ENT

Question 1

Symptoms and exam of a peritonsillar abscess

Answer 1

Severe sore throat
Fever
Trismus*
Hot potato voice
Dysphagia or odynophagia
Lymphadenopathy
Asymmetric tonsillar bulge with displacement of the uvula

Question 2

Treatment of a peritonsillar abscess

Answer 2

Clinical dx, can use CT with contrast if debating cellulitis vs abscess
Surgical drainage + abx
Tonsillectomy if failure to improve within 24 hrs of abx, hx of recurrent PTAs or recurrent tonsillitis, or complications

Question 3

Symptoms of a retropharyngeal abscess

Answer 3

Fever, irritability, decreased PO, dysphagia
Drooling*, trismus can occur
Neck stiffness/torticollis, refusal to move the neck, often held flexed w refusal to extend
May have sore throat, muffled voice, stridor, resp distress

Question 4

Diagnosis and treatment of a RPA

Answer 4

Low suspcision = can do lateral neck XR
CT with contrast is preferred
Tx with IV abx (CTX + clinda for anaerobes, vanco if not responding)
Drainage if resp distress or failure to improve with IV

Question 5

Complications from RPA

Answer 5

Upper airway obstruction
Rupture leading to aspiration pneumonia
Extension to the mediastinum
Thrombophlebitis of the internal jugular vein
Erosion of the carotid sheath

Question 6

Leimerre disease

Answer 6

Infection from the oropharynx extends to cause septic thrombophlebitis of the internal jugular vein and embolic abscesses in the lungs (Fusibacterium necrophorum)
Prev healthy adolescent with recent pharyngitis, acutely ill with fever, hypoxia, tachypnea, and resp distress
CT shows cavitary nodules and pleural effusion
TX with IV abx (penicillin) +/- surgical drainage

Question 7

Indications for tonsillectomy

Answer 7

Recurrent pharyngitis: 7 episodes in 1 year, 5 in each of the past 2 years, or 3 in each of the past 3 years
Marked/severe adenotonsillar hypertrophy
Severe sleep apnea

Question 8

Indications for adenoidectomy

Answer 8

Persistent mouth breathing
Repeated or chronic otitis media with effusion
Hyponasal speech
Adenoid facies
Persistent or recurrent nasopharyngitis related to hypertrophy

Question 9

Differences between bacterial tracheitis and epiglottitis

Answer 9

Bacterial trach: can lie flat, no drooling, no dysphagia

Question 10

Symptoms of bacteial tracheitis

Answer 10

Usually follows a viral URTI
Ill appearing with high fever, brassy productive cough, resp distress
Stridor does not respond to usual treatment

Question 11

Management of bacterial tracheitis

Answer 11

Clinical diagnosis
Intubation/trach is frequently required
Abx (CTX and vanco)

Question 12

Symptoms of epiglottitis

Answer 12

Fever, sore throat, drooling, stridor
Ill appearing
Tripod position with chin extended

Question 13

Management of epiglottitis

Answer 13

Keep child calm, no tongue depressors d/t risk of airway spasm
Consult ENT or anesthesia for intubation
Abx (CTX and vanco)

Question 14

Laryngomalacia symptoms

Answer 14

Inspiratory stridor
Worse with agitation, feeds, and lying supine
Exacerbated by viral resp infections, dysphagia, and GERD

Question 15

Where is the obstruction with
1. Inspiratory
2. Expiratory
3. Biphasic
stridor?

Answer 15

1. Extrathoracic (above cords)
2. Intrathoracic (below cords)
3. Fixed obstruction

Question 16

Difference between laryngomalacia and tracheomalacia?

Answer 16

Laryngo = inspiratory stridor
Tracheo = expiratory stridor

Question 17

What other issue is associated with a vascular ring?

Answer 17

Stridor plus feeding issues
Causes esophageal compression

Question 18

Symptoms of vocal cord paralysis

Answer 18

Absent or weak cry
Risk for aspiration (if unilateral, cord open)
Subdued or hoarse raspy voice
Bilateral tends to have more resp distress and stridor (closed cords)

Question 19

Where is the obstruction (plus example) if the flow volume loop is truncated on the
1. Bottom
2. Top
3. Both sides

Answer 19

1. Inspiratory (ex: vocal cord dysfunction)
2. Expiratory (asthma)
3. Fixed (hemangioma)

Question 20

Treatment for tube otorrhea

Answer 20

Topical quinolone drops
Do not need PO antibiotics unless systemic symptoms, cannot tolerate PO, or failed topical

Question 21

Which children with AOM can you use watchful waiting approach for?

Answer 21

Mild or moderately bulging TM
Mildly ill
Alert
Fever <39
Responding to antipyretics
Mild ear pain

Question 22

Which children with AOM can you NOT use watchful waiting approach for and must treat with abx

Answer 22

Bulging TM
Fever > 39
Moderately to severely ill
Severe otalgia
Significantly ill x48 hours
Perforated TM with purulent drainage

Question 23

Treatment choices for AOM

Answer 23

Amoxicillin
Use amox clav if tx with amox in past 30 days OR if amox fails as it could be due to H flu or Moraxella

Question 24

How long to treat for AOM

Answer 24

2 years or older = 5 days
< 2 years, recurrent AOM, perforated AOM, failure of initial therapy = 10 days

Question 25

Symptoms of sinusitis

Answer 25

Nasal congestion, rhinorrhea, daytime cough for 10+ days Temp 39+ Purulent nasal discharge for 3+ days Recurrence after initial improvement or new symptoms

Question 26

Treatment for sinusitis

Answer 26

Amox +/- clav for 10-14 days

Question 27

Symptoms of mumps

Answer 27

Prodrome for 1-2 days with fever, headache, vomiting and ache Then develop parotitis - often unilateral but can spread to bilateral Ear is pushed up and out

Question 28

2 most common complications from mumps

Answer 28

Meningoencephalitis Orchitis

Question 29

Thyroglossal duct cyst vs branchial cleft cyst vs dermoid cyst

Answer 29

TDC: midline, moves with swallowing and tongue protrusion, often appears after viral URTI BCC: lateral, usually presents infected DC: midline, does NOT move with swallowing All require surgical excision

Question 30

Which symptoms qualify a child for neb epi for croup

Answer 30

Moderate to severe croup Stridor at rest, moderate retractions, more severe sxA

Question 31

ABCDs risk factors for hearing loss

Answer 31

Affected family member Bilirubin Congenital TORCH infection Defect of the ears, nose, throat Small at birth (<1500 g), low APGARs, NICU stay

Question 32

Ranula

Answer 32

Cyst associated with salivary gland in the sublingual area Large, soft, painless, mucus containing Tx with surgical excision

Question 33

Mucocele

Answer 33

Salivary gland lesion most common on lower lip Appears like fluid filled vesicle or fluctuant nodule Tx with surgical excision

Question 34

Development of the 1. Ethmoidal 2. Maxillary 3. Sphenoid 4. Frontal Sinuses

Answer 34

1. Present and pneumatized at birth 2. Present at birth, pneumatized by 4 years 3. Present by 5 years 4. Begin development at 7-8 years, completed in adolescence

Question 35

When should children first see the dentist?

Answer 35

Within 6 months of first tooth eruption or no later than 12 months of age

Question 36

Most common cause of nasal polyposis

Answer 36

CF

Question 37

Treatment for nasal polyps

Answer 37

Intranasal steroid sprays Decongestants for symptoms (but will not shrink the polyps) Surgical removal for complete obstruction, uncontrolled rhinorrhea, or deformity of the nose

Question 38

Perichondritis symptoms and treatment

Answer 38

Infection of skin and perichondrium of the auricular cartilage Pain, swelling, erythema, +/- purulent discharge Lobe is classically spared Treat with abx that cover pseudomonas! Surgery may be needed for abscess drainage

Question 39

Benign vertigo of childhood symptoms and treatment

Answer 39

Common migraine equivalent Brief episodes of vertigo, postural imbalances, nystagmus, may have diaphoresis, N/V Normal EEG and MRI Tx: diphenhydramine for cluster of attacks, preventative therapy with cyproheptadine may be rarely used