Optho/ENT Flashcards
A 3-year-old boy is seen by the otolaryngologist for progressive hoarseness over the last few months. When crying, his voice is weak and he has respiratory distress. He has an intermittent cough without fever, rhinorrhea, congestion, emesis, or abdominal pain. He was born at term via vaginal delivery and does not have any chronic medical conditions. Vital signs include a temperature of 37°C, heart rate of 115 beats/min, respiratory rate of 30 breaths/min, and blood pressure of 95/52 mm Hg. On physical examination there is moderate stridor. Nasopharyngoscopy is performed (Item Q47 ).
Of the following, the MOST likely cause of this boy’s symptoms is
A. laryngeal web B. respiratory papillomatosis C. subglottic hemangioma D. vocal fold nodule
respiratory papillomatosis
Respiratory papillomatosis is thought to result from vertical transmission of human papillomavirus (types 6 or 11) from the genital tract of a mother to her child.
Symptoms of respiratory papillomatosis include hoarseness, stridor, and abnormal cry; severe forms can lead to airway obstruction.
Human papillomavirus types 6 and 11 have low potential for malignant transformation.
The lesions are managed with surgical excision.
Laryngeal webs and subglottic hemangiomas are congenital laryngeal anomalies. In laryngeal webs, the vocal folds are connected by a web that can be located either anteriorly or posteriorly. Symptoms can mimic those of respiratory papillomatosis. Subglottic hemangiomas have a higher prevalence in females. Like other hemangiomas, they undergo a rapid proliferation phase followed by stabilization and then involution. This boy’s lesion does not have the appearance of a hemangioma. Vocal fold nodules result from repeated abuse of the vocal folds from screaming and shouting. They are the most common cause of hoarseness in school-aged children, and most commonly occur in boys at the age of 9 years. Vocal fold nodules are visualized directly on the vocal folds and are bilateral.
A 13-year-old adolescent boy is seen after being hit in the left orbital area with a handball. He immediately complained of left eye pain and nausea and was brought to the emergency department for evaluation. On physical examination, there is mild left periorbital edema and ecchymosis but no bony tenderness. His pupils are equal, round, and reactive to light, and extraocular movements are intact. The conjunctivae are clear, and fluorescein examination reveals no corneal or scleral abrasions. Tonometry reveals normal intraocular pressure; visual acuity is 20/20 bilaterally. Slit-lamp inspection reveals a hyphema that occupies less than 25% of the anterior chamber (Item Q85).
Of the following, the BEST next management step for this boy is
A. administration of 100% oxygen B. administration of topical tissue plasminogen activator C. placement of an eye shield D. placement of the bed in the Trendelenburg position
placement of an eye shield
Hyphema should be considered any time a child is struck in the eye with a baseball, handball, or similar object.
Management of hyphema includes an eye shield, bed rest in a reverse Trendelenburg position at 30 degrees, topical cycloplegics and corticosteroids, and aggressive pain and nausea control.
Children with underlying bleeding disorders, sickle cell disease, and those taking anticoagulation medications are at increased risk for complications of hyphema.
A previously healthy, 3-year-old boy has complained intermittently of pain in the left ear for the last 4 weeks. He had rhinorrhea and a cough around the time the pain began, which self-resolved. He has not had any fevers. He is developing appropriately.
On physical examination, the boy appears well. He has no rhinorrhea or nasal congestion. His right tympanic membrane appears gray and translucent with good landmarks. His left tympanic membrane appears gray with clear fluid visible behind it (Item Q98).
Of the following, the BEST next step in management of this boy’s condition is to
A. monitor clinically for 2 months
B. prescribe an antihistamine
C. refer for a hearing evaluation
D. refer for tympanostomy tube placement
monitor clinically for 2 months
Otitis media with effusion is typically self-limiting and usually resolves within 3 months.
Antihistamines are not recommended in the treatment of otitis media with effusion.
At each follow-up visit, the appearance of the tympanic membrane, including position; color and quality of any fluid; and visualization of landmarks should be documented. The provider should inquire about symptoms such as difficulty paying attention, delayed speech, or difficulties with balance
Children with chronic medical conditions affecting speech or balance, such as trisomy 21, autism, or craniofacial abnormalities, are at increased risk of acquiring OME and require special consideration during treatment of OME. They may require earlier intervention and more frequent audiology testing.
file:///Users/mariagasque/Downloads/Q98.pdf
