Pediatrics Flashcards
Border between the primary/secondary palate?
incisive foramen
Arterial supply of the hard palate?
greater palatine artery (basically everything else is soft palate)
Lack of fusion between which structures creates clefting of the primary palate? Secondary palate?
anterior nasal prominences + medial maxillary prominences; maxillary prominence/contralateral maxillary prominence
Is cleft palate or cleft lip more likely to be associated with a syndrome? Name 2-3 syndromes a/w CP.
CP more likely to be associated with a syndrome. CP - CHARGE, van der woede, Down
Name 2-3 syndromes a/w CL.
DiGeorge, Stickler, OAV
2/3 cleft lips are (right/left) and (male/female). 2/3 cleft palates are (male/female).
2/3 CL are left and male. 2/3 CP are female
Involvement of what structure(s) differentiates incomplete from complete cleft lip? cleft palate?
Complete CL involves the nasal floor/sill, incomplete does not. Complete CP involves primary palate, incomplete CP does not.
Label the following as infancy (<1 year), childhood (1-11 years), adolescence (12-18 years) with respect to timing for multidisciplinary cleft care surgical planning: cleft lip repair, orthognathic surgery, ortho-palatal expanders, palatoplasty, primary rhinoplasty, intermediate rhinoplasty, final rhinoplasty, VPI surgery
infancy: CL repair, primary rhinoplasty, palatoplasty
childhood: ortho-palatal expanders, intermediate rhinoplasty, VPI surgery
adolescence: orthognathic surgery, final rhinoplasty
What is the rule of 10s and what is it in reference to?
timing for CL repair - 10 weeks, >10 lbs, >10hgb
Name two palatoplasty techniques that lengthen the soft palate
Furlow palatoplasty, V-Y advancement
Initial treatment for VPI? When should surgery be considered? Nonsurgical option?
Speech therapy. Failure for 6-12 month trial of speech therapy. Non surgical option - dental obturator
Choanal atresia: more common in females or males? right or left?
females, right
Name 2-3 syndromes associated with choanal atresia
CHARGE. Also Apert, Crouzon, Treacher Collins.
At what age does unilateral choanal atresia commonly present? bilateral?
5-6 months for unilateral; at birth for bilateral.
What is paradoxical cyanosis and what diagnosis does it imply?
paradoxical cyanosis is cyanosis that improves with tachypneic breathing, suggests bilateral choanal atresia.
Nasopharyngeal or cervical mass with internal calcifications on plain films - pathognomonic for what diagnosis?
Teratoma
Rathke’s Pouch Cyst vs Thornwald’s Cyst: a) location b) embryological origin
a) rathke in the sella turcica; thornwald’s in the nasopharynx (but submucosal. b) rathke from rathke’s pouch which becomes anterior pituitary. Thornwald’s is remnant of notochord
What is a tumor of rathke’s pouch called?
craniopharyngioma
In which type of pediatric CRS is systemic steroids 1mg/kg starting dose supported by level Ib evidence?
CRS with nasal polyps.
Name 3-5 indications for sinus surgery in the pediatric population.
orbital or intracranial complications, mucocele, fungus ball/fungal sinusitis
Congenital vs infantile hemangioma: a) time of presentation? b) GLUT1 positive/negative?
congenital presents at birth and is GLUT1 negative. infantile presents after birth and is GLUT1+.
Infantile hemangioma: a) clinical exam characteristics? b) 3 phases of growth? c) 3 distributions?
a) firm — compressible suggests vascular malformation. b) proliferative - involuting - involuted (50% by 5 years, 70% by 7 years, 90% by 9 years). c) unifocal, multifocal, segmental (often trigeminal).
infantile hemangioma: significance of beard/V3 distribution?
needs an endoscopy to rule out subglottic hemangioma
what is PHACES syndrome?
posterior cranial fossa, hemangioma, intracranial arteries, cardiac, eye, sternum
stridor in a patient with cutaneous hemangioma?
needs a DL/endoscopy to eval for subglottic hemangioma
Management of hemangioma: 2 examples of when intervention is indicated?
symptomatic or cosmetically sensitive areas.
What is kasabach merritt phenomenon?
consumptive coagulopathy
2-3 potential indications for laser in management of hemangioma? what type of laser?
resurfacing, telangiectasias after regression, ulcerated lesions. Nd-YAG for deeper tissue. pulsed dye laser for superficial.
when is laser contraindicated in subglottic hemangioma?
contraindicated in circumferential lesions.
Name 3 medical treatments for hemangioma.
propranolol, steroid, chemo
Slow Flow Vascular Malformations: a) 3 types? b) Which type is Sturge Weber? Which type is a telangiectasia?
a) capillary, venous, lymphatic. b) both are capillary.
most common site in the body for lymphatic malformations?
head and neck
2 types of lymphatic malformations, what study used to tell the difference, and optimal management strategy for each?
macrocystic vs microcystic; ultrasound; macrocystic=sclerotherapy, microcystic = surgery.
What is OK-432?
OK-432 is inactivated strep pyogenes
what is first-line therapy for skin & mucosal venous malformations? when should pulsed dye laser be considered?
Nd-YAG or KTP first line for skin & mucosal VENOUS. Pulsed dye laser considered in capillary
Fast Flow Vascular Malformations: a) 2 types? b) etiology of each and differences in vascular structure?
a) AVM vs AVF b) AVM is nidus of abnormal capillary bed; AVF is posttraumatic and involves a single arteriovenous connection.
Options for management in AVM?
multidisciplinary surgery and may involve preop embolization and a flap, high recurrence rate. Usually operate if very small and resectable or so large as to be life threatening.
Options for management in AVF?
AVF surgery also with embo followed by resection if highly visible; can do embo alone if deep lesion
