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Flashcards in Pediatrics Deck (37):
1

What is the sequence of sinus development

Maxillary - birth
Ethmoid - birth
Sphenoid - 5yo
Frontal - 10yo

2

What drains into the osteomeatal complex?

Maxillary sinus
Anterior ethmoids
Frontal sinus

3

What three structures bound the osteomeatal complex, and therefore can occlude it via mucosal hypertrophy or anatomic enlargement

Ethmoid bulla
Uncinate
Middle turbinate

4

At which age does the pinna reach almost full adult size?

4-5 yo, full at 9

5

What allows establishment of a nasopharyngeal airway in infants?

The more superior cervical postition of the larynx and overlap of the epiglottis and velum (palate)

6

At what level is the pediatric larynx located at rest and with swallowing?
Adult?

Peds: at rest - 3rd-4th vertebrae, swallowing - 1st-2nd
Adult: 5th

7

Chonal atresia is a potential manifestation of which syndrome, whose presence may make other intervention necessary prior to repair of atresia?

CHARGE
Coloboma, Heart defects, Atresia of the choanae, Retardation, Genital abnormalities, Ear abnormalities

8

What should be ruled out in the setting of pyriform aperature stenosis?

Holoprosencephaly (central mega-incisor syndrome): get CNS imaging

9

What are the three main types of congenital nasal masses that typically present with s/s nasal obstruction?

Encephaloceles
Gliomas
Dermoids

10

Location of lymphatic vascular malformations often defines if the lesion is macrocystic or microcystic. Where are each more commonly found?

Macrocystic: Infrahyoid and extrinsic to the laryngotracheal airway
Microcystic: Suprahyoid and involved with the laryngotracheal airway

11

What study is important in a child with bilateral VF paralysis?

MRI to r/o posterior fossa abnormalities

12

What is the major source of saliva production at rest? During mealtime?

Rest: submandibular gland
Meals: parotid gland

13

During normal nasal development (weeks 4-12), what provides communication between the prenasal space and the anterior neuropore?

Foramen cecum

14

What are the two thickenings of the frontonasal prominence which burrow to form nasal pits, flanked by the medial and lateral nasal prominences

Nasal placodes

15

What is the name of the primitive oral cavity

Stomodeum

16

What is the mandibular arch subdivided into?

Mandibular and maxillary processes

17

Oral-nasal patterning of the palate and oral cavity/tongue devlopment is under the control of what gene?

Sonic hedgehog (Shh)

18

What 4 regions fuse to form the tongue?

Lateral lingual swellings: 1st arch, oral tongue, ant 2/3
Midline lingual swelling: 1st arch, oral tongue, ant 2/3
Hypobranchial eminence: 2nd-4th arch, oropharyngeal, post 1/3

19

What is the V shaped sulcus that seperates the anterior 2/3 from the posterior 1/3 of the tongue? What lies at the center?

Sulcus terminalis
Foramen cecum (origin of the mesodermally derived thyroid)

20

What is a mass of normal tissue in an abnormal location that is classified based on the predominant epithelial lining?

Choristoma

21

Where do most oral choristomas occur?

Near the ventral reflection of the tongue onto the FOM

22

What is the mechanism by which vallecular cysts cause stridor and respiratory distress?

Mass forces the epiglottis into the laryngeal inlet

23

Is congenital or acquired subglottic stenosis more common?

Congential is 1/10 as common as aquired SGS

24

What is the initial therapy for subglottic hemangiomas?

Propranolol (others include steroid injection, systemic steroids, laser ablation, and open resection with LTR)

25

Laryngeal cleft can occur in isolation, or in association with one of the following syndromes (3)

Pallister-Hall: hypothalamic hamartoma, polydactyly, bifid epiglottis
Opitz-G: midline abnormalities- optic hypertelorism, LTE defects, and hypopspadias
VACTER/VACTERL

26

Classification system for laryngeal clefts

Benjamin Ingles Classification
Type I: deep interarytenoid notch
Type II: extends into but not through cricoid
Type III: through cricoid into cervical trachea
Type IV: into thoracic trachea/bronchi

27

What percent of patients with TEF have esophagial atresia?

95%

28

What is the most common of the 5 types of TEF?

Esophagial atresia with distal TEF

29

What is the only type of TEF that may remain occult and present with aspiration pneumonias?

H type

30

What imaging should be performed in the setting of tracheal stenosis?

CTA with 3D recon

31

What is cyclical cyanosis indicative of?

Complete nasal obstruction--cyanosis that resolves with crying

32

What is piriform aperature stenosis associated with?

Single upper central incisor

33

Findings of micrognathia and glossoptosis in a neonate with airway obstruction is pathognomotic for:

Robin sequence

34

What worsens the stridor causes by laryngomalacia

Feeding
Agitation
Supine positioning

35

Infants with persistent 'croup' sx should be suspected of having

Subglottic hemangioma
**physical exam will reveal a cutaneous hemangioma of the H&N in 50% of cases

36

What is the tx of choice for complete tracheal rings?

Slide tracheoplasty

37

What is the MCC tracheomalacia

Secondary tracheomalacia 2/2 vascular compression