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Pediatrics > Otolaryngology > Flashcards

Otolaryngology Flashcards

1
Q

What in what order do you acquire/pneumatize your various sinuses?

A

Birth - ethmoid and maxillary sinuses
4 yrs - maxillary sinuses
5-6 yrs - sphenoid sinuses
7-8 yrs - frontal sinuses

Ethmoid + Maxillary (Earliest Made - at birth)
Sphenoid (SK - 5 years)
Frontal (Final)

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2
Q

What are the typical pathogens found in cases of sinusitis?

A
  • morexella catarrhalis
  • H. influenza (non-typable)
  • strep pneumo
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3
Q

What are the diagnostic criteria for sinusitis?

A
  • persistenceof nasal congestion
  • rhinorrhea (of any quality)
  • daytime cough ≥10 days without improvement
  • severe symptomsof temperature ≥39°C (102°F) with purulent nasal discharge for 3 days or longer
  • recurrence of symptoms after an initial improvement or new symptoms of fever, nasal discharge and daytime cough
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4
Q

What antibiotic should be used in the treatment of sinusitis?

A
  • 45 mg/kg/day divided BID of amoxicillin

- for second-line treatment 80-90 mg/kg/day Amox-clav

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5
Q

What are the possible complications of sinusitis?

A
  • Sinus venous thrombosis
  • Meningitis
  • Pott’s puffy tumour
  • Sinus venous thrombosis
  • Periorbital cellulitis, orbital cellulitis
  • Subdural abscess
  • Periosteal abscess
  • Mucoceles
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6
Q

What are the most common infectious agents in bacterial tracheitis?

A

S. aureus

MRSA, S. pneumoniae, S. pyogenes, Moraxella catarrhalis, non-typable H. influenza, anaerobes

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7
Q

What are the clinical signs of Bacterial tracheitis?

A

○ Brassy cough
○ High fever
○ Toxic with respiratory distress
§ May be immediate or after a few days of apparent improvement
○ Able to lie flat
○ No drooling
○ Usual treatment for croup (racemic epi) is ineffective

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8
Q

What empiric therapy is used with bacterial tracheitis?

A

Clindamycin or vancomycin + 3rd generation cephalosporin

Consideration or preparation for alternative airway

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9
Q

What is the etiology of Obstructive Sleep Apnea?

A

1) Decreased upper airway patency
□ Nose, nasopharynx/oropharynx, hypopharynx narrowing
□ Chronic rhinitis, craniofacial abnormalities, hypoplasia of the maxilla/mandible, GERD with resulting pharyngeal reactive edema, septal deviation
□ Adenotonsillar hypertrophy (Note: tonsillar size does not necessarily correlate with degree of obstruction)

  1. Increased upper airway collapsibility (reduced pharyngeal muscle tone)
    □ Hypotonic CP, muscular dystrophy
  2. Decreased drive to breathe
    □ Arnold-Chiari malformation, rapid-onset obesity with hypothalamic dysfunction, hypoventilation, autonomic dysregulation and meningomyelocele
  3. Mixed picture: T21
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10
Q

What does the AAP suggest the work-up is in children with suspected OSA?

A

1) polysomnogram (gold standard) OR
2) refer the patient to a sleep specialist or otolaryngologist OR
3) perform alternative diagnostic tests i.e. Nocturnal video recording, nocturnal oximetry, daytime nap polysomnography, ambulatory polysomnography

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11
Q

What treatment options are suggested for children with OSA?

A

○ T+A as first line treatment
○ If signs/symptoms persist, should refer to a sleep specialist, perform an objective test and/or refer for CPAP management
○ Clinicians should recommend weight loss as adjunct if the child is overweight or obese
○ Topical intranasal corticosteroids for mild OSA if whole T+A is contraindicated

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12
Q

What are the clinical manifestations of mastoditis?

A
  • Acute otitis media on the affected side
  • Protrusion of the ear
  • Retroauricular swelling and tenderness
  • Retroauricular erythema
  • Fever
  • Otalgia
  • Hearing loss
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13
Q

What is empiric treatment for mastoiditis?

A
  • IV antibiotics (3rd generation cephalosporin +/- vancomycin)
  • total duration: 3-4 weeks
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14
Q

What are some potential complications of retropharyngeal abscess?

A
  • Airway obstruction
  • Septicemia
  • Aspiration pneumonia if the abscess ruptures
  • Internal jugular vein thrombosis
  • Jugular vein suppurative thrombophlebitis (Lemierre’s syndrome)
  • Carotid artery rupture
  • Mediastinitis
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15
Q

How to differentiate Epiglottitis from RPA, from PTA?

A

Epiglottitis - drooling, stridor, toxic
RPA - no drooling, stridor, neck stiffness, no trismus, able to lie down
PTA - trismus, dyphagia, uvular deviation

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16
Q

A child with mastoiditis presents with ocular findings; what is their diagnosis now?

A

Gradenigo syndrome: triad

(1) Suppurative OM 
(2) Paralysis of the external rectus muscle (CN VI, no lateral eye movement, medial deviation)
(3) Pain to ipsilateral orbit
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17
Q

What are the indications for Tonsillectomy/Adenoidectomy?

A

Paradise criteria: 7 episodes of pharyngitis in the past year (5 in last 2 years, or at least 3 in the preceding 3 years)

  • Rhinosinusitis unresponsive to conservative management - INCS, rinses, avoidance, Singulair
  • OSA
  • Nasal obstruction
  • Chronic adenoiditis
  • Malignancy
  • PFAPA
18
Q

What are some post-operative complications of T/A?

A
  • Nasal voice as a result of velopharyngeal insufficiency
  • Bleeding
  • Recurrence
  • Insufficient pain management - first line Tylenol/NSAIDs, caution to avoidance of opioids
19
Q

Which virus is responsible for the majority of cases of croup?

A

Human parainfluenzavirus (75% of cases)

20
Q

What distinguishes a severe from a moderate case of croup?

A

Presence of both inspiratory and expiratory wheezes, marked lethargy and severe indrawing

21
Q

When is dexamethasone not indicated in children with croup?

A

In cases of concurrent TB or varicella infection

22
Q

What is the dose of dexamethasone for treatment of croup? Epinephrine?

A

0.6 mg/kg

5 mL of 1:1000 L-epinephrine or 0.5 mL of racemic 1:10000 epinephrine nebulized

23
Q

What medications can cause hearing loss?

A
  • Cisplatin
  • Aminoglycosides (gent > tobra > amikacin > neomycin)
  • High-dose IV loop diuretics
  • Macrolides, vanco, tetracycline
  • Chemo agents (5-fluorouracil, bleomycin)
  • Salicylates
  • Antimalarial meds (quinine and chloroquine)
24
Q

What causes most cases of congenital hearing loss?

A

Genetic (50%)

most involving Connexin 26

25
Q

What are some inherited conditions that can lead to hearing loss?

A
  • Usher Syndrome
  • T21
  • Treacher Collins syndrome
  • Crouzon syndrome
  • Alport syndrome
  • Waardenburg syndrome
  • Stickler’s syndrome
  • Pendred syndrome
  • Jervell-Lange-Nielsen
26
Q

What are some risk factors for hearing loss?

A

ABCDs
• Affected family member
• Bilirubin (high)
• Congenital intrauterine infection (TORCH)
• Defects of the ear, nose and throat
• Small at birth (<1500 g), low apgar, NICU stay

27
Q

What is the most common cause of stridor in early childhood?

A

Laryngomalacia

28
Q

In counselling parents, what is the natural history of laryngomalacia

A

begins as early as 2 weeks of life and can worsen up until 6 months of life before resolving with age

29
Q

Clinically, what is the difference between tracheomalacia and bronchomalacia?

A

Trancheomalacia - expiratory stridor

Bronchomalacia - expiratory wheeze

30
Q

Which children should be considered for supraglottoplasty?

A
  • apnea
  • failure to thrive
  • respiratory distress
  • persistent cyanosis
31
Q

4 Causes of secondary trancheobronchomalacia?

A
  • Post TEF repair
  • External compression i.e. vascular ring
  • Prolonged mechanical ventilation
  • Connective tissue disorder
32
Q

What are the clinical features of vocal cord paralysis?

A
  • Variable extrathoracic upper airway obstructive pattern on respiratory curves
  • Soft breathy cry (if unilateral)
  • May see aspiration, choking, coughing
33
Q

What are the clinical features of vocal cord dysfunction?

A
  • Sudden, paroxysmal respiratory distress and wheezing
  • Not responsive to ventolin
  • Adolescent onset, usually female
  • Triggered by exercise
34
Q

Name 4 causes of centrally located neck masses

A
  • Thyroglossal duct cyst
  • Teratoma
  • Ranula
  • Vascular malformation
  • Dermoid cyst
35
Q

Name 4 causes of lateral neck masses

A
  • Branchial cleft anomaly
  • Vascular malformation
  • Congeintal torticollis
  • Thymic cyst
36
Q

What is the pathognomonic sign of thyroglossal duct cysts?

A

Vertical motion of the mass with swallowing and tongue protrusion

37
Q

Where is the most common site of bleeding in cases of epistaxis?

A

Kiesselbach’s plexus

38
Q

What are some strategies for preventing recurrent nosebleeds?

A
  • Room humidifier (should feel tropical in there)
  • Saline drops
  • Vaseline applied to the septum (alternate and occlude nares qhs)
  • Antiseptic cream (e.g.: mupirocin)
  • Stop nose picking
  • Stop nasal steroid sprays if you can
39
Q

What clinical scenario of epistaxis is particularly concerning?

A

Profuse unilateral epistaxis associated with a nasal mass in an adolescent boy near puberty
- Juvenile nasopharyngeal angiofibroma

40
Q

How do you manage a translucent, bluish growth found beneath the tongue?

A

Rannula

Requires surgical management (excision)

41
Q

What is the difference between Ebstein’s pearls and Bohn’s nodules?

A

“Ebstein pearl” - P - on the palate

“Bohn nodules” are typically seen on gingival ridges

42
Q

What are some potential complications of tracheostomy tubes?

A
  • granuloma formation
  • infection
  • fistulization
  • decannulation
  • obstruction
  • pain and irritation

Pediatrics (27 decks)

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