Pediatric ENT

Question 1

DDx for red eye, categories

Answer 1

Conjunctivitis, foreign body, trauma, infection, allergy, irritating noxious agents

Question 2

painful eye ddx

Answer 2

foreign body, corneal abrasion, lacerations, acute infection, iritis, angle-closure glaucoma, trichiasis (inturned lashes), trauma

Question 3

visual changes ddx

Answer 3

amblyopia, chemical burns, globe injury, alignment and mobility issues, illness, infection, allergy

Question 4

ptosis ddx

Answer 4

defective levator muscles, myasthenia gravis, lid injuries, thrid nerve palsy, horner syndrome

Question 5

anisocoria ddx

Answer 5

(unequal sized pupils)
horner syndrome
third nerve palsy, adie tonic pupil, iritis, trauma, medication

Question 6

leukocoria ddx

Answer 6

retinoblastoma, retinopathy of prematurity, pupillary membrane, cataract, vitreous opacities, retinal detachment, toxocara infection, retinal dysplasia

Question 7

What is toxocariasis?

Answer 7

A parisite that lives in dogs and cats and can be contracted from their feces.
- Many people don’t get sick but some get ocular toxocariasis, or visceral version.

Question 8

What is retinoblastoma

Answer 8

Eye cancer that begins in the retina,, commonly affects young children.
S/sx: white reflex, strabismus

Question 9

conjunctivitis

Answer 9

Bact: S. pneumo, Hflu, Moraxella, N. gonorrhoeae
Viral: adenovirus
S/sx: copious purulent or watery discharge, mild discomfort, no blurring of vision, redness
Tx: ophth erythromycin

Question 10

dacryostenosis

Answer 10

Eti: blockage of tear ducts, up to 6% of newborns
S/sx: history of chronic or intermittent tearing and debris on the eyelashes. palpating lac sac may cause reflux of tears

Question 11

Dacryocystitis

Answer 11

Eti: infection of lac sac by s. pnuemo, h flu, s aureus, strep p. P aeruginosa
S/sx: uniL. Pus may be expressed from tear sac, pain, swelling, tenderness, redness near sac.
Tx: warm compresses, or oral abx

Question 12

Hyphema

Answer 12

Pooling or collection of blood in the anterior chamber of the eye.
Eti: Blunt trauma, sickle cell, blood dyscrasias

Question 13

orbital or periorbital cellulitis

Answer 13

Eti: S. pneumo, hflu, moraxella, s aureus, GAS
S/sx: fever, proptosis, double vision, restriction of EOMs
Tx: amp/sulbact or cefotaxime

Question 14

Hordeolum

Answer 14

infection of glands, usually by staph a.
S/sx: Pain, redness, swelling
Tx: warm compresses TID
- if unresolved I&D

Question 15

Exophthalmos/proptosis

Answer 15

Eti: hyperthyroidism

S/sx: bluging eyes

Question 16

Chalazion

Answer 16

Eti: Chronic inflammation of the meibomian gland

Question 17

Ptosis

Answer 17

Eti: dysfunction of the levator muscle or superior rectus, horner’s etc. MYASTHENIA GRAVIS
Tx: surgical except for myastenia gravis

Question 18

Blepharitis

Answer 18

Eti: inflammation of eyelid, staph most common
S/sx: crusty debris at the base of the lashes, erythema at the lid margins
Tx: lid scrubs with baby shampoo, topical abx

Question 19

Congenital cataract

Answer 19

Eti: chromosomal syndrome
S/sx; leukocoria, poor fixation, strabismus, nystagmus, no red reflex
Tx: surgical removal

Question 20

Keratitis

Answer 20

Eti: bacterial, HSV, fungal,amoebic
S/sx: hypopyon, pain, reduced vision, photophobia, corneal ulcers…
Tx: topical abx

Question 21

Uveitis

Answer 21

Eti: idiopathic, immunologic (Ank, psoriasis, IBD, SLE) emds, infections
s/sx: hypopyon, unilateral pain, redness, photophobia, visual loss, iris nodules, abnormal funoscopic exam

Question 22

Amblyopia

Answer 22

Lazy eye
Eti: unilateral or bilateral reduction in vision due to strabsimus, refraction errors and or visual deprivation
- Can only occur during the period of visual development
Tx; the early treatment the better, address underlying cause

Question 23

strabismus

Answer 23

Misalignment of the eyes
-Eso, exo, hyper or hypotropia that is consistent or intermittent
Tx: early treatment increase chance of improving visual acuity

Question 24

Cholesteatoma

Answer 24

Eti: Hypertrophy of inner ear from chronic infections or congenital
S/sx: Greasy looking mass or pearly white mass in retraction pocket of perforation, persistent, recurrent, foul-smelling drainage.
Dx: CT
Tx: surgical

Question 25

Acute otitis media

Answer 25

Eti: Infection of the inner ear: S. pneumoniae, H flu, M. catarrhalis, S. pyogenes, RSV, influenza, adenovirus…
Sx: ear tenderness, redness, discharge, Bulging TM, middle ear effusion
Tx: Amoxicillin
Comp: mastoiditis

Question 26

Serous otitis media

Answer 26

Eti: Otitis media for 2-4 weeks without signs of infection.
Sx: Bubbles, poor hearing in affected ear
Dx: otoscope
Tx: Spontaneous resolution w/o abx in 3 months

Question 27

Otitis externa

Answer 27

Eti: Cellulitis of soft tissue of ear canal: MC: staph a., P aeruginosa
Sx: rapid onset or ear canal inflam, tenderness, edema, erythema, otorrhea
Tx: fluoroquinolone eardrops, oral abx if systemic sx

Question 28

Mastoiditis

Answer 28

Eti: spread of middle ear infection
Sx: postauricular pain, fever, erythema, ear protrusion
Dx: clinical, CT
Tx: IV vancomycin
Comp: meningitis

Question 29

TM perforation

Answer 29

Eti: infection
Sx: acute infection becomes chronic with ongoing purulent ear drainage
Dx; culture drainage

Question 30

Hearing loss

Answer 30

Eti: conductive vs. sensorineural
Tx: depends on eti,

Question 31

Cerumen impaction

Answer 31

Sx: pruritis, pain, hearing loss
Dx: otoscope
Tx: ear curette and 1% sodium docusate solution
Pt ed: don’t use q-tips

Question 32

Tympanometry

Answer 32

Measures TM compliance in graphical form to evaluate for pathology
Not reliable in younger than 6 months

Question 33

Acoustic reflectometry

Answer 33

Measures the spectral gradient of the TM w/o airtight seal. Not currently comerically availble

Question 34

Tympanocentesis

Answer 34

Aspirating the middle ear fluid

Question 35

Tympanostomy

Answer 35

Ear tubs, for recurrent AOM

Question 36

Audiometry

Answer 36

Subjective eval of hearing