FRCPC HEENT and Ophtho Review Flashcards
List the three diagnostic criteria for AOM
- History of acute onset of signs and symptoms
- Presence of MEE
- Signs and symptoms of ME inflammation
List 5 ways to prevent AOM
- Keep vaccinations up to date
- Avoid pacifier use
- Avoid second hand smoke
- Breastfeed
- Avoid exposure to other sick children
List 5 indications for tympanostomy tube placement
- Recurrent AOM with MEE
- Bilateral AOM > 3 months with CHL
- AOM complications: mastoiditis
- Lack of response to medical therapy
- Chronic retraction of TM
- Uni or bilateral AOM > 3 months with vestibular, behavioural problems, discomfort, poor school performance
List 5 extracranial complications of AOM
- TM perforation
- Mastoiditis
- Post auricular abscess
- Labyrinthitis, labyrinthine fistula
- Facial nerve paralysis
- Bezold’s abscess
- Cholesteatoma
List 5 intracranial complications of AOM
- Meningitis
- Brain abscess
- Sino-venous thrombosis
- Petrositis
- Otic hydrocephalus
- CSF Leak
What is the management for AOM in a child with tubes in situ that are draining?
Cipro-dex drops
List 5 differential diagnoses for epistaxis
- Bleeding disorders
- AVMs
- Local trauma (nose picking)
- HTN
- Nasal infection
- Wegener granulomatosis
- Juvenile nasal angiofibroma
- CF
- Septal abnormality: deviated septum, septal spurs
List 3 pieces of advice to give to a kid following a nose bleed
- Use nasal moisturizing spray
- Avoid harsh nose blowing
- Sneeze with open mouth
- No nose picking
- Avoid hot showers
- No NSAIDs
List 5 neonatal risk factors for hearing loss
- Family history of hereditary childhood SNHL
- In utero infection: CMV, rubella, syphilis, HSV, toxoplasmosis
- Craniofacial anomalies
- BW < 1500g
- Hyperbilirubinemia requiring exchange transfusion
- Ototoxic medications
- Bacterial meningitis
- APGAR scores 0-4 at 1 minute or 0-6 at 5 min
- Mechanical ventilation > 5 days, ECMO
- Stigmata associated with a syndrome
What is the most common cause of SNHL?
Genetic causes account for > 50% (PIR)
What is the typical lateral XR finding for epiglottitis?
Thumb sign
What is the treatment for epiglottitis?
- Cetriaxone
- Cefuroxime
- Cefotaxime
What is the treatment for bacterial tracheitis?
- Ceftriaxone and cloxacillin
- Clindamycin of allergic to penicillin
- Could also consider adding vancomycin (per Nelsons)
List 6 language red flags that would need referral for audiology assessment
- 12 months: no babbling
- 18 months: no use of single words
- 24 months: single word vocabulary of < 10 words
- 30 months: < 100 words; no 2 words combinations, unintelligible
- 36 months: < 200 words; no sue of telegraphic sentences; clarity < 50%
- 48 months: < 600 words, no use of simple sentences, clarity < 80%
What is the most common cause of unilateral cervical adenitis?
- Group A Strep and Staph aureus
List four other infectious causes of cervical adenitis besides GAS and staph aureus
- Bartonella henselae
- Toxoplasma gondii
- Non tuberculuos mycobacteria
- Pasteurella
- Yersinia
- GBS
- Tularemia
What is the most common cause of chronic bilateral cervical adenitis?
EBV
What is the most common congenital neck mass?
- Thyroglossal duct cyts
What is the most common presentation of thyroglossal duct cyst?
- Usually asymptomatic until they are infected
- Will present with a red inflamed midline mass
- Moves with swallowing or tongue protrusion
What is the treatment of a thyroglossal duct cyst?
- If they present while infected (most likely) then need to treat with antibiotics first and then when infection is cleared up arrange for surgical removal.
What is the best management for a ranula?
Surgical excision
Child presents with a fever and torticollis following URTI. Most likely diagnosis?
Retropharygeal abscess
What is the diagnostic imaging modality of choice in retropharyngeal abscess
CT is the gold standard
What findings on lateral neck X ray would make you worried about retropharyngeal abscess?
- Soft tissue is more than 1/2 the width of the vertebral body
- Soft tissue is two times the size of C2
What antibiotics should be used to manage retropharyngeal abscess?
- Ceftriaxone or cefotaxime plus clindamycin
List 3 complications of retropharyngeal abscess
- Airway obstruction
- Lemierre syndrome (jugular vein suppurative thrombophlebitis)
- Pneumonia
- Carotid artery rupture
- Spread of infection: mediastinitis, pericarditis, pleuritis, empyema
Child presents with history of URTI and new onset fever with trismus. Most likely diagnosis?
Peritonsillar abscess
List three physical exam findings seem commonly with peritonsillar abscess
- Trismus
- Halitosis
- Uvular deviation
- Dysphonia
Antibiotic management of peritonsillar abscess?
- Ceftriaxone + clindamycin
- If outpatient consider amoxiclav
List 5 differential diagnoses for trismus
- Tetanus
- Peritonsillar abscess
- Osteomyelitis
- Fracture
- Ankylosing spondylitis
- Neuroleptic medications (acute dystonic reaction)
- Malignant hyperthermia
- TMJ disorder
What is one physical examination maneuvre that supports a diagnosis of laryngomalacia?
- Place child supine and the stridor should improve
List indications for supraglottoplasty in infants with laryngomalacia
- ALTE
- Cor pulmonale
- Cyanosis
- FTT
Which finding on spirometry is consistent with vocal cord dysfunction?
- Truncated inspiratory curves
A child is found to have bilateral vocal cord paralysis. What is the next best investigation to order?
Brain MRI because bilateral VCP is often associated with congenital CNS lesions: myelomeningocele, Arnold Chiari malformation, hydrocephalus
What is the best treatment for a child found to have vesicles in their ear canal and ipsilateral facial nerve palsy?
- Acyclovir and steroids
List 5 predisposing factors that increase a child’s risk of getting sinusitis
- Viral URTIs
- Allergic rhinitis
- Immunodeficiency
- CF
- Polyps or other anatomical abnormalities
- GERD
List 5 intracranial complications of sinusitis
INTRACRANIAL
- Epidural abscess
- Meningitis
- Sinus thrombosis
- Subdural empyema
- Brain abscess
List three clinical presentations that make you worried about sinusitis
- Persistent illness with nasal discharge, daytime cough or both lasting > 10 days without improvement
- Worsening course: worsening or new onset of nasal discharge, daytime cough or fever after initial improvement
- Severe onset purulent nasal discharge and concurrent fever > 39 C for at least 3 consecutive days
List indications for imaging in sinusitis
Order a CT or MRI when a child is thought to have CNS complications of sinusitis or orbital cellulitis
What is the first line for antibiotic management of sinusitis?
Amoxicillin with or without clavulanate
List 7 indications for tonsillectomy in children
- 7 episodes tonsillitis in the past year
- 5 episodes in the past 2 years
- 3 episodes per year for the past three years
- Child with multiple antibiotic allergies/ intolerances
- PFAPA
- History of peritonsillar abscess
- Confirmed OSA with tonsillar hypertrophy
What eye manifestations are seen in the following illnesses? A. Marfan syndrome B. JIA C. Congenital CMV D. CHARGE syndrome
A. Ectopia lentis
B. Anterior uveitis
C. Chorioretinitis
D. Coloboma
List 5 differential diagnoses for acutely painful red eye in a child
- Conjunctivitis
- Corneal abrasion
- Primary glaucoma
- Preseptal cellulitis
- Dacryocystitis
- Blepharitis
- Dry eye syndrome
- Episcleritis, scleritis, uveitis
- Eye contusion
List 5 differential diagnoses for acutely painful but non injected eye in a child
- Eye strain due to refractive error
- Convergence insufficiency
- Acute optic neuropathy
- Intracranial process
- Orbital tumour
- Sinus infection
- Functional pain (diagnosis of exclusion)
Describe three features of conjunctivitis due to adenovirus
- Itching, burning, edema, photophobia
- Sensation of sandpaper foreign body
- Preauricular adenopathy
- Pseudomembranes on conjunctivae
- Highly contagious
List five things that cause cataracts in children
- Cystinosis
- Rubella (associated specifically with unilateral cataracts)
- Infantile cataracts
- Toxoplasmosis
- CMV
- HSV
- Measles
- Trisomy 13, 18, 21, XO
- Corticosteroids cause posterior subcapsular lens opacification
- Galactosemia
- T1DM
- Hypocalcemia
List three differential diagnoses for ectopia lentis
- Trauma
- Connective tissue disease: Marfan
- Homocystinuria
- Sturge Weber syndrome
- Glaucoma
- Aniridia
- Intraocular tumor
What is the typical presentation of anterior uveitis?
- Pain
- Photophobia
- Lacrimation
- Conjunctival hyperemia
- Keratitic precipitates
What is the treatment for both anterior and posterior uveitis?
- Anterior: topical corticosteroids
- Poster: systemic corticosteroids
List four causes of amblyopia
- Strabismus
- Refraction differences between the two eyes
- Combination of strabismus and refractive error
- Deprivational amblyopia
List two ways to test for amblyopia
- Visual acuity testing with optotypes
- Check for ocular alignment using the cover uncover test
- Bruckner simultaneous red reflex test
- Corneal light test to look for symmetry of the light on the cornea
What is the most common cause of vision loss in children under the age of 6?
Amblyopia
List indications for referral to ophthalmology in a child who has esotropia or exotropia
- Constant strabismus at any age
- Persistent esodeviation > 4 months
- Corneal light or cover testing shows deviation
- Pupillary asymmetry
- Torticollis unexplained by MSK causes
- Parental concern about ocular alignment
- Incomitant deviation (changes depending on gaze)
List 5 risk factors for primary glaucoma
- Sturge Weber syndrome
- NF1
- Marfan syndrome
- Trisomy 13
- Aniridia
List 5 risk factors for secondary glaucoma
- Previous cataract surgery is a big RF with 25% of these kids going on to develop glaucoma
- Trauma
- Neoplasm: retinoblastoma, leukemia, melanoma
- Steroids
- ROP
- HSV infection
Which sport is the most common cause of eye injury in Canada?
Baseball
List three steps in the management of corneal abrasion
- Topical antibiotic
- Cycloplegic agent: like cyclopentolate hydrochloride 1%
- Analgesia with Tylenol
- Recommend against the use of a pressure patch
List 5 things to manage hyphema
- Bed rest with HOB elevated 30 degrees
- Shield over the eye
- Cycloplegic agent to immobilize iris
- Topical or systemic corticosteroids
- Consult ophthalmology: some of these kids need surgery
- Avoid NSAIDs and ASA
List 4 complications of hyphema
- Rebleeding: most likely to happen within 4 days of original injury
- Glaucoma
- Vision loss
- Corneal blood staining
How to treat a hordeolum/stye?
- Warm compresses for 15 minutes QID
- Topical antibiotics used but little evidence to show that this is helpful
- Surgical incision and drainage of lid or orbit if mo improvement with non surgical management
What is one complication of a hordeolum?
Can harden and turn into a chalazion (granulomatous inflammation of Meibomian gland)
List 5 differential diagnoses for retinal hemorrhage
- Physical abuse
- Vaginal delivery: seen in 20-45%
- Operative delivery
- Glutaric aciduria type I
- Carbon monoxide poisoning
- Purtcher retinopathy
- CPR: super rare to see this in otherwise well kids
List 5 differential diagnoses foe leukocoria
- Retinoblastoma
- Congenital cataracts
- Persistent fetal vasculature
- ROP stage 4 and 5
- Vitreous hemorrhage
- Coats disease
- Astrocytic hamartoma
- Uveitis
- Toxocariasis
- Retinal dysplasia/detachment
List 5 differential diagoses for a cherry red spot on the retinal seen on eye exam
- Tay Sachs disease
- Mucopolysaccharidoses
- Hurler disease
- Niemann Pick disease
- Lysosomal storage diseases
- Poisoning: Carbon monoxide, methanol
List 5 clinical signs to differentiate septal from pre septal cellulitis
With septal cellulitis more likely to see the following:
- Pain with eye movements
- Proptosis
- Ophthalmoplegia +/- diplopia
- Vision impairment
- Pupillary changes
List 3 complications of septal cellulitis
- Vision loss
- Thrombosis
- Meningitis
- Epidural/Subdural empyema
- Brain abscess
What is the incidence of anisocoria?
25% normal population has unequal pupils
List 4 extracranial complications of sinusitis
EXTRACRANIAL
- Periorbital cellulitis
- Orbital cellulitis
- Osteomyelitis
- Mucoceles
