Pediatric Otolaryngology Flashcards
Nose/Nasopharynx pathology differential diagnoses (vitamin C)?
Inflammatory: allergic rhinitis, rhinitis of infancy
Infectious: viral rhinitis, bacterial rhinitis (diptheria, pertussis, chlamydia, syphilis)
Idiopathic: adenoid hypertrophy
Trauma: septal deviation, septal hematoma, nasal bone fracture, nasoethmoid fracture, nasal foreign body
Autoimmune: Wegener granulomatosis, systemic lupus erythematosus, sarcoid, pemphigus
Neoplastic: nasopharyngeal teratoma, juvenile nasopharyngeal angiofibroma, rhabdomyosarcoma, lymphoma
Congenital: choanal atresia/stenosis, pyriform aperture stenosis, nasolacrimal duct obstruction/cyst, encephalocele, glioma, dermoid, cleft lip nasal deformity, Tornwaldt disease, immotile cilia syndrome/primary ciliary dyskinesia
Paranasal sinus pathology differential diagnoses (vitamin C)?
Infectious: acute rhinosinusitis, recurrent acute rhinosinusitis, chronic rhinosinusitis, complicated rhinosinusitis
Idiopathic: antrochoanal polyps
Trauma: orbital floor fracture
Neoplastic: fibrous dysplasia
Congenital: cystic fibrosis/nasal polyposis
Oral cavity/oropharynx pathology differential diagnoses (vitamin C)?
Trauma: penetrating trauma
Infectious: tonsillitis, peritonsillar abscess, tonsillar hypertrophy, retropharyngeal abscess, parapharyngeal abscess
Neoplastic: rhabdomyosarcoma, lymphoma, squamous cell carcinoma, epulis, epignathus
Congenital: ankyloglossia, cleft lip/palate, ranula, lingual thyroid, midline rhomboid glossitis, branchial cleft anomalies, glossoptosis (often syndromic), macroglossia
Larynx/subglottis pathology differential diagnoses (vitamin C)?
Infectious: laryngotracheobronchitis/croup, epiglottitis, recurrent respiratory papillomatosis,
Idiopathic: vocal cord dysfunction, subglottic stenosis, paroxysmal vocal fold dysfunction
Iatrogenic: vocal cord dysfunction, subglottic stenosis, intubation injury
Neoplasm: subglottic hemangioma, granular cell tumor, neurofibroma, malignant laryngeal tumors
Congenital: laryngomalacia, vocal cord dysfunction, subglottic stenosis, laryngeal cleft, vallecular cyst
Tracheobronchial tree pathology differential diagnoses (vitamin C)?
Infectious: allergic bronchopulmonary aspergillosis, tuberculosis
Trauma: foreign body aspiration
Congenital: tracheomalacia, tracheoesophageal fistula, tracheal stenosis
Esophagus pathology differential diagnoses (vitamin C)?
Inflammatory: Stevens-Johnson syndrome, dermatomyositis
Idiopathic: GERD
Traumatic: foreign body ingestion, caustic ingestion
Neoplastic: rare
Congenital: tracheoesophageal fistula, esophageal stenosis, achalasia
Outer ear pathology differential diagnoses (vitamin C)?
Traumatic: auricular hematoma
Congenital: preauricular pit, preauricular tag, microtia, aural atresia, prominent ear deformity
Middle ear pathology differential diagnoses (vitamin C)?
Vascular: high jugular bulb, aberrant carotid artery
Infectious: acute otitis media
Traumatic: temporal bone fractures, impalement of middle ear
Neoplastic – benign: glomus tumors, histiocytosis, dermoid, adenomatous tumor
Neoplastic – malignant: rhabdomyosarcoma, adenocarcinoma, leukemia, Ewing sarcoma, chondrosarcoma, fibrosarcoma, endodermal sinus
Congenital: congenital cholesteatoma, congenital footplate fixation, juvenile otosclerosis
Inner ear pathology differential diagnoses (vitamin C)?
Infectious: toxoplasmosis, syphilis, rubella, CMV, HSV, meningitis, mumps
Toxins: cisplatin, carboplatin, furosemide, aminoglycoside
Trauma: noise, temporal bone fracture
Congenital – autosomal recessive: connexin mutation GJB2, Usher syndrome, Pendred syndrome, Jervell and Lange-Nielsen, Refsum’s hearing loss and retinitis pigmentosa
Congenital – autosomal dominant: branchio-oto-renal, Stickler, Waardenburg, neurofibromatosis, AD nonsyndromic
Congenital – X-linked recessive: Alport syndrome, DFN1
Congenital – mitochondrial
Head and neck pathology differential diagnoses (vitamin C)?
Vascular: hemangioma, vascular malformations,
Infectious: cervical lymphadenitis (cat scratch, atypical mycobacteria, Kawasaki disease)
Traumatic: congenital torticollis/fibromatosis colli, traumatic arteriovenous fistulas
Neoplastic: rhabdomyosarcoma, Hodgkin lymphoma, non-Hodgkin lymphoma, Burkitt lymphoma, histiocytoses (eosinophilic granuloma, Hand-Christian-Schuller disease, Letterer-Siwe disease)
Congenital: branchial cleft remnants, thyroglossal duct cyst, dermoid
Facial nerve palsy differential diagnosis (vitamin C)?
Infectious: otomastoiditis, herpes zoster oticus, Bell palsy
Idiopathic: temporal bone pathology
Traumatic: assisted forcep vaginal delivery, difficult labor/delivery
Congenital: congenital lower lip palsy, Mobius syndrome, CHARGE syndrome, myotonic dystrophy
Salivary gland disease differential diagnosis (vitamin C)?
Vascular: hemangioma
Infectious: lymphadenitis, recurrent parotitis of childhood
Autoimmune: sarcoidosis
Neoplastic: pleomorphic adenoma, mucoepidermoid carcinoma, acinar cell carcinoma, rare high grade malignancies
Congenital: cystic fibrosis
Most common etiology of tonsillitis?
Viral
Most common bacterial pathogen of tonsillitis?
Group A beta-hemolytic streptococcus
Possible complications of group A strep tonsillitis?
Rheumatic fever, acute poststreptococcal glomerulonephritis
Signs/symptoms of peritonsillar abscess?
Odynophagia, fever, unilateral palatal edema/fullness, asymmetric tonsils, deviation of uvula to contralateral side, trismus
Signs/symptoms and associated symptoms of tonsillar hypertrophy?
Airway (usually manifesting as obstructed sleep) difficulties, feeding difficulties; associated: excessive daytime somnolence, short nap latency, enuresis, failure to thrive, behavioral disturbance, poor school performance
Indications for tonsillectomy?
> 7/5/3 episodes tonsillitis per 1/2/3 years, persistent halitosis/chronic tonsillitis, recurrent PTA, acute PTA, asymmetric tonsils, tonsillar hypertrophy in immunocompromised children, OSA, malocclusion, impaired facial growth, chronic/recurrent tonsillitis due to strep carrier state
Adenotonsillectomy complications?
Bleeding (0.1-3%), aspiration PNA, VPI, nasopharyngeal stenosis, torticollis, carotid artery injury, death, airway obstruction
Retropharyngeal space occurs between which fascial planes?
AP: visceral/buccopharyngeal fascia, alar fascia (anterior to prevertebral fascia)
Lateral: carotid sheath
Craniocaudal: skull base, superior mediastinum
Signs/symptoms retropharyngeal abscess?
High fever, progressive sialorrhea, torticollis, anorexia/dysphagia, airway obstruction, edema/mass posterior pharyngeal wall
Diagnosis of retropharyngeal abscess?
Lateral neck film: prevertebral soft tissue thickening, possible air-fluid level
Neck CT w/ contrast: to differentiate cellulitis from abscess
Treatment of retropharyngeal abscess?
Hydration
IV antibiotics
Surgical drainage
Differences in patients with RP versus PP abscesses?
PP abscess patients usually older, worse trismus
Signs/symptoms laryngeal pathology?
Inspiratory (supraglottic) stridor Biphasic (glottic) stridor Dysphonia Feeding difficulties/aspiration Tachypnea Tachycardia Use of accessory respiratory muscles
Signs/symptoms subglottic pathology?
Biphasic stridor
Croupy cough
Feeding difficulties
Most common cause of stridor in infants?
Laryngomalacia
Clinical manifestations of laryngomalacia?
Inspiratory stridor within first 6 weeks of life
Variable stridor, usually resolves during crying
Severe: severe airway compromise, feeding difficulties, failure to thrive
Natural history of laryngomalacia?
90% patients experience spontaneous resolution of symptoms by 12 months of age
