What is the most common cause of this?

A

Pott puffy tumour (osteomyelitis of frontal bone)

Sinusitis

55
Q
A

Bifid uvula - concern for submucosal cleft

56
Q
A

Peritonsillar abscess

57
Q
A

Retropharyngeal abscess

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
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
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?

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)

  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

RC Study Cards (20 decks)

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