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FRCPC HEENT and Ophtho Review > FRCPC HEENT and Ophtho Review > Flashcards

FRCPC HEENT and Ophtho Review Flashcards

1
Q

List the three diagnostic criteria for AOM

A
  • History of acute onset of signs and symptoms
  • Presence of MEE
  • Signs and symptoms of ME inflammation
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2
Q

List 5 ways to prevent AOM

A
  • Keep vaccinations up to date
  • Avoid pacifier use
  • Avoid second hand smoke
  • Breastfeed
  • Avoid exposure to other sick children
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3
Q

List 5 indications for tympanostomy tube placement

A
  • 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
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4
Q

List 5 extracranial complications of AOM

A
  • TM perforation
  • Mastoiditis
  • Post auricular abscess
  • Labyrinthitis, labyrinthine fistula
  • Facial nerve paralysis
  • Bezold’s abscess
  • Cholesteatoma
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5
Q

List 5 intracranial complications of AOM

A
  • Meningitis
  • Brain abscess
  • Sino-venous thrombosis
  • Petrositis
  • Otic hydrocephalus
  • CSF Leak
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6
Q

What is the management for AOM in a child with tubes in situ that are draining?

A

Cipro-dex drops

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7
Q

List 5 differential diagnoses for epistaxis

A
  • Bleeding disorders
  • AVMs
  • Local trauma (nose picking)
  • HTN
  • Nasal infection
  • Wegener granulomatosis
  • Juvenile nasal angiofibroma
  • CF
  • Septal abnormality: deviated septum, septal spurs
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8
Q

List 3 pieces of advice to give to a kid following a nose bleed

A
  • Use nasal moisturizing spray
  • Avoid harsh nose blowing
  • Sneeze with open mouth
  • No nose picking
  • Avoid hot showers
  • No NSAIDs
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9
Q

List 5 neonatal risk factors for hearing loss

A
  • 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
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10
Q

What is the most common cause of SNHL?

A

Genetic causes account for > 50% (PIR)

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11
Q

What is the typical lateral XR finding for epiglottitis?

A

Thumb sign

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12
Q

What is the treatment for epiglottitis?

A
  • Cetriaxone
  • Cefuroxime
  • Cefotaxime
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13
Q

What is the treatment for bacterial tracheitis?

A
  • Ceftriaxone and cloxacillin
  • Clindamycin of allergic to penicillin
  • Could also consider adding vancomycin (per Nelsons)
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14
Q

List 6 language red flags that would need referral for audiology assessment

A
  • 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%
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15
Q

What is the most common cause of unilateral cervical adenitis?

A
  • Group A Strep and Staph aureus
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16
Q

List four other infectious causes of cervical adenitis besides GAS and staph aureus

A
  • Bartonella henselae
  • Toxoplasma gondii
  • Non tuberculuos mycobacteria
  • Pasteurella
  • Yersinia
  • GBS
  • Tularemia
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17
Q

What is the most common cause of chronic bilateral cervical adenitis?

A

EBV

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18
Q

What is the most common congenital neck mass?

A
  • Thyroglossal duct cyts
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19
Q

What is the most common presentation of thyroglossal duct cyst?

A
  • Usually asymptomatic until they are infected
  • Will present with a red inflamed midline mass
  • Moves with swallowing or tongue protrusion
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20
Q

What is the treatment of a thyroglossal duct cyst?

A
  • 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.
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21
Q

What is the best management for a ranula?

A

Surgical excision

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22
Q

Child presents with a fever and torticollis following URTI. Most likely diagnosis?

A

Retropharygeal abscess

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23
Q

What is the diagnostic imaging modality of choice in retropharyngeal abscess

A

CT is the gold standard

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24
Q

What findings on lateral neck X ray would make you worried about retropharyngeal abscess?

A
  • Soft tissue is more than 1/2 the width of the vertebral body
  • Soft tissue is two times the size of C2
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25
Q

What antibiotics should be used to manage retropharyngeal abscess?

A
  • Ceftriaxone or cefotaxime plus clindamycin
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26
Q

List 3 complications of retropharyngeal abscess

A
  • Airway obstruction
  • Lemierre syndrome (jugular vein suppurative thrombophlebitis)
  • Pneumonia
  • Carotid artery rupture
  • Spread of infection: mediastinitis, pericarditis, pleuritis, empyema
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27
Q

Child presents with history of URTI and new onset fever with trismus. Most likely diagnosis?

A

Peritonsillar abscess

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28
Q

List three physical exam findings seem commonly with peritonsillar abscess

A
  • Trismus
  • Halitosis
  • Uvular deviation
  • Dysphonia
29
Q

Antibiotic management of peritonsillar abscess?

A
  • Ceftriaxone + clindamycin

- If outpatient consider amoxiclav

30
Q

List 5 differential diagnoses for trismus

A
  • Tetanus
  • Peritonsillar abscess
  • Osteomyelitis
  • Fracture
  • Ankylosing spondylitis
  • Neuroleptic medications (acute dystonic reaction)
  • Malignant hyperthermia
  • TMJ disorder
31
Q

What is one physical examination maneuvre that supports a diagnosis of laryngomalacia?

A
  • Place child supine and the stridor should improve
32
Q

List indications for supraglottoplasty in infants with laryngomalacia

A
  • ALTE
  • Cor pulmonale
  • Cyanosis
  • FTT
33
Q

Which finding on spirometry is consistent with vocal cord dysfunction?

A
  • Truncated inspiratory curves
34
Q

A child is found to have bilateral vocal cord paralysis. What is the next best investigation to order?

A

Brain MRI because bilateral VCP is often associated with congenital CNS lesions: myelomeningocele, Arnold Chiari malformation, hydrocephalus

35
Q

What is the best treatment for a child found to have vesicles in their ear canal and ipsilateral facial nerve palsy?

A
  • Acyclovir and steroids
36
Q

List 5 predisposing factors that increase a child’s risk of getting sinusitis

A
  • Viral URTIs
  • Allergic rhinitis
  • Immunodeficiency
  • CF
  • Polyps or other anatomical abnormalities
  • GERD
37
Q

List 5 intracranial complications of sinusitis

A

INTRACRANIAL

  • Epidural abscess
  • Meningitis
  • Sinus thrombosis
  • Subdural empyema
  • Brain abscess
38
Q

List three clinical presentations that make you worried about sinusitis

A
  • 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
39
Q

List indications for imaging in sinusitis

A

Order a CT or MRI when a child is thought to have CNS complications of sinusitis or orbital cellulitis

40
Q

What is the first line for antibiotic management of sinusitis?

A

Amoxicillin with or without clavulanate

41
Q

List 7 indications for tonsillectomy in children

A
  • 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
42
Q 
What eye manifestations are seen in the following illnesses?
A. Marfan syndrome
B. JIA
C. Congenital CMV
D. CHARGE syndrome
A

A. Ectopia lentis
B. Anterior uveitis
C. Chorioretinitis
D. Coloboma

43
Q

List 5 differential diagnoses for acutely painful red eye in a child

A
  • Conjunctivitis
  • Corneal abrasion
  • Primary glaucoma
  • Preseptal cellulitis
  • Dacryocystitis
  • Blepharitis
  • Dry eye syndrome
  • Episcleritis, scleritis, uveitis
  • Eye contusion
44
Q

List 5 differential diagnoses for acutely painful but non injected eye in a child

A
  • Eye strain due to refractive error
  • Convergence insufficiency
  • Acute optic neuropathy
  • Intracranial process
  • Orbital tumour
  • Sinus infection
  • Functional pain (diagnosis of exclusion)
45
Q

Describe three features of conjunctivitis due to adenovirus

A
  • Itching, burning, edema, photophobia
  • Sensation of sandpaper foreign body
  • Preauricular adenopathy
  • Pseudomembranes on conjunctivae
  • Highly contagious
46
Q

List five things that cause cataracts in children

A
  • 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
47
Q

List three differential diagnoses for ectopia lentis

A
  • Trauma
  • Connective tissue disease: Marfan
  • Homocystinuria
  • Sturge Weber syndrome
  • Glaucoma
  • Aniridia
  • Intraocular tumor
48
Q

What is the typical presentation of anterior uveitis?

A
  • Pain
  • Photophobia
  • Lacrimation
  • Conjunctival hyperemia
  • Keratitic precipitates
49
Q

What is the treatment for both anterior and posterior uveitis?

A
  • Anterior: topical corticosteroids

- Poster: systemic corticosteroids

50
Q

List four causes of amblyopia

A
  • Strabismus
  • Refraction differences between the two eyes
  • Combination of strabismus and refractive error
  • Deprivational amblyopia
51
Q

List two ways to test for amblyopia

A
  • 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
52
Q

What is the most common cause of vision loss in children under the age of 6?

A

Amblyopia

53
Q

List indications for referral to ophthalmology in a child who has esotropia or exotropia

A
  • 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)
54
Q

List 5 risk factors for primary glaucoma

A
  • Sturge Weber syndrome
  • NF1
  • Marfan syndrome
  • Trisomy 13
  • Aniridia
55
Q

List 5 risk factors for secondary glaucoma

A
  • 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
56
Q

Which sport is the most common cause of eye injury in Canada?

A

Baseball

57
Q

List three steps in the management of corneal abrasion

A
  • Topical antibiotic
  • Cycloplegic agent: like cyclopentolate hydrochloride 1%
  • Analgesia with Tylenol
  • Recommend against the use of a pressure patch
58
Q

List 5 things to manage hyphema

A
  • 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
59
Q

List 4 complications of hyphema

A
  • Rebleeding: most likely to happen within 4 days of original injury
  • Glaucoma
  • Vision loss
  • Corneal blood staining
60
Q

How to treat a hordeolum/stye?

A
  • 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
61
Q

What is one complication of a hordeolum?

A

Can harden and turn into a chalazion (granulomatous inflammation of Meibomian gland)

62
Q

List 5 differential diagnoses for retinal hemorrhage

A
  • 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
63
Q

List 5 differential diagnoses foe leukocoria

A
  • Retinoblastoma
  • Congenital cataracts
  • Persistent fetal vasculature
  • ROP stage 4 and 5
  • Vitreous hemorrhage
  • Coats disease
  • Astrocytic hamartoma
  • Uveitis
  • Toxocariasis
  • Retinal dysplasia/detachment
64
Q

List 5 differential diagoses for a cherry red spot on the retinal seen on eye exam

A
  • Tay Sachs disease
  • Mucopolysaccharidoses
  • Hurler disease
  • Niemann Pick disease
  • Lysosomal storage diseases
  • Poisoning: Carbon monoxide, methanol
65
Q

List 5 clinical signs to differentiate septal from pre septal cellulitis

A

With septal cellulitis more likely to see the following:

  • Pain with eye movements
  • Proptosis
  • Ophthalmoplegia +/- diplopia
  • Vision impairment
  • Pupillary changes
66
Q

List 3 complications of septal cellulitis

A
  • Vision loss
  • Thrombosis
  • Meningitis
  • Epidural/Subdural empyema
  • Brain abscess
67
Q

What is the incidence of anisocoria?

A

25% normal population has unequal pupils

68
Q

List 4 extracranial complications of sinusitis

A

EXTRACRANIAL

  • Periorbital cellulitis
  • Orbital cellulitis
  • Osteomyelitis
  • Mucoceles

FRCPC HEENT and Ophtho Review (1 decks)

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