Paeds ENT Flashcards
What % of children with choanal atresia have other congenital anomalies
0.2
What % of theses patients require tracheotomy
0.9
How many serotypes of pneumococcus are responsible for 83°/o of invasive disease in children
7
How much mobilization can be achieved with peritracheal mobilization
(dissection of the annular ligaments)? Up to 1.5 cm.
What is the incidence of carcinoma arising in a TGDC
What % of these require surgical intervention
What are the A A 0-HNS indications for myringotomy and tympanostomy tubes
- 3 or more episodes of OM in 6 months;
- 4 or more episodes in 12 months.
- Hearing loss >30 dB from OME.
- OME >3 months.
- Chronic TM retraction.
- Impending mastoiditis or other complication of OM.
- Autophony secondary to patulous eustachian tube.
- ET dysfunction secondary to craniofacial anomalies or head and neck radiation.
What is the incidence of hemorrhage after adenotonsillectomy
0.1 - 8.1%.
What is the recurrence rate following the Sistrunk procedure
1 - 4%.
What is the incidence of submucous cleft palate
1 in 1200.
What % of cases of choana! atresia involve only a mucosal diaphragm or membrane
1 O%.
In what % of the population does the carotid artery lie deep to the floor of the tonsillar fossa
1%.
What is the incidence of clinically significant VPI after adenoidectomy?
1:1500-3000.
What percent of patients with Down syndrome have an unstable transverse ligament of the atlas?
10%.
What % of patients with Down syndrome have an unstable transverse ligament of the atlas
10%.
What % of infants have a hemangioma by age 1
12%.
How should contacts be treated
14 days of erythromycin.
What is the recurrence rate following the Sistrunk procedure?
1-4%.
What is the incidence of synchronous airway lesions in children with laryngomalacia
18- 20%.
When should aspirin be discontinued prior to surgery? Naproxen? All other NSAIDS
2 weeks, 4 days, 3 days, respectively.
When should aspirin, naproxen, and all other NSAIDs be discontinued prior to surgery?
2 weeks, 4 days, and 3 days, respectively.
What proportion of children will have had at least one episode of OM by age 1
2/3.
Birth trauma accounts for what % of vocal cord paralysis in children
20% (associated with forceps use and C-section).
What % of cases of congenital vocal cord paralysis are bilateral
20%.
What is the recovery rate for idiopathic vocal cord paralysis in children
20%.
What % of TGDC contains thyroid tissue
20%.
What % of teratomas become malignant
20%.
What is the reduction in the need for myringotomy tubes in children who receive the heptavalent pneumococcal vaccine
20.1 %.
What is the earliest gestational age that complete glottic atresia could be detected on ultrasound
22 weeks.
What is the incidence of hemangiomas in premature infants weighing less than 1000 grams
23%.
What % of middle ear fluid cultures are negative for bacteria
25 - 30%.
What % of neonates less than 5 days old have a functioning cough reflex
25%.
How long should the patient remain intubated after single-stage L TR
3 - 7 days with anterior graft only; 12 – 15 days with anterior and posterior grafts.
How much trachea can be resected without using a release technique?
3 cm (possibly 4 em with the patient’s head in extreme flexion).
How much trachea can be resected without using a release technique
3 em (possibly 4 em with the patient’s head in extreme flexion).
At what age gestation can an infant suckle feed
34 weeks.
What is the mortality in children with congenital tracheal stenosis treated conservatively with tracheotomy and intensive respiratory care
35%.
How long should the patient remain intubated after single-stage LTR?
3-7 days with anterior graft only; 12-15 days with anterior and posterior grafts.
What is the recurrence rate following excision of a thyroglossal duct cysts without removal of the midportion of the hyoid and the ductal remnant?
38%.
What is the recurrence rate following excision of a TGDC without removal of the midportion of the hyoid and the ductal remnant
38%.
Which branchial pouch is the thymus derived from
3rd •
What % of premature infants develops subglottic stenosis (SGS)
4%.
What is the incidence of laryngeal papillomas in children
4.3 per I 00,000 children per year.
What is the mean duration of otitis media with effusion after AOM
40 days.
When do serum levels peak after administration of IV desmopressin
45 - 60 minutes.
At what angle does the eustachian tube lie in adults? In children
45 degrees in relation to the horizontal plane~ I 0 degrees in children.
When do serum levels peak after administration of IV desmopressin?
45-60 minutes.
Slide tracheoplasty increases the cross-sectional airway area by how much
4-fold.
What % of acute tonsillar infections are bacterial
5 - 30°/o.
What % of Caucasians carry the gene defect for cystic fibrosis
5%.
What % of patients with a subglottic hemangioma have an associated cutaneous hemangioma
50%.
What age group has the highest incidence of OM
6 - 18 months.
What is the sensitivity and specificity of inspiratory/expiratory and lateral decubitus films for foreign body aspiration
67°/o sensitive, 67% specific.
What is the sensitivity of an upper Gl for detecting aspiration
69%.
What % of hemangiomas regress by age 7
70%.
Between what ages do hemangiomas grow most rapidly
8 to I 8 months.
What is the sensitivity of this test
80% (less if already on antibiotics).
What is the overall decannulation rate after single-stage L TR
83% (Cotton).
What is the sensitivity and specificity of this test
85% sensitivity; 80% specificity.
What % of infants with G ERD will spontaneously resolve by 18 months
85%.
What is the reduction in total invasive pneumococcal disease in children who receive one or more doses of the heptavalent pneumococcal vaccine
89.1 %.
What is the sensitivity of the 24 hour pH probe for GERD.
92 - 94%
What is the significance of passive smoke exposure on the risk of developing OM
A higher incidence of tympanostomy tubes, chronic and recurrent OM, and otorrhea is seen in children whose mothers smoke. High concentrations of serum cotinine (marker for tobacco exposure) are associated with an increased incidence of AOM and persistent middle ear effusion following AOM.
What has been shown to accelerate the return to a normal diet after tonsillectomy?
A single intraoperative dose of steroids.
What has been shown to accelerate the return to a normal diet after tonsillectomy
A single intraoperative dose of steroids.
What is the typical appearance of a type 1 posterior laryngeal cleft
A soft tissue defect in the interarytenoid musculature without a defect in the cricoid cartilage.
How does one avoid injury to the recurrent laryngeal nerves during repair of tracheal stenosis
A void dissecting out the nerves and carry out dissection immediately on the trachea.
What are the advantages of single-stage laryngotracheoplasty
A voidance of prolonged indwelling stents with associated danger of displacement or breakage, no need for tracheotomy care, single procedure, long term antibiotic therapy (such as with stenting) is not required.
Other than URI, what are the most common causes of cough in infants up to 18 months
Aberrant innominate artery, cough-variant asthma, and GERD.
What is the most common anomaly associated with congenital tracheal stenosis
Aberrant left pulmonary artery (pulmonary artery sling complex).
What is the primary advantage of slide tracheoplasty compared with end-to-end anastomosis for the repair of tracheal stenosis?
Ability to span longer segments.
What is the primary advantage of slide tracheoplasty compared to end-to-end anastomosis for the repair of tracheal stenosis
Ability to span longer segments.
What are the contraindications to single-stage LTR?
Abnormal pulmonary function, coexistent medical problems that require a tracheostomy, and severe grade 4 stenosis.
What are the contraindications to single-stage L TR
Abnormal pulmonary function, co-existent medical problems that require a tracheostomy, and severe grade 4 stenosis.
What prevents air from escaping through the glottis during the cough reflex
Adduction and turning down of the false vocal cords (FVC).
What the clinical features of cervical tuberculosis
Affects all ages, bilateral supraclavicular lymph nodes, positive PPD, positive CXR, respond to curretage and macrolide antibiotics.
What group of patients is at increased risk for hemorrhage
Age >20 who have surgery during the winter.
What group of patients is at increased risk for hemorrhage?
Age >20 who have surgery during winter.
What is the most important factor associated with successful and permanent decannulation after LTR
Age >24 months at the time of L TR.
What is the most important factor associated with successful and permanent decannulation after LTR?
Age >24 months at the time of LTR.
By what age is the adenoid pad mostly atrophied
Age 7 or 8.
In what age groups is rhabdomyosarcoma most common
Ages 2 - 5 and 15 - 19.
In what age group is tonsillitis from group A streptococci most common
Ages 6 - 12.
What is the mechanism of resistance for S. pneumoniae
Altered penicillin-binding proteins.
What is the most common neurologic condition causing vocal cord paralysis in children
Amold-Chiari malformation.
What finding on CT scan is pathognomonic for JNA
Anterior bowing of the posterior wall of the maxillary antrum (Holman-Miller sign).
What is the most common complication after repeated laser treatments for recurrent respiratory papillomatosis (RRP)?
Anterior glottic webs.
What immunoglobulin is produced by the tonsils
Antigen-specific secretory lgA.
What is Grillo’s rule
Any patient who develops symptoms of airway obstruction, who has been intubated and ventilated in the recent past, must be considered to have an airway lesion until proven otherwise.
What is the optimal treatment for port wine stains
Argon laser in darker-skinned adults; tlashlamp pulsed tunable dye laser in children and lighter-skinned adults.
What is the typical course of the tract of right-sided 4th branchial cleft cysts
As above, except they loop around the subclavian artery instead of the aorta.
What is the typical course of the tract of 3rd branchial cleft cysts
Ascend lateral to the common carotid artery, pass posterior to the internal carotid artery, superior to XII and inferior to IX; course medially to pierce the thyrohyoid membrane superior to the internal branch of the superior laryngeal nerve
What must be done prior to single-stage laryngotracheoplasty
Assess for adequate vocal cord mobility and treat G ERD.
What must be done prior to single-stage LTR?
Assess for adequate vocal cord mobility and treat GERD.
What is the most common diagnosis given inappropriately to a child with an airway fureign body
Asthma.
What criteria should be met before performing single-stage L TR in neonates
At least 2 failed attempts at extubation, documentation of stenosis endoscopically, weight > 1500 g, spontaneous ventilation with F102
According to the Paradise study from 1984, what are the criteria for adenotonsillectomy for recurrent tonsillitis
At least 3 episodes in each of 3 years or 5 episodes in each of 2 years or 7 episodes in I year… with each episode documented by a physician.
What criteria should be met before performing single-stage laryngotracheal reconstruction (LTR) in neonates?
At least two failed attempts at extubation, documentation of stenosis endoscopically, weight >1500 g, spontaneous ventilation with F1o2
Where do most laryngeal webs occur
At the anterior glottis (75%).
How does one avoid injury to the recurrent laryngeal nerves during repair of tracheal stenosis?
Avoid dissecting out the nerves and carry out dissection immediately on the trachea.
What are the advantages of single-stage LTR?
Avoidance of prolonged indwelling stents with associated danger of displacement or breakage, no need for tracheotomy care, single procedure, long-term antibiotic therapy (such as with stenting) is not required.
What is the typical course of the tract of left-sided 4t” branchial cleft cysts
Begin at the apex of the pyriform sinus, descend lateral to the recurrent laryngeal nerve into the thorax, loop around the aortic arch, ascend to the neck posterior to the common carotid artery, cross XII, descend to open into the skin at the anterior-inferior aspect of the sternocleidomastoid muscle.
Where are most 2nd branchial cleft cysts located
Below the angle of the mandible and anterior to the sternocleidomastoid muscle.
What is the primary advantage of early LTR?
Better speech acquisition.
What is the primary advantage of early laryngotracheal reconstruction
Better speech acquisition.
What are the physical signs associated with submucous cleft palate
Bifid uvula, abnormal palatal motion, midline diastasis of the palatal muscles, V -shaped notch of the hard palate.
In what age groups is Hodgkin’s lymphoma most common
Bimodal peak incidence, with one peak in the 15 - 34 year old age group and another in later adulthood.
What are the most common complications of pharyngeal flap surgery?
Bleeding, airway obstruction, and obstructive sleep apnea.
What are the most common complications of pharyngeal flap surgery
Bleeding, airway obstruction, obstructive sleep apnea.
What is the mechanism of action of steroids in the treatment of hemangiomas
Block the estradiol- 17 receptor.
What tests confirm the diagnosis of infectious mononucleosis
Blood smear showing atypical mononuclear cells and a positive Paul-Bunnell test (elevated heterophile titer of Epstein-Barr virus).
What are the clinical features of arteriovenous malformations
Brightly erythematous lesions of the skin with an associated thrill and bruit.
What diseases may present with hemoptysis in children
Bronchiectasis, cystic fibrosis, foreign body, pulmonary hemosiderosis, TB.
Persistence of what membrane results in choana! atresia
Buccopharyngeal.
Which lymphoma accounts for 50°/o of childhood malignancies in equatorial Africa
Burkitt’s lymphoma.
How does one identify the anterior commissure during laryngofissure?
By identifying Montgomery’s aperture, a small hole just inferior to the anterior commissure or through direct laryngoscopy.
How does one identify the anterior commissure during laryngofissure
By identifying Montgomery’s aperture, a small hole just inferior to the anterior commissure or through direct laryngoscopy.
What is the 2”d leading cause of death among children ages 1 to 14
Cancer.
What are the 4 categories of lymphatic malformations
Capillary, cavernous, cystic (hygroma), and lymphangiohemangioma.
What are the 4 main types of vascular malformations
Capillary, venous, lymphatic, and arteriovenous malformations.
Which type of vascular malformation is a port wine stain
Capillary.
Which of these is most commonly found on the tongue or floor of mouth
Capillary.
How are children with ITP managed perioperatively
CBC is drawn I week prior to the procedure, and if thrombocytopenia is present, IVIG is administered preoperatively (400 mg/kg for 4 days).
What are the histologic differences between a hemangioma and a vascular malformation
Cellular proliferation is characteristic of hemangiomas; vessel dilatation is characteristic of vascular malformations.
What is the most common head and neck manifestation of neuroblastoma
Cervical metastatic disease.
What is the significance of day care on the risk of developing OM
Children in group day care are more likely to develop OM after URI compared to those in home care. The rate of tympanostomies and adenoidectomies is 59 - 67°/o higher in children
What disease is characterized by a staccato cough
Chlamydia! pneumonia.
What adjunctive test should be performed in a female with suspected JNA
Chromosome analysis.
What are some predictors of failure for endoscopic CO 2 laser treatment of subglottic stenosis?
Circumferential scarring, scarring longer than 1 em, tracheomalacia and loss of cartilage support, history of severe bacterial infection associated with tracheostomy, posterior laryngeal inlet scarring with arytenoid fixation, and multiple stenotic sites.
What are some predictors of failure for endoscopic C02 laser treatment of SGS
Circumferential scarring, scarring longer than 1 em, tracheomalacia and loss of cartilage support, history of severe bacterial infection associated with tracheostomy, posterior laryngeal inlet scarring with arytenoid fixation, multiple stenotic sites.
What medical conditions predispose a child to OM
Cleft palate, craniofacial anomalies, congenital or acquired immune deficiencies, ciliary dysfunction, enlarged adenoids, sinusitis, Down syndrome.
What is the sequence of events during the glottic closure reflex
Closure of the true vocal cords (TVC), followed by closure of the FVC, followed by adduction of the aryepiglottic folds.
What other factors can predispose an infant to aspirate
CNS disease, prematurity, mechanical barriers (NG tube, ET tube, tracheostomy), anatomic barriers (esophageal atresia/stricture. vascular rings, T -E fistula), scoliosis.
What is the most common esophageal foreign body in children
Coins.
Which of these is most likely to result in prolonged postoperative dysphagia?
Combined infrahyoid and inferior constrictor release.
Which of these is most likely to result in prolonged postoperative dysphagia
Combined infrahyoid and inferior constrictor release.
Why are infants more prone to aspiration than adults
Compared to adults, infants have a relatively lax epiglottis, large arytenoids, and wide aryepiglottic folds.
What are lathyrogenic agents
Compounds that inhibit collagen cross-linking, such as penicillamine and N-acetyi-L-cysteine.
What are other etiologies of SGS
Congenital anomalies, increased infant activity, autoimmune mechanisms (antibodies to type II collagen, anti-neutrophil cytoplasmic antibodies), infection, GERD, caustic injury, high tracheostomy.
What are the indications for four-quadrant cartilage division?
Congenital elliptical cricoid cartilage, severe congenital or acquired SGS, and calcification of the cricoid cartilage from failed LTRs.
What are the indications for four-quadrant cartilage division
Congenital elliptical cricoid cartilage, severe congenital or acquired SGS, calcification of the cricoid cartilage from failed L TRs.
Which of these is more likely to result in rebound growth with discontinuance
Corticosteroids.
What is the initial treatment for patients with adenotonsillar hypertrophy and infectious mononucleosis
Corticosteroids.
In children 6 to 16 years
Cough-variant asthma (45%), psychogenic (32%), and sinusitis (27°/o).
What is the function of aminocaproic acid
Counteracts the high concentration of fibrinolytic enzymes in the oral cavity.
What disease is characterized by a seal-like barking cough
Croup.
What test is used to diagnose pertussis
Culture from the nasopharynx using a Dacron or calcium alginate swab placed on a Regan-Lowe or Bordet- Gengou agar plate.
What is the most useful study of nontuberculous mycobacterial adenitis of the head and neck region in children
Culture.
What is the only clinical sign that is strongly associated with a synchronous airway lesion
Cyanosis.
What is a Thornwaldt’s cyst
Cyst in the nasopharyngeal bursa secondary to persistent embryonic communication between the anterior tip of the notochord and the nasopharyngeal epithelium.
Which of these is associated with location in the posterior triangle of the neck
Cystic hygroma.
What is the significance of adenoidectomy on OM
Data by Gates showed a 4 7% reduction in recurrent effusion in children who received adenoidectomy and myringotomy tubes compared to a 29°/o reduction in recurrent effusion in children who received only myringotomy tubes.
How can one differentiate a dermoid cyst from a thyroglossal duct cyst
Dermoid cyst will not elevate with tongue protrusion.
What are the 4 types of germ cell tumors
Dermoid cyst, teratoid cyst, teratoma, and epignathi.
Which of these are composed only of mesoderm and ectoderm
Dermoid cysts.
What factors increase the risk of postintubation tracheal stenosis
Difficult intubation, an overinflated cuff, repeated reintubations, poorly performed tracheostomy.
Why is end-to-end tracheal anastomosis rarely used in children?
Difficult to perform in the subglottic region without damaging the vocal cords.
Why is end-to-end tracheal anastomosis rarely used in children
Difficult to perform in the subglottic region without damaging the vocal cords.
What hormone receptors are present in JNAs
Dihydrotestosterone and testosterone.
What is the treatment for acute airway obstruction secondary to postintubation tracheal stenosis
Dilatation with rigid ventilating bronchoscopes; tracheostomy is only performed if a prolonged period is needed prior to definitive treatment of the stenosis.
What are the histologic features of venous malformations
Dilated, ectatic vascular channels with a normal endothelial lining and areas of thrombosis.
What are the treatment options for SGS
Dilation, steroid injection, lathyrogenic agents, cryotherapy, laser therapy, anterior cricoid split, one-stage laryngotracheoplasty, autogenous cartilage grafts, four-quadrant cartilage division, end-to-end tracheal anastomosis, flaps.
What test has the highest yield for diagnosis of vascular rings
Direct laryngoscopy and bronchoscopy.
How does one avoid postoperative hemorrhage from the innominate artery after repair of tracheal stenosis?
Dissect immediately on the trachea without disrupting the artery or its investments; if the artery has been previously dissected or the lesion is fixed to it, interpose a pedicled strap muscle between the anastomosis and the artery.
How does one avoid postoperative hemorrhage from the innominate artery after repair of tracheal stenosis
Dissect immediately on the trachea without disrupting the artery or its investments; if the artery has been previously dissected or the lesion is fixed to it, interpose a pedicled strap muscle between the anastomosis and the artery.
What is the most common complication of GERD in infants
Distal esophagitis.
What would the ultrasound show in a fetus with complete glottic atresia
Distension of the airway and lung parenchyma; flattening of the diaphragm; edema of the placenta; compression of the heart, great vessels, and thoracic duct.
What is the term for the treatment of airway obstruction in children with craniofacial abnormalities where the mandible is gradually elongated
Distraction osteogenesis.
What is the etiology of a type 2 first branchial cleft cyst
Duplication error of the ectodermal and mesodermal elements of the EAC.
What is the etiology of a type 1 first branchial cleft cyst
Duplication error of the ectodermal elements of the external auditory canal (EAC).
What are the indications for surgical treatment of laryngomalacia
Dyspnea at rest or during effort, feeding difticulties and failure to thrive.
What organisms are most commonly cultured from this disorder
E. Coli, Klebsiella, Proteus, and Clostridium.
What tests confirm the diagnosis of von Willebrand’s disease?
Elevated PTT and bleeding time, decreased or absent von Willebrand factor serum levels.
What tests confirm the diagnosis of von Willebrand’s disease
Elevated PTT and bleeding time, decreased or absent von Willebrand factor serum levels.
What is Eagle’s syndrome
Elongation of the styloid process or ossification of the stylohyoid ligament resulting in nonspecific throat pain, foreign body sensation, and increased salivation.
Why is it important to avoid dissection of the trachea for more than 1-1.5
em proximal or distal to the anastomotic site? To protect the blood supply to the trachea.
What are the 3 main histologic types of rhabdomyosarcoma
Embryonal, alveolar, and pleomorphic.
Which is most common in the head and neck
Embryonal.
What tests are most sensitive and specific for diagnosing the etiology of cough in infants up to 18 months of age
Endoscopy, barium esophagram, and empiric treatment with bronchodilators.
What is the most common etiology of posterior glottic stenosis
Endotracheal intubation.
What are the treatment options when sleeve resection is contraindicated
Endotracheal prosthesis, tracheostomy with a cannula or a Montgomery T tube.
What are the treatment options when sleeve resection contraindicated?
Endotracheal prosthesis, tracheostomy with a cannula, or a Montgomery T tube.
What findings on CT scan are diagnostic for encephalocele
Enlarged foramen cecum, crista galli erosion, increased interorbital distance, and a mixed soft tissue and fluid density mass.
What are the three laryngeal closure procedures?
Epiglottic flap, glottic closure, and vertical laryngoplasty.
What are the 3 laryngeal closure procedures
Epiglottic flap, glottic closure, and vertical laryngoplasty.
What is the procedure of choice for reconstruction of the anterior commissure?
Epiglottopexy laryngoplasty.
What is the procedure of choice for reconstruction of the anterior commissure
Epiglottopexy laryngoplasty.
Which organisms more frequently cause AOM in infants younger than 6 weeks
Escherichia coli, Klebsiella, and Pseudomonas aeruginosa.
What is the relationship between laryngomalacia and GERD
Essentially all children with laryngomalacia have GERD.
Why is jet ventilation contraindicated in patients with tracheal stenosis
Expiration of air is more difificult than inspiration during jet ventilation in patients with tracheal stenosis and can result in air trapping and pneumothoraces.
What kind of stridor is heard in patients with tracheomalacia
Expiratory.
What ten techniques are available to gain additional tracheal length in resection cases?
Extreme flexion, suprahyoid release, infrahyoid release, inferior constrictor release, peritracheal mobilization, intercartilaginous incisions, dissection and mobilization of the right hilum, release of the inferior pulmonary ligament, dissection of the pulmonary vasculature, and transection and reimplantation of the left main stem bronchus.
What techniques are available to gain additional tracheal length in resection cases (10)
Extreme flexion, suprahyoid release, infrahyoid release, inferior constrictor release, peritracheal mobilization, intercartilaginous incisions, dissection and mobilization of the right hilum, release of the inferior pulmonary ligament, dissection of the pulmonary vasculature, and transsection and reimplantation of the left main stem bronchus.
What structure is most at risk during removal of a 1st branchial arch sinus?
Facial nerve.
What is the etiology of a preauricular pit
Failure of fusion between Hillocks of His 1 and 2.
What are other signs or complications of GERD in infants
Failure to thrive, vomiting, recurrent aspiration pneumonia, acute life-threatening events.
True/False: Division of the cricoid cartilage has been shown to inhibit its further growth.
False.
T/F: Airway foreign bodies are more common than esophageal foreign bodies
False.
T/F: Thickening formula decreases the amount of reflux in children
False; no studies have proven any benefit of this. It may decrease the amount of visible regurgitation, but it does not improve reflux.
What are the potential side effects of interferon alpha-2b
Fever. weight loss, liver enzyme elevation, DIC.
What is the test of choice for diagnosing laryngomalacia
Flexible fiberoptic laryngoscopy in the oftice.
What test should be performed prior to operating on these children
Flexion and extension lateral neck films
What test should be performed prior to operating on these children?
Flexion and extension lateral neck films.
When is intervention warranted
For massive, ulcerative, disfiguring lesions; for those that produce hematologic, cardiovascular, or upper aerodigestive tract compromise; and for large periorbital lesions that obstruct vision.
Slide tracheoplasty increases the cross-sectional airway area by how much?
Fourfold.
What is Cotton’s grading system for SGS
Grade I : less than 50°/o laryngeal lumen obstruction; Grade 2: 51 - 70% laryngeal lumen obstruction; Grade 3: 71 - 99% laryngeal lumen obstruction; Grade 4: complete obstruction.
When found in the mandible, how do these lesions appear !radiographically
Have a honeycomb or soap bubble appearance.
What condition is seen in adolescent patients with severe, frequently recurring epistaxis and pulmonary arteriovenous malformations
Hereditary hemorrhagic telangiectasia.
What medications can be used to treat hemangiomas
High-dose corticosteroids (2 - 3 mg/kg/day) and interferon alpha-2a or 2b.
What is the typical presentation of child with a laryngeal cleft type 2 or greater
History of aspiration pneumonia, choking, coughing during feeds, and symptoms of airway obstruction.
How is croup managed
Humidification, dexamethasone and racemic epinephrine.
Why is tonsillectomy recommended prior to or in conjunction with these procedures?
Hypertrophied tonsils may tether the palate and contribute to the VPI; raising the flaps is more difficult in the presence of tonsils; keeping the tonsils increases the risk of obstructive sleep apnea postoperatively.
Why is tonsillectomy recommended prior to or in conjunction with these procedures
Hypertrophied tonsils may tether the palate and contribute to the VPI; raising the flaps is more difficult in the presence of tonsils; keeping the tonsils increases the risk of obstructive sleep apnea postoperatively.
How do lymphatic malformations appear on MRI
Hypointense on Tl, hyperintense on T2.
What are the adverse effects of desmopressin
Hyponatremia , seizures, and tachyphylaxis.
What are the adverse effects of desmopressin?
Hyponatremia, seizures, and tachyphylaxis.
What is the incidence of clinically significant VPI after adenoidectomy
I : I 5 00 - 3 000.
What ‘Yo of infants with laryngomalacia require surgical treatment
I O%.
What % of children with an episode of AOM will still have an effusion present 3 months later
I O%.
What is the sequence of events during a normal swallow
I. Oral phase: food is chewed and mixed with saliva. 2. Oropharyngeal phase: the food bolus is propelled posteriorly. 3. Pharyngeal phase: the soft palate elevates, glottis closes, pharyngeal constrictors contract, and the cricopharyngeus relaxes. 4. Esophageal phase: the bolus is propelled into the stomach by peristaltic waves.
What is the most likely cause of stridor after ligation of a patent ductus arteriosus?
Iatrogenic injury of the left recurrent laryngeal nerve.
What is the most likely cause of stridor after ligation of a patent ductus arteriosus
Iatrogenic injury of the left recurrent laryngeal nerve.
What are the indications for polysomnography prior to adenotonsillectomy for obstructive sleep apnea?
If history and physical exam are not in agreement or if the child is at an unusually high risk for perioperative complications.
What are the indications for polysomnography prior to adenotonsillectomy for obstructive sleep apnea
If history and physical exam are not in agreement or if the child is at an unusually high risk for perioperative complications.
What is the treatment for postadenoidectomy VPI?
If it persists beyond 2 months, speech therapy; beyond 6-12 months, palatal pushback, pharyngeal flap surgery, or sphincter pharyngoplasty.
What is the treatment for post-adenoidectomy VPI
If it persists beyond 2 months, speech therapy; beyond 6 - 12 months, palatal push back, pharyngeal flap surgery, or sphincter pharyngoplasty.
When is a post-treatment culture indicated in a child with group A streptococcal pharyngitis
If the child is at an unusually high risk for rheumatic fever, remains symptomatic, or develops recurring symptoms.
What effect does the timing of treatment for Arnold-Chiari have on the outcome of vocal cord paralysis
If the ICP is normalized within 24 hours, vocal cord function will recover within 2 weeks in most patients.
When should an asymptomatic patient with a positive post-treatment culture for group A streptococci be treated
If the patient or someone in his family has a history of rheumatic fever.
Decreased levels of which immunoglobulin are common in children who are prone to otitis media
IgG2.
What is the stage of a JNA eroding the skull base with minimal intracranial extension
IliA.
What finding on pneumatic otoscopy is most specific for OM
Immobility of the tympanic membrane.
When is hilar release contraindicated?
In patients with poor pulmonary reserve.
When is hilar release contraindicated
In patients with poor pulmonary reserve.
How does the position of the larynx differ between neonates and adults
In the neonate, the larynx is positioned more anterosuperiorly, lying at the level of C2-C3, with the cricoid lying at C3-C4. In the adult, the larynx lies at the level of C5 and the cricoid at C7.
Where are most type 1 cysts located
In the periauricular region, lateral to VII, connecting the skin to the EAC.
What effects do multiple laser procedures have on the airway?
Increased scarring, ossification of the cricoid cartilage.
What effects do multiple laser procedures have on the airway
Increased scarring, ossification of the cricoid cartilage.
In which countries does this tumor most often occur
India and Egypt.
What effect do estrogens have on nasal mucosa
Induce metaplasia of nasal mucosa from ciliated columnar epithelium to stratified keratinizing squamous epithelium.
What are the typical presenting features of ankyloglossia
Infant has difficulty latching-on during breast feeding and mother experiences prolonged nipple pain.
Vaccination against what virus had been shown to decrease the incidence of acute otitis media in infants and children
Influenza.
What are the mechanisms of action of interferon alpha-2b
Inhibit epithelial cell migration and proliferation and inhibit growth factor.
What is the most common vascular ring
Innominate artery compression.
What is stertor
Inspiratory low-pitched sound resulting from turbulent airflow through the nasal cavity and nasopharynx.
Where does the main blood supply to these tumors most often come from
Internal maxillary artery or the ascending pharyngeal artery.
What are the 3 types of laryngoceles
Internal, external, and combined.
What are the problems with this test
Invasive; false positives possible from breakdown of endogenous lipids or toxic response to certain medications; clearance time of lipids from the lungs is unknown.
What are the contraindications to tracheal sleeve resection
Involvement of the glottis or subglottis, stenosis longer than 6 em, temporary or chronic respiratory failure or neurological deficit.
What are the contraindications to tracheal sleeve resection?
Involvement of the glottis or subglottis, stenosis longer than 6cm, temporary or chronic respiratory failure or neurological deficit
What are the primary disadvantages of glottic closure?
It does not allow speech, is difficult to reverse, and rarely works unless the larynx is bilaterally denervated.
What are the primary disadvantages of glottic closure
It does not allow speech, is difficult to reverse, and rarely works unless the larynx is bilaterally denervated.
How are children with von Willebrand ‘s disease managed perioperatively
IV administration of desmopressin (0.3 microgram/kg) preoperatively, 12 hours postoperatively, and every morning until the fossae are completely healed; aminocaproic acid pre- and postoperatively. Alternatively, Factor VIII concentrate can be given peri operatively.
Where are most type 2 cysts located
Just inferior or posterior to the angle of the mandible with variable relationship to VII.
After benign lymphoid hyperplasia, what is the most common benign nasopharyngeal tumor
Juvenile nasopharyngeal angiofibroma (JNA).
What syndrome is characterized by profound thrombocytopenia associated with a hemangioma
Kasabach-Merritt syndrome.
Which of these is associated with episodic bleeding
L ymphangiohemangioma.
Which of these is more likely to rapidly enlarge during a t Rl
L ymphangiohemangioma.
Stridor that increases in intensity with crying, agitation, or straining is characteristic of what disorders
Laryngomalacia and subglottic hemangioma.
What are the 3 most common causes of stridor in children
Laryngomalacia, vocal cord paralysis, and congenital subglottic stenosis.
Using the system of Session et al, what is the stage of a JNA involving the posterior nares and the sphenoid sinus
lB.
Which lesions respond best to pulsed dye laser
Lesions less than 20 cm2 in children
Why are children under 3 routinely admitted after adenotonsillectomy
Less likely to cooperate with oral intake and more likely to have surgery for airway obstruction.
What is the advantage of using ibuprofen over acetaminophen with codeine for postoperative tonsillectomy pain
Less postoperative nausea.
Which chromosome carries the gene responsible for cystic fibrosis
Long arm of chromosome 7.
Why is pulmonary edema a potential complication after adenotonsillectomy?
Long-standing partial airway obstruction from enlarged tonsils serves as a natural PEEP. Sudden relief of the obstruction/PEEP can result in transudation of fluid into the interstitial and alveolar spaces.
Why is pulmonary edema a potential complication after adenotonsillectomy
Long-standing partial airway obstruction from enlarged tonsils serves as a natural PEEP. Sudden relief of the obstruction/PEEP can result in transudation of fluid into the interstitial and alveolar spaces.
How does the composition of gas in the middle ear differ from that of room air
Lower oxygen level and higher carbon dioxide and nitrogen levels.
Of tracheoesophageal diversion (TED) and laryngotracheal separation (LTS), which is technically easier?
LTS.
Of tracheoesophageal diversion (TED) and laryngotracheal separation (LTS), which is preferred if the patient has or has had a tracheostomy?
LTS.
Of TED and L TS, which is technically easier
LTS.
Which is preferred if the patient has or has had a tracheostomy
LTS.
What is Gerlach’s tonsil
Lymphoid tissue arising from the fossa of RosenmUller that extends into the eustachian tube.
What is the most common head and neck tumor of children
Lymphoma.
What is laryngospasm
Maladaptive and exaggerated glottic closure reflex.
What prenatal condition is associated with a higher incidence of cervical teratomas
Maternal polyhydramnios.
What is the significance of hemoptysis after tracheal sleeve resection?
May portend rupture of the innominate artery.
What is the significance of hemoptysis after tracheal sleeve resection
May portend rupture of the innominate artery.
What is the best surgical approach to resection of JNAs
Medial maxillectomy via lateral rhinotomy or midface degloving approach.
Which lesions are less likely to respond to sclerosis with OK-432 ( Picibanil)
Microcystic, previously operated-on, and those with massive craniofacial involvement.
What is the most common presenting complaint of patients with rheumatic fever
Migratory joint pain (75%) that is out of proportion to physical findings.
What are the indications for antireflux surgery in children?
Mild to moderate symptoms that fail medical therapy; severe gastroesophageal reflux disease with life-threatening symptoms.
What are the indications for antireflux surgery in children
Mild to moderate symptoms that fail medical therapy; severe GERD with life-threatening symptoms.
What is the most common valvular problem resulting from rheumatic fever
Mitral valve stenosis.
Which of these allows the greatest amount of mobilization?
Mobilization of the right hilum with release of the inferior pulmonary ligament, dissection of the pulmonary vasculature, and transection and reimplantation of the left main stem bronchus allow up to 6 cm of superior mobilization.
Which of these allows the greatest amount of mobilization
Mobilization of the right hilum with release of the inferior pulmonary ligament, dissection of the pulmonary vasculature, and transection and reimplantation of the left main stem bronchus allows up to 6 em of superior mobilization.
What is the imaging modality of choice for lymphatic malformations
MRI. CXR should also be performed to rule out mediastinal extension or pleural effusion.
What is the treatment for rhabdomyosarcoma
Multimodality; primary chemoradiation followed by surgery for recurrent or residual disease.
What are the typical histologic characteristics of lymphatic malformations
Multiple dilated lymphatic channels lined by a single layer of epithelium.
What are the disadvantages of serial bouginage
Multiple treatment applications over a prolonged period of time, lack of stabilization if cartilaginous destruction or instability has occurred, generally requires a tracheotomy.
What are the 2 most common inflammatory salivary diseases of childhood
Mumps parotitis and recurrent parotitis of childhood.
What are the most common organisms causing nontuberculous mycobacterium
Mycobacterium avium-intracellulare complex and Mycobacterium scrofulaceum.
What are the surgical options for treatment of intractable aspiration
Narrow-field laryngectomy, endolaryngeal stent, laryngeal closure, and tracheoesophageal diversion (TED) or laryngotracheal separation (L TS).
How is atlantoaxial subluxation diagnosed
Neck pain and torticollis with an atlas-dens interval of >4 mm in children and > 3 mm in adults.
What is the primary disadvantage of augntentation tracheoplasty for the treatment of tracheal stenosis?
Need for multiple bronchoscopies due to recurrent granulation tissue formation at cartilage graft sites (thought to be secondary to the need for prolonged intubation postoperatively).
What is the primary disadvantage of augmentation tracheoplasty for the treatment of tracheal stenosis
Need for multiple bronchoscopies due to recurrent granulation tissue formation at cartilage graft sites (thought to be secondary to the need for prolonged intubation postoperatively).
What are the precursor cells of neuroblastoma
Neural crest cells.
What is the most common solid malignant tumor in infants
Neuroblastoma.
What is the difference between a Nissen and a Thai fundoplication
Nissen is a 270 degree wrap; Thai is a 360 degree, or complete, wrap.
What is the difference between a Nissen and a Thai fundoplication?
Nissen is a 270-degree wrap and Thai is a 360-degree, or complete, wrap.
What is a Grillo stitch?
Nonabsorbable suture extending from the periosteum of the mentum to the sternum used to keep the neck flexed after tracheal resection.
What is a Grillo stitch
Non-absorbable suture extending from the periosteum of the mentum to the sternum used to keep the neck flexed after tracheal resection.
What are the advantages of using argon plasma coagulation for the treatment of hereditary hemorrhagic telangiectasia (HHT)
Noncontact application, limited and controlled tissue penetration with low risk of septal perforation, no safety measures required ( ie, for lasers), low thermal damage to adjacent tissue, inexpensive.
Which muscles constrict the eustachian tube
None.
What are the advantages of serial bouginage for the treatment of SGS
Non-invasive, growth may take care of the stenosis, avoids concerns regarding the potential for laryngeal growth inhibition with open procedures.
What is the leading cause of chronic cervical lymphadenopathy in young children
Nontuberculous mycobacterium or atypical TB.
What is the “Waterson sign”
Obliteration of the right radial pulse by compressing the anterior tracheal indentation with the tip of the bronchoscope.
What is the most common treatment for hemangiomas
Observation, parental reassurance.
What factors affect pain after adenotonsillectomy?
Old age and use of electrocautery are associated with greater pain; postoperative administration of antibiotics has been shown to decrease pain.
What factors affect pain after adenotonsillectomy
Older age, use of electrocautery are associated with greater pain; postoperative administration of antibiotics has been shown to decrease pain.
What is the significance of the seasons on the risk of developing OM
OM is most common in the winter and lasts longer when it occurs in the winter.
Involvement in which area of the head and neck by rhabdomyosarcoma has the best prognosis
Orbit.
Where does the nasopharyngeal orifice of the eustachian tube lie in relation to the hard palate in adults? In children
Orifice is situated I 0 mm above the plane of the hard palate in adults; at the level of the hard palate in children.
What organisms most frequently cause chronic suppurative OM
P. aeruginosa(most common), S. aureus, Corynebacterium, and Klebsiella.
Which muscles form the anterior and posterior tonsillar pillars
Palatoglossus and palatopharyngeus, respectively.
What is the most common type of well-differentiated thyroid carcinoma in children
Papillary.
What is the most common benign neoplasm of the larynx in children
Papillomas.
What is the most common cause of laryngotracheobronchitis (croup) in children
Parainfluenza virus.
In children 18 months to 6 years
Paranasal sinus films, endoscopy, and empiric treatment with bronchodilators.
What is the best initial approach for management of mild GERD with no adverse clinical consequences in an infant
Parental reassurance; reverse Trendelenburg, prone positioning after feeding.
What is the typical course of the tract of 2nd branchial cleft cysts
Pass superiorly and laterally to IX, XII; turn medially to pass between the internal and external carotid arteries; terminate close to the middle constrictor muscle or may open into the tonsillar fossa.
Which patients are at increased risk for atlantoaxial subluxation during tonsillectomy?
Patients with Down syndrome, achondroplasia, Arnold-Chiari, and rheumatoid arthritis.
Which patients are at risk for atlantoaxial subluxation
Patients with Down syndrome, achondroplasia, Arnold-Chiari, and rheumatoid arthritis.
What is aspiration
Penetration of secretions below the TVC.
What is an absolute contraindication to treatment with OK-432
Penicillin allergy.
What is the etiology of thyroglossal duct cysts (TGDC)
Persistence of the connection between the base of tongue (foramen cecum) and the descended thyroid gland.
What is the etiology of cervical thymic cysts
Persistence of the thymopharyngeal duct.
What is intractable aspiration
Persistent aspiration despite maximum medical management and minor surgery.
What is the most cost-effective predictor of posttonsillectomy hemorrhage?
Personal and family history of bleeding.
What is the most cost-effective predictor of post-tonsillectomy hemorrhage
Personal and family history of bleeding.
What is the most common notifiable and vaccine-preventable disease in children under age 5
Pertussis.
What is platybasia
Phenotypic characteristic of VCFS where the cranial base is angled obtusely, resulting in expanded velopharyngeal volume and incomplete velopharyngeal closure.
What is the plica triangularis
Point at which the palatine and lingual tonsils meet.
What are the guidelines set by the AAO-HNS for 23-hour admission after adenotonsillectomy
Poor oral intake, vomiting, hemorrhage, age younger than 3, home more than 45 minutes from the nearest hospital, poor socioeconomic situation with possible neglect, and other medical problems.
What are the contraindications to surgical resection of JNAs
Poor surgical risk, recurrent tumor that has proved refractory to previous excisions, and involvement of vital structures.
What is the most common vascular malformation
Port wine stain.
Where exactly are most subglottic hemangiomas located
Posterolaterally and submucosally.
Can patients with laryngotracheal separation talk?
Potentially, via esophageal speech.
Can these patients talk
Potentially, via esophageal speech.
How are children with sickle cell disease managed perioperatively
Preoperative transfusion to decrease the hemoglobin S ratio to less than 40% and preoperative intravenous hydration are recommended.
What are the 2 types of aspiration
Primary or direct from oral substances and secondary or indirect from gastric substances.
What are the 3 modes of supraglottic obstruction causing laryngomalacia
Prolapse of the mucosa overlying the arytenoids, foreshortened aryepiglottic folds, and posterior displacement of the epiglottis.
What is the biggest risk factor for acquired SGS
Prolonged endotracheal intubation.
In children 6 to 16 years
Pulmonary function tests (PFT) with methacholine challenge, paranasal sinus films.
What is the typical endoscopic appearance of innominate artery compression
Pulsatile compression of the anterior tracheal wall in the distal trachea.
What inflammatory disease is associated with 3rd and 4th branchial anomalies in children
Recurrent acute suppurative thyroiditis.
What cells are unique to Hodgkin’s lymphoma
Reed-Sternberg cells.
What is the most common sign of GERD in infants
Regurgitation.
What is the initial management of posttonsillectomy pulmonary edema?
Reintubation and administration of PEEP, gentle diuresis.
What is the initial management of post-tonsillectomy pulmonary edema
Reintubation and administration of PEEP, gentle diuresis.
What is the primary disadvantage of this technique?
Requires long-term stenting (1-12 months).
What is the primary disadvantage of this technique
Requires long-term stenting (I - 12 months).
What is the most common soft tissue sarcoma of the head and neck in children
Rhabdomyosarcoma.
What is the significance of genetics on the risk of developing OM
Risk of OM is higher if a sibling has a history of recurrent OM.
What are the 3 most commonly identified viruses in middle ear fluid
RSV (74°/o), parainfluenza, and influenza.
What is the lipid laden alveolar macrophage index
Secretions are collected during bronchoscopy and stained with oil red 0 (which detects lipids). 100 macrophages are counted and scored from 0 - 4 according to the amount of staining. A score of>70 is significant for aspiration.
What are the typical M RI findings of hemangiomas
Serpentine high-volume flow voids surrounded by nonvascular soft tissue.
What are the indications for rigid bronchoscopy in children with laryngo malacia
Severe or atypical stridor, an abnormal high kilovolt cervical radiograph, or a high degree of suspicion for a synchronous airway lesion.
What is the best approach for the treatment of the funnel-like morphologic variant of congenital long-segment tracheal stenosis
Single-stage anterior L TR with cartilage or pericardium grafting.
What is the best approach for the treatment of the funnel-like morphologic variant of congenital long-segment tracheal stenosis?
Single-stage anterior LTR with cartilage or pericardium grafting.
In children 18 months to 6 years
Sinusitis (50°/o), cough-variant asthma (27%).
What is the standard surgical approach for removal of thyroglossal duct cysts (TGDCs)?
Sistrunk procedure.
What is the standard surgical approach for removal of TGDCs
Sistrunk procedure.
What are the typical clinical features of venous malformations
Soft, compressible, nonpulsatile masses most commonly found on the lip or cheek within the head and neck~ also can be found within the masseter muscle or mandible.
After open repair of subglottic stenosis, what adjuvant treatment is necessary postoperatively
Speech therapy.
Which of these procedures is best for patients with poor lateral wall movement and good palate movement?
Sphincter pharyngoplasty.
Which of these procedures is best for patients with poor lateral wall movement and good palate movement
Sphincter pharyngoplasty.
Involvement of 2 or more lymph node sites on the same side of the diaphragm is designated as which stage according to the Ann Arbor system
Stage II.
What organism is the most common cause of bacterial tracheitis in children
Staphylococcus aureus.
What organisms most frequently cause AOM
Streptococcus pneumoniae (30 - 35°/o), nontypeable strains of Haemophilus injluenzae (20 - 25% ), and Moraxella cat arrha/is (I 0 - 15% ).
What syndrome is characterized by capillary hemangiomas along the distribution of Vl with concomitant capillary, venous, and arteriovenous malformations of the leptomeninges
Sturge-Weber syndrome.
What structures are removed or transected with the suprahyoid release
Stylohyoid, mylohyoid, geniohyoid, and genioglossus muscles are transected, and the body of the hyoid bone is transected at its attachments to the greater and lesser comus.
What structures are removed or transected with the suprahyoid release?
Stylohyoid, mylohyoid, geniohyoid, and genioglossus muscles are transected, and the body of the hyoid bone is transected at its attachments to the greater and lesser cornus.
After 2 weeks of intubation for ventilatory support, a 32-week premature infant is extubated and severe upper airway obstruction results. What is the most likely cause
Subglottic edema.
What is the best treatment for nasal pyriform aperture stenosis?
Sublabial medial maxillectomy.
What is the best treatment for nasal pyriform aperture stenosis
Sublabial medial maxillectomy.
Where are dermoid cysts most commonly found in the head and neck
Submental area.
What is mitomycin C
Substance produced by Streptomyces caespitosus that inhibits DNA synthesis and fibroblast proliferation.
Unlike the glottic closure reflex, laryngospasm is mediated solely by stimulation of what nerve
Superior laryngeal nerve.
Which of these procedures is best for patients with poor palate movement and good lateral wall movement?
Superior pharyngeal flap.
Which of these procedures creates lateral ports through the nasopharynx for breathing?
Superior pharyngeal flap.
Which of these procedures is best for patients with poor palate movement and good lateral wall movement
Superior pharyngeal flap.
Which of these procedures creates lateral ports through the nasopharynx for breathing
Superior pharyngeal flap.
What disease increases the risk of nasopharyngeal stenosis after adenotonsillectomy?
Syphilis.
What disease increases the risk of nasopharyngeal stenosis after adenotonsillectomy
Syphilis.
What is the first sign of respiratory distress in children
Tachypnea.
Of tracheoesophageal diversion (TED) and laryngotracheal separation (LTS), which is easier to reverse?
TED.
Which is easier to reverse
TED.
What is the only muscle related to active opening of the eustachian tube
Tensor veli palatini.
What is the significance of breast feeding on the risk of developing OM
The duration of breast-feeding is inversely related to the incidence of OM.
What differentiates a teratoid cyst from a teratoma
The germ layers are well-differentiated in teratomas such that recognizable organs may be found within the masses.
How does infant swallowing differ from adult swallowing
The pharyngeal phase of swallowing in infants is faster and more frequent.
Why should general anesthesia be avoided in patients with mononucleosis?
They are at a heightened risk of suffering hepatotoxicity from the anesthetics.
Why should general anesthesia be avoided in patients with mononucleosis
They are at a heightened risk of suffering hepatotoxicity from the anesthetics.
Which patients are at greatest risk for respiratory problems after adenotonsillectomy
Those with PSG-proven OSA, Down syndrome, cerebral palsy, or congenital defects.
What is the term for the connection of the 3rd branchial pouch to the thymus gland as the gland descends into the thorax
Thymopharyngeal duct.
What muscle adducts the FVC and aryepiglottic folds
Thyroarytenoid muscle.
What is the differential diagnosis of a midline neck mass in a child
Thyroglossal duct cyst, dermoid cyst, ectopic thyroid tissue, lymphadenopathy, lipoma, hemangioma, fibroma.
Which of these is most common
Thyroglossal duct cyst.
Through which membrane do external laryngoceles protrude
Thyrohyoid.
What is the surgical treatment of choice for giant congenital melanocytic nevi?
Tissue expansion followed by total excision.
What is the surgical treatment of choice for giant congenital melanocytic nevi
Tissue expansion followed by total excision.
What is the microtrapdoor flap used for?
To correct posterior glottic stenosis.
What is the microtrapdoor flap used for
To correct posterior glottic stenosis.
Why do some people recommend radioisotope scanning or ultrasound of the thyroid gland prior to removal of a TGDC
To prevent inadvertent removal of the only functioning thyroid tissue.
Why is it important to avoid dissection of the trachea for more than 1 - 1.5 em proximal or distal to the anastomotic site
To protect the blood supply to the trachea.
In placing an autogenous cartilage graft, where does the surface bearing perichondrium face?
Toward the lumen of the larynx.
In placing an autogenous cartilage graft, where does the surface bearing perichondrium face
Toward the lumen of the larynx.
After pericardia} patch augntentation tracheoplasty, what factors significantly increase the likelihood of fatal outcome?
Tracheal involvement within 1cm of the carina or involvement of either mainstem bronchus.
After pericardia! patch augmentation tracheoplasty, what factors significantly increase the likelihood of fatal outcome
Tracheal involvement within I em of the carina or involvement of either mainstem bronchus.
What surgical procedure is the most common cause of iatrogenic vocal cord paralysis in children?
Tracheoesophageal fistula repair.
What surgical procedure is the most common cause of iatrogenic vocal cord paralysis in children
Tracheo-esophageal fistula repair.
What is the most common cause of GERD in children
Transient lower esophageal sphincter relaxation.
What approach is used for revisions of failed choanal atresia repairs?
Transpalatal.
What approach is used to for revisions of failed choana! atresia repairs
Transpalatal.
How is adenoidectomy related to Grisel’s syndrome
Traumatic adenoidectomy can result in Grise I’ s syndrome.
How is adenoidectomy related to Grisel’s syndrome?
Traumatic adenoidectomy can result in Grisel’s syndrome.
From which site in the nasopharynx does this tumor develop
Trifurcation of the palatine bone, horizontal ala of the vomer, and the root of the pterygoid process.
True/False: Children with congenital laryngotracheal stenosis have a better voice outcome after surgical correction compared with children with acquired stenosis.
True.
T/F: Compared to the gag reflex, the cough reflex correlates better with a newborn’s ability to eat safely
True.
T/F: Children with congenital laryngotracheal stenosis have a better voice outcome after surgical correction compared to children with acquired stenosis
True.
T /F: Division of the cricoid cartilage has not been shown to inhibit its further growth.
True.
T/F: Nasal steroids given twice daily for 6 months are likely to reduce adenoidal size
True.
T/F: The mortality rate is highest in patients who bleed within 24 hours after adenotonsillectomy
True.
T/F: Electrocautery tonsillectomy reduces intraoperative bleeding but has the same postoperative bleeding rate as the cold technique
True.
T/F: The 23-valent pneumococcal vaccine is not effective in children
True.
T/F: Axillary, inguinal, and Waldeyer’s ring involvement is uncommon in patients with Hodgkin’s lymphoma
True.
T/F: Frontal sinus hypoplasia is common in patients with cystic fibrosis
True.
Which subtype of von Willebrand’s disease responds to treatment with desmopressin?
Type I, the most common, where qualitatively normal von Willebrand factor is present in subnormal levels.
Which subtype of von Willebrand’s disease responds to treatment with desmopressin
Type I, the most common, where qualitatively normal von Willebrand factor is present in subnormal levels.
What are the clinical features of cervical nontuberculous mycobacterium
Typically affects children ages I - 5 years, unilateral, upper cervicofacial lymph nodes, negative or weakly positive PPD, normal CXR.
What are the clinical features of recurrent parotitis of childhood
Typically presents at age 5 - 7, more common in males, unilateral, gets less severe with time, 55% will resolve spontaneously, and frank pus is rarely seen.
What is the histologic appearance of these tumors
Unencapsulated admixture of vascular tissue and fibrous stroma; vessel walls lack elastic fibers and have decreased or no smooth muscle; mast cells are abundant in the stroma.
What common cause of congenital airway obstruction is characterized by inspiratory stridor at birth that decreases when placed on the side of the lesion
Unilateral vocal cord paralysis.
How much mobilization can be achieved with peritracheal mobilization (dissection of the annular ligaments)
Up to 1.5 em.
How much mobilization can be achieved with the suprahyoid release?
Up to 5 cm.
How much mobilization can be achieved with the suprahyoid release
Up to 5 em.
What information does esophageal manometry provide
Upper esophageal sphincter responsiveness and pharyngeal peristalsts.
What is the most common cause of cough in children
URI.
What has been shown to decrease the incidence of postoperative granulomas after LTR?
Use of absorbable suture.
What has been shown to decrease the incidence of postoperative granulomas after L TR
Use of absorbable suture.
When is the typical onset of symptoms in patients with subglottic hemangioma
Usually asymptomatic at birth and symptomatic by 6 months of age.
What are the clinical differences between a hemangioma and a vascular malformation
Vascular malformations are present at birth, grow proportionately with the child, and are associated with distortion or destruction of surrounding bone or cartilage; hemangiomas generally emerge after birth, proliferate and then regress, and do not affect surrounding bone or cartilage.
What syndrome, characterized by deletion of band 11 on the long arm of chromosome 22, is a contraindication to adenoidectomy
Velocardiofacial syndrome (VCFS).
What syndrome is characterized by hypernasal speech, cardiac malformations, cleft palate, and medial displacement of the carotid arteries
Velocardiofacial syndrome.
What is Grisel’s syndrome?
Vertebral body decalcification and laxity of the anterior transverse ligament secondary to infection in the nasopharynx.
What is Grisel’s syndrome
Vertebral body decalcification and laxity of the anterior transverse ligament secondary to infection in the nasopharynx.
What is the characteristic feature of a teratoid cyst
Very poor differentiation of all three germ layers.
What is the best test to evaluate swallowing
Videofluoroscopic barium swallow.
Disorders of which clotting factors can cause prolongation of the PTT
VIII, IX, XI, XII, and lupus anticoagulant.
When is open repair of posterior glottic stenosis in a patient with RRP possible?
When there has been no papilloma regrowth 8 or more weeks after ablation.
What are the indications for definitive treatment of lymphatic malformations
When vital structures are endangered, when episodic hemorrhage occurs, or if macroglossia is present.
How can one diagnose exercise-induced laryngomalacia
With exercise flow-volume spirometry.
What is the Euler-Byrne formula
X + 4Y where X = # episodes pH5 minutes; a score of 50+ is clinically significant for GERD.
What is the term for the treatment of airway obstruction in children with craniofacial abnormalities where the mandible is gradually elongated?
Distraction osteogenesis.
