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Flashcards in Paeds ENT Deck (455):
1

What % of children with choanal atresia have other congenital anomalies

0.2

2

What % of theses patients require tracheotomy

0.9

3

How many serotypes of pneumococcus are responsible for 83°/o of invasive disease in children

7

4

How much mobilization can be achieved with peritracheal mobilization

(dissection of the annular ligaments)? Up to 1.5 cm.

5

What is the incidence of carcinoma arising in a TGDC

6

What % of these require surgical intervention

7

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.

8

What is the incidence of hemorrhage after adenotonsillectomy

0.1 - 8.1%.

9

What is the recurrence rate following the Sistrunk procedure

1 - 4%.

10

What is the incidence of submucous cleft palate

1 in 1200.

11

What % of cases of choana! atresia involve only a mucosal diaphragm or membrane

1 O%.

12

In what % of the population does the carotid artery lie deep to the floor of the tonsillar fossa

1%.

13

What is the incidence of clinically significant VPI after adenoidectomy?

1:1500-3000.

14

What percent of patients with Down syndrome have an unstable transverse ligament of the atlas?

10%.

15

What % of patients with Down syndrome have an unstable transverse ligament of the atlas

10%.

16

What % of infants have a hemangioma by age 1

12%.

17

How should contacts be treated

14 days of erythromycin.

18

What is the recurrence rate following the Sistrunk procedure?

1-4%.

19

What is the incidence of synchronous airway lesions in children with laryngomalacia

18- 20%.

20

When should aspirin be discontinued prior to surgery? Naproxen? All other NSAIDS

2 weeks, 4 days, 3 days, respectively.

21

When should aspirin, naproxen, and all other NSAIDs be discontinued prior to surgery?

2 weeks, 4 days, and 3 days, respectively.

22

What proportion of children will have had at least one episode of OM by age 1

2/3.

23

Birth trauma accounts for what % of vocal cord paralysis in children

20% (associated with forceps use and C-section).

24

What % of cases of congenital vocal cord paralysis are bilateral

20%.

25

What is the recovery rate for idiopathic vocal cord paralysis in children

20%.

26

What % of TGDC contains thyroid tissue

20%.

27

What % of teratomas become malignant

20%.

28

What is the reduction in the need for myringotomy tubes in children who receive the heptavalent pneumococcal vaccine

20.1 %.

29

What is the earliest gestational age that complete glottic atresia could be detected on ultrasound

22 weeks.

30

What is the incidence of hemangiomas in premature infants weighing less than 1000 grams

23%.

31

What % of middle ear fluid cultures are negative for bacteria

25 - 30%.

32

What % of neonates less than 5 days old have a functioning cough reflex

25%.

33

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.

34

How much trachea can be resected without using a release technique?

3 cm (possibly 4 em with the patient's head in extreme flexion).

35

How much trachea can be resected without using a release technique

3 em (possibly 4 em with the patient's head in extreme flexion).

36

At what age gestation can an infant suckle feed

34 weeks.

37

What is the mortality in children with congenital tracheal stenosis treated conservatively with tracheotomy and intensive respiratory care

35%.

38

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.

39

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%.

40

What is the recurrence rate following excision of a TGDC without removal of the midportion of the hyoid and the ductal remnant

38%.

41

Which branchial pouch is the thymus derived from

3rd •

42

What % of premature infants develops subglottic stenosis (SGS)

4%.

43

What is the incidence of laryngeal papillomas in children

4.3 per I 00,000 children per year.

44

What is the mean duration of otitis media with effusion after AOM

40 days.

45

When do serum levels peak after administration of IV desmopressin

45 - 60 minutes.

46

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.

47

When do serum levels peak after administration of IV desmopressin?

45-60 minutes.

48

Slide tracheoplasty increases the cross-sectional airway area by how much

4-fold.

49

What % of acute tonsillar infections are bacterial

5 - 30°/o.

50

What % of Caucasians carry the gene defect for cystic fibrosis

5%.

51

What % of patients with a subglottic hemangioma have an associated cutaneous hemangioma

50%.

52

What age group has the highest incidence of OM

6 - 18 months.

53

What is the sensitivity and specificity of inspiratory/expiratory and lateral decubitus films for foreign body aspiration

67°/o sensitive, 67% specific.

54

What is the sensitivity of an upper Gl for detecting aspiration

69%.

55

What % of hemangiomas regress by age 7

70%.

56

Between what ages do hemangiomas grow most rapidly

8 to I 8 months.

57

What is the sensitivity of this test

80% (less if already on antibiotics).

58

What is the overall decannulation rate after single-stage L TR

83% (Cotton).

59

What is the sensitivity and specificity of this test

85% sensitivity; 80% specificity.

60

What % of infants with G ERD will spontaneously resolve by 18 months

85%.

61

What is the reduction in total invasive pneumococcal disease in children who receive one or more doses of the heptavalent pneumococcal vaccine

89.1 %.

62

What is the sensitivity of the 24 hour pH probe for GERD.

92 - 94%

63

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.

64

What has been shown to accelerate the return to a normal diet after tonsillectomy?

A single intraoperative dose of steroids.

65

What has been shown to accelerate the return to a normal diet after tonsillectomy

A single intraoperative dose of steroids.

66

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.

67

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.

68

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.

69

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.

70

What is the most common anomaly associated with congenital tracheal stenosis

Aberrant left pulmonary artery (pulmonary artery sling complex).

71

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.

72

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.

73

What are the contraindications to single-stage LTR?

Abnormal pulmonary function, coexistent medical problems that require a tracheostomy, and severe grade 4 stenosis.

74

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.

75

What prevents air from escaping through the glottis during the cough reflex

Adduction and turning down of the false vocal cords (FVC).

76

What the clinical features of cervical tuberculosis

Affects all ages, bilateral supraclavicular lymph nodes, positive PPD, positive CXR, respond to curretage and macrolide antibiotics.

77

What group of patients is at increased risk for hemorrhage

Age >20 who have surgery during the winter.

78

What group of patients is at increased risk for hemorrhage?

Age >20 who have surgery during winter.

79

What is the most important factor associated with successful and permanent decannulation after LTR

Age >24 months at the time of L TR.

80

What is the most important factor associated with successful and permanent decannulation after LTR?

Age >24 months at the time of LTR.

81

By what age is the adenoid pad mostly atrophied

Age 7 or 8.

82

In what age groups is rhabdomyosarcoma most common

Ages 2 - 5 and 15 - 19.

83

In what age group is tonsillitis from group A streptococci most common

Ages 6 - 12.

84

What is the mechanism of resistance for S. pneumoniae

Altered penicillin-binding proteins.

85

What is the most common neurologic condition causing vocal cord paralysis in children

Amold-Chiari malformation.

86

What finding on CT scan is pathognomonic for JNA

Anterior bowing of the posterior wall of the maxillary antrum (Holman-Miller sign).

87

What is the most common complication after repeated laser treatments for recurrent respiratory papillomatosis (RRP)?

Anterior glottic webs.

88

What immunoglobulin is produced by the tonsils

Antigen-specific secretory lgA.

89

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.

90

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.

91

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.

92

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

93

What must be done prior to single-stage laryngotracheoplasty

Assess for adequate vocal cord mobility and treat G ERD.

94

What must be done prior to single-stage LTR?

Assess for adequate vocal cord mobility and treat GERD.

95

What is the most common diagnosis given inappropriately to a child with an airway fureign body

Asthma.

96

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

97

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.

98

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

99

Where do most laryngeal webs occur

At the anterior glottis (75%).

100

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.

101

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.

102

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.

103

Where are most 2nd branchial cleft cysts located

Below the angle of the mandible and anterior to the sternocleidomastoid muscle.

104

What is the primary advantage of early LTR?

Better speech acquisition.

105

What is the primary advantage of early laryngotracheal reconstruction

Better speech acquisition.

106

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.

107

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.

108

What are the most common complications of pharyngeal flap surgery?

Bleeding, airway obstruction, and obstructive sleep apnea.

109

What are the most common complications of pharyngeal flap surgery

Bleeding, airway obstruction, obstructive sleep apnea.

110

What is the mechanism of action of steroids in the treatment of hemangiomas

Block the estradiol- 17 receptor.

111

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).

112

What are the clinical features of arteriovenous malformations

Brightly erythematous lesions of the skin with an associated thrill and bruit.

113

What diseases may present with hemoptysis in children

Bronchiectasis, cystic fibrosis, foreign body, pulmonary hemosiderosis, TB.

114

Persistence of what membrane results in choana! atresia

Buccopharyngeal.

115

Which lymphoma accounts for 50°/o of childhood malignancies in equatorial Africa

Burkitt's lymphoma.

116

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.

117

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.

118

What is the 2"d leading cause of death among children ages 1 to 14

Cancer.

119

What are the 4 categories of lymphatic malformations

Capillary, cavernous, cystic (hygroma), and lymphangiohemangioma.

120

What are the 4 main types of vascular malformations

Capillary, venous, lymphatic, and arteriovenous malformations.

121

Which type of vascular malformation is a port wine stain

Capillary.

122

Which of these is most commonly found on the tongue or floor of mouth

Capillary.

123

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).

124

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.

125

What is the most common head and neck manifestation of neuroblastoma

Cervical metastatic disease.

126

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

127

What disease is characterized by a staccato cough

Chlamydia! pneumonia.

128

What adjunctive test should be performed in a female with suspected JNA

Chromosome analysis.

129

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.

130

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.

131

What medical conditions predispose a child to OM

Cleft palate, craniofacial anomalies, congenital or acquired immune deficiencies, ciliary dysfunction, enlarged adenoids, sinusitis, Down syndrome.

132

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.

133

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.

134

What is the most common esophageal foreign body in children

Coins.

135

Which of these is most likely to result in prolonged postoperative dysphagia?

Combined infrahyoid and inferior constrictor release.

136

Which of these is most likely to result in prolonged postoperative dysphagia

Combined infrahyoid and inferior constrictor release.

137

Why are infants more prone to aspiration than adults

Compared to adults, infants have a relatively lax epiglottis, large arytenoids, and wide aryepiglottic folds.

138

What are lathyrogenic agents

Compounds that inhibit collagen cross-linking, such as penicillamine and N-acetyi-L-cysteine.

139

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.

140

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.

141

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.

142

Which of these is more likely to result in rebound growth with discontinuance

Corticosteroids.

143

What is the initial treatment for patients with adenotonsillar hypertrophy and infectious mononucleosis

Corticosteroids.

144

In children 6 to 16 years

Cough-variant asthma (45%), psychogenic (32%), and sinusitis (27°/o).

145

What is the function of aminocaproic acid

Counteracts the high concentration of fibrinolytic enzymes in the oral cavity.

146

What disease is characterized by a seal-like barking cough

Croup.

147

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.

148

What is the most useful study of nontuberculous mycobacterial adenitis of the head and neck region in children

Culture.

149

What is the only clinical sign that is strongly associated with a synchronous airway lesion

Cyanosis.

150

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.

151

Which of these is associated with location in the posterior triangle of the neck

Cystic hygroma.

152

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.

153

How can one differentiate a dermoid cyst from a thyroglossal duct cyst

Dermoid cyst will not elevate with tongue protrusion.

154

What are the 4 types of germ cell tumors

Dermoid cyst, teratoid cyst, teratoma, and epignathi.

155

Which of these are composed only of mesoderm and ectoderm

Dermoid cysts.

156

What factors increase the risk of postintubation tracheal stenosis

Difficult intubation, an overinflated cuff, repeated reintubations, poorly performed tracheostomy.

157

Why is end-to-end tracheal anastomosis rarely used in children?

Difficult to perform in the subglottic region without damaging the vocal cords.

158

Why is end-to-end tracheal anastomosis rarely used in children

Difficult to perform in the subglottic region without damaging the vocal cords.

159

What hormone receptors are present in JNAs

Dihydrotestosterone and testosterone.

160

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.

161

What are the histologic features of venous malformations

Dilated, ectatic vascular channels with a normal endothelial lining and areas of thrombosis.

162

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.

163

What test has the highest yield for diagnosis of vascular rings

Direct laryngoscopy and bronchoscopy.

164

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.

165

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.

166

What is the most common complication of GERD in infants

Distal esophagitis.

167

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.

168

What is the term for the treatment of airway obstruction in children with craniofacial abnormalities where the mandible is gradually elongated

Distraction osteogenesis.

169

What is the etiology of a type 2 first branchial cleft cyst

Duplication error of the ectodermal and mesodermal elements of the EAC.

170

What is the etiology of a type 1 first branchial cleft cyst

Duplication error of the ectodermal elements of the external auditory canal (EAC).

171

What are the indications for surgical treatment of laryngomalacia

Dyspnea at rest or during effort, feeding difticulties and failure to thrive.

172

What organisms are most commonly cultured from this disorder

E. Coli, Klebsiella, Proteus, and Clostridium.

173

What tests confirm the diagnosis of von Willebrand's disease?

Elevated PTT and bleeding time, decreased or absent von Willebrand factor serum levels.

174

What tests confirm the diagnosis of von Willebrand's disease

Elevated PTT and bleeding time, decreased or absent von Willebrand factor serum levels.

175

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.

176

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.

177

What are the 3 main histologic types of rhabdomyosarcoma

Embryonal, alveolar, and pleomorphic.

178

Which is most common in the head and neck

Embryonal.

179

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.

180

What is the most common etiology of posterior glottic stenosis

Endotracheal intubation.

181

What are the treatment options when sleeve resection is contraindicated

Endotracheal prosthesis, tracheostomy with a cannula or a Montgomery T tube.

182

What are the treatment options when sleeve resection contraindicated?

Endotracheal prosthesis, tracheostomy with a cannula, or a Montgomery T tube.

183

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.

184

What are the three laryngeal closure procedures?

Epiglottic flap, glottic closure, and vertical laryngoplasty.

185

What are the 3 laryngeal closure procedures

Epiglottic flap, glottic closure, and vertical laryngoplasty.

186

What is the procedure of choice for reconstruction of the anterior commissure?

Epiglottopexy laryngoplasty.

187

What is the procedure of choice for reconstruction of the anterior commissure

Epiglottopexy laryngoplasty.

188

Which organisms more frequently cause AOM in infants younger than 6 weeks

Escherichia coli, Klebsiella, and Pseudomonas aeruginosa.

189

What is the relationship between laryngomalacia and GERD

Essentially all children with laryngomalacia have GERD.

190

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.

191

What kind of stridor is heard in patients with tracheomalacia

Expiratory.

192

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.

193

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.

194

What structure is most at risk during removal of a 1st branchial arch sinus?

Facial nerve.

195

What is the etiology of a preauricular pit

Failure of fusion between Hillocks of His 1 and 2.

196

What are other signs or complications of GERD in infants

Failure to thrive, vomiting, recurrent aspiration pneumonia, acute life-threatening events.

197

True/False: Division of the cricoid cartilage has been shown to inhibit its further growth.

False.

198

T/F: Airway foreign bodies are more common than esophageal foreign bodies

False.

199

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.

200

What are the potential side effects of interferon alpha-2b

Fever. weight loss, liver enzyme elevation, DIC.

201

What is the test of choice for diagnosing laryngomalacia

Flexible fiberoptic laryngoscopy in the oftice.

202

What test should be performed prior to operating on these children

Flexion and extension lateral neck films

203

What test should be performed prior to operating on these children?

Flexion and extension lateral neck films.

204

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.

205

Slide tracheoplasty increases the cross-sectional airway area by how much?

Fourfold.

206

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.

207

When found in the mandible, how do these lesions appear !radiographically

Have a honeycomb or soap bubble appearance.

208

What condition is seen in adolescent patients with severe, frequently recurring epistaxis and pulmonary arteriovenous malformations

Hereditary hemorrhagic telangiectasia.

209

What medications can be used to treat hemangiomas

High-dose corticosteroids (2 - 3 mg/kg/day) and interferon alpha-2a or 2b.

210

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.

211

How is croup managed

Humidification, dexamethasone and racemic epinephrine.

212

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.

213

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.

214

How do lymphatic malformations appear on MRI

Hypointense on Tl, hyperintense on T2.

215

What are the adverse effects of desmopressin

Hyponatremia , seizures, and tachyphylaxis.

216

What are the adverse effects of desmopressin?

Hyponatremia, seizures, and tachyphylaxis.

217

What is the incidence of clinically significant VPI after adenoidectomy

I : I 5 00 - 3 000.

218

What 'Yo of infants with laryngomalacia require surgical treatment

I O%.

219

What % of children with an episode of AOM will still have an effusion present 3 months later

I O%.

220

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.

221

What is the most likely cause of stridor after ligation of a patent ductus arteriosus?

Iatrogenic injury of the left recurrent laryngeal nerve.

222

What is the most likely cause of stridor after ligation of a patent ductus arteriosus

Iatrogenic injury of the left recurrent laryngeal nerve.

223

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.

224

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.

225

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.

226

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.

227

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.

228

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.

229

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.

230

Decreased levels of which immunoglobulin are common in children who are prone to otitis media

IgG2.

231

What is the stage of a JNA eroding the skull base with minimal intracranial extension

IliA.

232

What finding on pneumatic otoscopy is most specific for OM

Immobility of the tympanic membrane.

233

When is hilar release contraindicated?

In patients with poor pulmonary reserve.

234

When is hilar release contraindicated

In patients with poor pulmonary reserve.

235

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.

236

Where are most type 1 cysts located

In the periauricular region, lateral to VII, connecting the skin to the EAC.

237

What effects do multiple laser procedures have on the airway?

Increased scarring, ossification of the cricoid cartilage.

238

What effects do multiple laser procedures have on the airway

Increased scarring, ossification of the cricoid cartilage.

239

In which countries does this tumor most often occur

India and Egypt.

240

What effect do estrogens have on nasal mucosa

Induce metaplasia of nasal mucosa from ciliated columnar epithelium to stratified keratinizing squamous epithelium.

241

What are the typical presenting features of ankyloglossia

Infant has difficulty latching-on during breast feeding and mother experiences prolonged nipple pain.

242

Vaccination against what virus had been shown to decrease the incidence of acute otitis media in infants and children

Influenza.

243

What are the mechanisms of action of interferon alpha-2b

Inhibit epithelial cell migration and proliferation and inhibit growth factor.

244

What is the most common vascular ring

Innominate artery compression.

245

What is stertor

Inspiratory low-pitched sound resulting from turbulent airflow through the nasal cavity and nasopharynx.

246

Where does the main blood supply to these tumors most often come from

Internal maxillary artery or the ascending pharyngeal artery.

247

What are the 3 types of laryngoceles

Internal, external, and combined.

248

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.

249

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.

250

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

251

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.

252

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.

253

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.

254

Where are most type 2 cysts located

Just inferior or posterior to the angle of the mandible with variable relationship to VII.

255

After benign lymphoid hyperplasia, what is the most common benign nasopharyngeal tumor

Juvenile nasopharyngeal angiofibroma (JNA).

256

What syndrome is characterized by profound thrombocytopenia associated with a hemangioma

Kasabach-Merritt syndrome.

257

Which of these is associated with episodic bleeding

L ymphangiohemangioma.

258

Which of these is more likely to rapidly enlarge during a t Rl

L ymphangiohemangioma.

259

Stridor that increases in intensity with crying, agitation, or straining is characteristic of what disorders

Laryngomalacia and subglottic hemangioma.

260

What are the 3 most common causes of stridor in children

Laryngomalacia, vocal cord paralysis, and congenital subglottic stenosis.

261

Using the system of Session et al, what is the stage of a JNA involving the posterior nares and the sphenoid sinus

lB.

262

Which lesions respond best to pulsed dye laser

Lesions less than 20 cm2 in children

263

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.

264

What is the advantage of using ibuprofen over acetaminophen with codeine for postoperative tonsillectomy pain

Less postoperative nausea.

265

Which chromosome carries the gene responsible for cystic fibrosis

Long arm of chromosome 7.

266

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.

267

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.

268

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.

269

Of tracheoesophageal diversion (TED) and laryngotracheal separation (LTS), which is technically easier?

LTS.

270

Of tracheoesophageal diversion (TED) and laryngotracheal separation (LTS), which is preferred if the patient has or has had a tracheostomy?

LTS.

271

Of TED and L TS, which is technically easier

LTS.

272

Which is preferred if the patient has or has had a tracheostomy

LTS.

273

What is Gerlach's tonsil

Lymphoid tissue arising from the fossa of RosenmUller that extends into the eustachian tube.

274

What is the most common head and neck tumor of children

Lymphoma.

275

What is laryngospasm

Maladaptive and exaggerated glottic closure reflex.

276

What prenatal condition is associated with a higher incidence of cervical teratomas

Maternal polyhydramnios.

277

What is the significance of hemoptysis after tracheal sleeve resection?

May portend rupture of the innominate artery.

278

What is the significance of hemoptysis after tracheal sleeve resection

May portend rupture of the innominate artery.

279

What is the best surgical approach to resection of JNAs

Medial maxillectomy via lateral rhinotomy or midface degloving approach.

280

Which lesions are less likely to respond to sclerosis with OK-432 ( Picibanil)

Microcystic, previously operated-on, and those with massive craniofacial involvement.

281

What is the most common presenting complaint of patients with rheumatic fever

Migratory joint pain (75%) that is out of proportion to physical findings.

282

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.

283

What are the indications for antireflux surgery in children

Mild to moderate symptoms that fail medical therapy; severe GERD with life-threatening symptoms.

284

What is the most common valvular problem resulting from rheumatic fever

Mitral valve stenosis.

285

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.

286

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.

287

What is the imaging modality of choice for lymphatic malformations

MRI. CXR should also be performed to rule out mediastinal extension or pleural effusion.

288

What is the treatment for rhabdomyosarcoma

Multimodality; primary chemoradiation followed by surgery for recurrent or residual disease.

289

What are the typical histologic characteristics of lymphatic malformations

Multiple dilated lymphatic channels lined by a single layer of epithelium.

290

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.

291

What are the 2 most common inflammatory salivary diseases of childhood

Mumps parotitis and recurrent parotitis of childhood.

292

What are the most common organisms causing nontuberculous mycobacterium

Mycobacterium avium-intracellulare complex and Mycobacterium scrofulaceum.

293

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).

294

How is atlantoaxial subluxation diagnosed

Neck pain and torticollis with an atlas-dens interval of >4 mm in children and > 3 mm in adults.

295

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).

296

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).

297

What are the precursor cells of neuroblastoma

Neural crest cells.

298

What is the most common solid malignant tumor in infants

Neuroblastoma.

299

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.

300

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.

301

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.

302

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.

303

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.

304

Which muscles constrict the eustachian tube

None.

305

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.

306

What is the leading cause of chronic cervical lymphadenopathy in young children

Nontuberculous mycobacterium or atypical TB.

307

What is the "Waterson sign"

Obliteration of the right radial pulse by compressing the anterior tracheal indentation with the tip of the bronchoscope.

308

What is the most common treatment for hemangiomas

Observation, parental reassurance.

309

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.

310

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.

311

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.

312

Involvement in which area of the head and neck by rhabdomyosarcoma has the best prognosis

Orbit.

313

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.

314

What organisms most frequently cause chronic suppurative OM

P. aeruginosa(most common), S. aureus, Corynebacterium, and Klebsiella.

315

Which muscles form the anterior and posterior tonsillar pillars

Palatoglossus and palatopharyngeus, respectively.

316

What is the most common type of well-differentiated thyroid carcinoma in children

Papillary.

317

What is the most common benign neoplasm of the larynx in children

Papillomas.

318

What is the most common cause of laryngotracheobronchitis (croup) in children

Parainfluenza virus.

319

In children 18 months to 6 years

Paranasal sinus films, endoscopy, and empiric treatment with bronchodilators.

320

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.

321

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.

322

Which patients are at increased risk for atlantoaxial subluxation during tonsillectomy?

Patients with Down syndrome, achondroplasia, Arnold-Chiari, and rheumatoid arthritis.

323

Which patients are at risk for atlantoaxial subluxation

Patients with Down syndrome, achondroplasia, Arnold-Chiari, and rheumatoid arthritis.

324

What is aspiration

Penetration of secretions below the TVC.

325

What is an absolute contraindication to treatment with OK-432

Penicillin allergy.

326

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.

327

What is the etiology of cervical thymic cysts

Persistence of the thymopharyngeal duct.

328

What is intractable aspiration

Persistent aspiration despite maximum medical management and minor surgery.

329

What is the most cost-effective predictor of posttonsillectomy hemorrhage?

Personal and family history of bleeding.

330

What is the most cost-effective predictor of post-tonsillectomy hemorrhage

Personal and family history of bleeding.

331

What is the most common notifiable and vaccine-preventable disease in children under age 5

Pertussis.

332

What is platybasia

Phenotypic characteristic of VCFS where the cranial base is angled obtusely, resulting in expanded velopharyngeal volume and incomplete velopharyngeal closure.

333

What is the plica triangularis

Point at which the palatine and lingual tonsils meet.

334

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.

335

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.

336

What is the most common vascular malformation

Port wine stain.

337

Where exactly are most subglottic hemangiomas located

Posterolaterally and submucosally.

338

Can patients with laryngotracheal separation talk?

Potentially, via esophageal speech.

339

Can these patients talk

Potentially, via esophageal speech.

340

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.

341

What are the 2 types of aspiration

Primary or direct from oral substances and secondary or indirect from gastric substances.

342

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.

343

What is the biggest risk factor for acquired SGS

Prolonged endotracheal intubation.

344

In children 6 to 16 years

Pulmonary function tests (PFT) with methacholine challenge, paranasal sinus films.

345

What is the typical endoscopic appearance of innominate artery compression

Pulsatile compression of the anterior tracheal wall in the distal trachea.

346

What inflammatory disease is associated with 3rd and 4th branchial anomalies in children

Recurrent acute suppurative thyroiditis.

347

What cells are unique to Hodgkin's lymphoma

Reed-Sternberg cells.

348

What is the most common sign of GERD in infants

Regurgitation.

349

What is the initial management of posttonsillectomy pulmonary edema?

Reintubation and administration of PEEP, gentle diuresis.

350

What is the initial management of post-tonsillectomy pulmonary edema

Reintubation and administration of PEEP, gentle diuresis.

351

What is the primary disadvantage of this technique?

Requires long-term stenting (1-12 months).

352

What is the primary disadvantage of this technique

Requires long-term stenting (I - 12 months).

353

What is the most common soft tissue sarcoma of the head and neck in children

Rhabdomyosarcoma.

354

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.

355

What are the 3 most commonly identified viruses in middle ear fluid

RSV (74°/o), parainfluenza, and influenza.

356

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.

357

What are the typical M RI findings of hemangiomas

Serpentine high-volume flow voids surrounded by nonvascular soft tissue.

358

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.

359

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.

360

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.

361

In children 18 months to 6 years

Sinusitis (50°/o), cough-variant asthma (27%).

362

What is the standard surgical approach for removal of thyroglossal duct cysts (TGDCs)?

Sistrunk procedure.

363

What is the standard surgical approach for removal of TGDCs

Sistrunk procedure.

364

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.

365

After open repair of subglottic stenosis, what adjuvant treatment is necessary postoperatively

Speech therapy.

366

Which of these procedures is best for patients with poor lateral wall movement and good palate movement?

Sphincter pharyngoplasty.

367

Which of these procedures is best for patients with poor lateral wall movement and good palate movement

Sphincter pharyngoplasty.

368

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.

369

What organism is the most common cause of bacterial tracheitis in children

Staphylococcus aureus.

370

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% ).

371

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.

372

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.

373

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.

374

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.

375

What is the best treatment for nasal pyriform aperture stenosis?

Sublabial medial maxillectomy.

376

What is the best treatment for nasal pyriform aperture stenosis

Sublabial medial maxillectomy.

377

Where are dermoid cysts most commonly found in the head and neck

Submental area.

378

What is mitomycin C

Substance produced by Streptomyces caespitosus that inhibits DNA synthesis and fibroblast proliferation.

379

Unlike the glottic closure reflex, laryngospasm is mediated solely by stimulation of what nerve

Superior laryngeal nerve.

380

Which of these procedures is best for patients with poor palate movement and good lateral wall movement?

Superior pharyngeal flap.

381

Which of these procedures creates lateral ports through the nasopharynx for breathing?

Superior pharyngeal flap.

382

Which of these procedures is best for patients with poor palate movement and good lateral wall movement

Superior pharyngeal flap.

383

Which of these procedures creates lateral ports through the nasopharynx for breathing

Superior pharyngeal flap.

384

What disease increases the risk of nasopharyngeal stenosis after adenotonsillectomy?

Syphilis.

385

What disease increases the risk of nasopharyngeal stenosis after adenotonsillectomy

Syphilis.

386

What is the first sign of respiratory distress in children

Tachypnea.

387

Of tracheoesophageal diversion (TED) and laryngotracheal separation (LTS), which is easier to reverse?

TED.

388

Which is easier to reverse

TED.

389

What is the only muscle related to active opening of the eustachian tube

Tensor veli palatini.

390

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.

391

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.

392

How does infant swallowing differ from adult swallowing

The pharyngeal phase of swallowing in infants is faster and more frequent.

393

Why should general anesthesia be avoided in patients with mononucleosis?

They are at a heightened risk of suffering hepatotoxicity from the anesthetics.

394

Why should general anesthesia be avoided in patients with mononucleosis

They are at a heightened risk of suffering hepatotoxicity from the anesthetics.

395

Which patients are at greatest risk for respiratory problems after adenotonsillectomy

Those with PSG-proven OSA, Down syndrome, cerebral palsy, or congenital defects.

396

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.

397

What muscle adducts the FVC and aryepiglottic folds

Thyroarytenoid muscle.

398

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.

399

Which of these is most common

Thyroglossal duct cyst.

400

Through which membrane do external laryngoceles protrude

Thyrohyoid.

401

What is the surgical treatment of choice for giant congenital melanocytic nevi?

Tissue expansion followed by total excision.

402

What is the surgical treatment of choice for giant congenital melanocytic nevi

Tissue expansion followed by total excision.

403

What is the microtrapdoor flap used for?

To correct posterior glottic stenosis.

404

What is the microtrapdoor flap used for

To correct posterior glottic stenosis.

405

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.

406

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.

407

In placing an autogenous cartilage graft, where does the surface bearing perichondrium face?

Toward the lumen of the larynx.

408

In placing an autogenous cartilage graft, where does the surface bearing perichondrium face

Toward the lumen of the larynx.

409

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.

410

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.

411

What surgical procedure is the most common cause of iatrogenic vocal cord paralysis in children?

Tracheoesophageal fistula repair.

412

What surgical procedure is the most common cause of iatrogenic vocal cord paralysis in children

Tracheo-esophageal fistula repair.

413

What is the most common cause of GERD in children

Transient lower esophageal sphincter relaxation.

414

What approach is used for revisions of failed choanal atresia repairs?

Transpalatal.

415

What approach is used to for revisions of failed choana! atresia repairs

Transpalatal.

416

How is adenoidectomy related to Grisel's syndrome

Traumatic adenoidectomy can result in Grise I' s syndrome.

417

How is adenoidectomy related to Grisel's syndrome?

Traumatic adenoidectomy can result in Grisel's syndrome.

418

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.

419

True/False: Children with congenital laryngotracheal stenosis have a better voice outcome after surgical correction compared with children with acquired stenosis.

True.

420

T/F: Compared to the gag reflex, the cough reflex correlates better with a newborn's ability to eat safely

True.

421

T/F: Children with congenital laryngotracheal stenosis have a better voice outcome after surgical correction compared to children with acquired stenosis

True.

422

T /F: Division of the cricoid cartilage has not been shown to inhibit its further growth.

True.

423

T/F: Nasal steroids given twice daily for 6 months are likely to reduce adenoidal size

True.

424

T/F: The mortality rate is highest in patients who bleed within 24 hours after adenotonsillectomy

True.

425

T/F: Electrocautery tonsillectomy reduces intraoperative bleeding but has the same postoperative bleeding rate as the cold technique

True.

426

T/F: The 23-valent pneumococcal vaccine is not effective in children

True.

427

T/F: Axillary, inguinal, and Waldeyer's ring involvement is uncommon in patients with Hodgkin's lymphoma

True.

428

T/F: Frontal sinus hypoplasia is common in patients with cystic fibrosis

True.

429

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.

430

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.

431

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.

432

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.

433

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.

434

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.

435

How much mobilization can be achieved with peritracheal mobilization (dissection of the annular ligaments)

Up to 1.5 em.

436

How much mobilization can be achieved with the suprahyoid release?

Up to 5 cm.

437

How much mobilization can be achieved with the suprahyoid release

Up to 5 em.

438

What information does esophageal manometry provide

Upper esophageal sphincter responsiveness and pharyngeal peristalsts.

439

What is the most common cause of cough in children

URI.

440

What has been shown to decrease the incidence of postoperative granulomas after LTR?

Use of absorbable suture.

441

What has been shown to decrease the incidence of postoperative granulomas after L TR

Use of absorbable suture.

442

When is the typical onset of symptoms in patients with subglottic hemangioma

Usually asymptomatic at birth and symptomatic by 6 months of age.

443

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.

444

What syndrome, characterized by deletion of band 11 on the long arm of chromosome 22, is a contraindication to adenoidectomy

Velocardiofacial syndrome (VCFS).

445

What syndrome is characterized by hypernasal speech, cardiac malformations, cleft palate, and medial displacement of the carotid arteries

Velocardiofacial syndrome.

446

What is Grisel's syndrome?

Vertebral body decalcification and laxity of the anterior transverse ligament secondary to infection in the nasopharynx.

447

What is Grisel's syndrome

Vertebral body decalcification and laxity of the anterior transverse ligament secondary to infection in the nasopharynx.

448

What is the characteristic feature of a teratoid cyst

Very poor differentiation of all three germ layers.

449

What is the best test to evaluate swallowing

Videofluoroscopic barium swallow.

450

Disorders of which clotting factors can cause prolongation of the PTT

VIII, IX, XI, XII, and lupus anticoagulant.

451

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.

452

What are the indications for definitive treatment of lymphatic malformations

When vital structures are endangered, when episodic hemorrhage occurs, or if macroglossia is present.

453

How can one diagnose exercise-induced laryngomalacia

With exercise flow-volume spirometry.

454

What is the Euler-Byrne formula

X + 4Y where X = # episodes pH5 minutes; a score of 50+ is clinically significant for GERD.

455

What is the term for the treatment of airway obstruction in children with craniofacial abnormalities where the mandible is gradually elongated?

Distraction osteogenesis.