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116 Cards in this Set
- Front
- Back
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What do CHARGE syndrome, cleft lip and cleft palate have in common?
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All are associated with hearing loss.
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True or False.
Effusion from otitis media occurs without inflammation. |
True
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A child is brought in for regular checkup. You note that he needs to be spoken to in a louder than usual voice. His mom notes that she has had to increase the television volume for him. What type of hearing loss is this consistent with?
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Conductive.
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As pertaining to conductive hearing loss, this is the result of keratinization of the epithelial cells in the middle ear. What is it?
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Cholesteatoma
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As pertaining to conductive hearing loss, hearing loss is minimal and intermittent. What is this most consistent with?
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Otitis media with effusion.
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As pertaining to conductive hearing loss, this has is very easily corrected. What is this?
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Small ears
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A 9yo boy has foul smelling purulent discharge from his right ear over several months despite antibiotics. You note squamous debris on his ear. What is your next step?
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Call ENT. This is a cholesteatoma
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True or False
Lasix + aminoglycoside = temporary hearing loss |
True
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True or False
Aspirin causes irreversible hearing loss. |
False. It is reversible.
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What is the most common neonatal cause of hearing loss?
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Bacterial meningitis.
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Sensorineural hearing loss in neonates from meningitis is related to
A) Severity of illness B) Age of patient C) When the antibiotics were started D) None of the above. |
D.
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What is the most likely etiology of sudden onset bilateral sensorineural deafness?
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Viral labyrinthitis.
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Which of the following does not apply to Conventional Pure Tone Audiometry Screening?
A) It can be used in children of all ages B) You can test each ear independently C) It can differentiate between sensorineural and conductive hearing loss. |
A. It is good for school age children and up.
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True or False.
Newborns should be awake when hearing screening test is done. |
False. They should be sleeping.
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This test is used for infants less than 6 months of age. Infants who fail this test must undergo further testing. Which newborn hearing test is this?
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Behavioral Observational Audiometry
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This test is done in preschool age kids and tests for bilateral hearing loss. Which test is it?
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Visual reinforcement audiometry.
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Which of the following hearing tests can not be used in newborns?
A) Automated auditory brainstem response (AABR) B) Conventional Pure Tone Audiometry Screen C) Transient Evoked Otoacoustic Emissions Test (TEOAE) D) Distortion product otoacoustic emissions (DPOAE) E) Behavioural Observational Audiometry. |
B.
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True or False.
Tympanometry measures hearing sensitivity. |
False.
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What is the relevance of a flat tympanogram?
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It means there the TM is stiff. There is either effusion behind the drum or the tympanostomy tubes are plugged
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What is the relevance of a high?
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hypermobile TM
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A child complains of dizzyness, vomiting and has rapid eye movements when going on car rides or roller coasters. What else is this child prone to?
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This is benign positional vertigo. She is prone to migraines.
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A child has sudden onset of unsteadiness and decreased hearing. What is the underlying problem and what is your first step?
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This is perilymph fistula. There is an abnormal connection between inner and middle ear causing loss of perilymph fluid. CONSULT ENT.
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How do you distinguish perilymph fistula from medulloblastoma and from benign paroxysmal vertigo?
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Medulloblastoma is not acute and has positive CT
Benign paroxysmal vertigo does not have hearing loss. |
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True or False.
Babies fed with propped bottles are more likely to get OM. |
True
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What are the three most common bugs to cause OM?
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S. pneumoniae
H. flu Moraxella catarrhalis |
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What is the SECOND line of treatment for OM?
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Augmentin
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What is the treatment for recurrent OM?
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Tympanostomy tubes
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A 4yo child has chronic drainage through his perforated left TM. What is the best treatment?
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This is chronic suppaurative OM. Note the absence of keratinized tissue and that it is not acute. Treat for pseudomonas with otic floxacin drops.
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A child has chronic suppurative OM and you treat him appropriately, but he continues to have discharge. What is this and what is your next step?
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This is cholesteatoma in the face of chronic suppurative OM. Call ENT.
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A 4yo is being treated for OM, but now returns with fever, lethargy and nuchal rigidity. What is the reason?
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She has meningitis from the OM.
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When do you change the antibiotic regimen for OM?
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Persistent ear pain and/or fever after 2-3 days of treatment.
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True or False.
It is okay to withhold antibiotics for OM for 2-3 days to see if symptoms persist. |
True
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What percent of OM will resolve without antibiotics?
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80%
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A 5year old with tympanostomy tubes has 3 days of bloody otorrhea and nasal congestion. The exam reveals bloody discharge and a large erythematous mass. What is the most likely cause of the bloody otorrhea?
A) eosinophilic granuloma B) rhabdomyosarcoma C) otitis media D) cholesteatoma E) tympanostomy tube granuloma |
E.
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A developmentally delayed 4yo comes in crying. You examine him and he SCREAMS WHEN YOU PULL THE PINNA of his ear. You do manage to note otorrhea as well. What is the most likely problem?
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Foreign body in ear.
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What is the most frequent cause of otitis externa? How do you treat it?
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Pseudomonas. Treat with antibiotics and a wick.
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A 15yo boy was hit in the ear while wrestling. You note swelling and a deformity of the external ear. What is your treatment?
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Needle aspiration
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A 4yo presents with postauricular swelling and erythema over the mastoid process along with displacment of the outer ear and pinna. What is your diagnosis? How do you confirm it?
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Mastoiditis. Confirm with CT and tympanocentesis and culture.
See page 261 of picture book |
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A teenager comes in with nasal congestion and sneezing, without fever. You do a nasal smear and find lots of eosinophils. What is your diagnosis?
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Allergic rhinitis
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Which of the following is NOT associated with nasal polyps?
A) Cystic fibrosis B) Cocaine C) Asthma D) Allergic rhinitis E) Chronic sinusitis |
B
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You note nasal polyps on exam of a 5yo who also is underdeveloped and has recurrent upper respiratory infections. What is your next test?
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Sweat chloride.
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An infant is noted to be cyanotic while feeding. The cyanosis resolves with crying. What is your diagnosis?
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Choanal atresia.
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What syndrome is associated with choanal atresia?
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CHARGE syndrome
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A 3yo girl comes in with persistent nasal congestion, rhinorrhea, and cough. What is her most likely diagnosis and treatment?
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Chronic sinusitis. Treat with amoxicillin.
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What are the usual bugs that cause chronic sinusitis or acute sinusitis for that matter?
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S. pneumonia
H. flu Moraxella |
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A 4 yo has persistent nighttime cough and/or foul breath after a URI. What is his likely diagnosis?
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Acute sinusitis
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What is the most likely complication of ethmoid sinusitis?
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orbital cellulitis
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What is the most likely complication of frontal sinusitis?
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CNS infection.
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A child has nighttime cough AND fever with profuse nasal discharge. You diagnose Chronic Sinusitis. Which of the following is NOT predisposing factor?
A) Primary ciliary diskinesia B) CF C) Allergy D) Immune deficiency E) All of the above. |
E.
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A 3yo has unilateral blood tinged foul smelling discharge. He has no fever. What is most likely diagnosis?
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Foreign body in the nose.
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What is most common cause of epistaxis?
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Dry air.
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A 13yo comes in with recurrent epistaxis. The bleeding is increasing in frequency and severity and takes increasingly longer to stop. What is your next step in management?
A) Saline nasal spray B) Coagulopathy studies C) Gels D) CT scan E) Call ENT |
D. You may be looking at a nasopharyngeal carcinoma or adenofibroma.
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True or False.
EB virus is asymptomatic in preschool kids. |
True
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A 12yo girl presents to the ED with a 1 week history of fever, malaise, sore throat, pharyngitis with thick exudate. On exam you note palatal petechiae and hepatosplenomegaly. She was recently treated with amoxicillin for strep throat and now has a rash over her entire body. What is your diagnosis?
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EBV related rash post penicillin.
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What is the distinguishing factor between strep throat and EBV?
A) Hepatosplenomegaly B) Exudative pharyngitis C) Enlarged tonsils D) High Fever E) Group B positive |
A.
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How do you confirm a diagnosis of Mono?
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Send serology
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A child has high fever, swollen lymph nodes and hepatomegaly. The monospot is negative. What is your next step?
A) Treat with penicillin B) Treat with amoxicillin C) Repeat monospot test D) Treat with gancyclovir E) Check serology for EBV |
E.
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True or False
IgM antibodies to EBV rather than isolation of the virus make for a definitive diagnosis. |
True
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True or False.
Treatment for mono could include steroids and bed rest. |
True, if there is airway obstruction and/or splenomegaly.
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A 17yo working as a prostitute gets regular checkups in the past. She comes in today with erythematous patches on her pharynx. What is your next step?
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Check for GC and other STDs. This is likely GC pharyngitis.
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True or False.
A negative rapid strep still requires a throat culture because of high rate of false negatives. |
True
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A 6yo boy comes in with dysphagia and difficulty opening the mouth (TRISMUS). He is noted to be DROOLING and has a HOT POTATO voice with cervical LAD. On exam unilateral inflammation around the tonsil is noted and the uvula is deviated to one side. The WBC is elevated. What is the diagnosis?
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Peritonsillar abscess
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What is the treatment for peritonsillar abscess?
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needle aspiration and antibiotics.
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What are the indications for tonsillectomy?
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Repeat peritonsillar abscesses
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This is the x-ray of a febrile child who refuses to eat? He is crouched in sniff position with his neck HYPEREXTENDED! What is this?
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Retropharyngeal abscess.
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What is this in a child with fever and drooling and inability to eat?
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Epiglottitis.
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What is the treatment of retropharyngeal abscess?
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needle aspiration under general anesthesia. Antibiotic would be clindamycin or augmentin.
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A 2yo has 4 days of fever, irritability and decreased appetite. Her preschool teacher noted vesiculopapular lesions on the hands and feet. You not ulcers in the posterior cavity of her mouth. What is the most likely diagnosis?
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Cocksackie virus group A
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A 12yo has fever, cervical adenopathy and painful vesicles on the vermillion border of the lips and anterior mounth. What are these?
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HSV.
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A 10yo has sores in her mouth that appear grayins white surrounded by a thin rim of bright erythema. What are these?
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Canker sores
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A 9mos old infant has tensder red nodules on her cheek. She is afebril and has good PO intake, but because she is cutting teeth, she has been sleeping with a water filled pacifier. How do you treat this?
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Reassurance. It resolves spontaneously
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What is the most common cause of periorbital cellulitis?
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Maxillary dental abscess.
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What are the 5 causes of delayed teeth eruption?
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Hypothyroid
Hypopitutarism Hypoplasia Hypohidrosis Rickets |
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A 9mos old is brought in with a croupy cough. This is the x-ray. What is the diagnosis?
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Foreign body aspiration
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What are four causes of inspiratory stridor?
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Remember that these are all outside the thoracic cage.
I=immobile vocal cords N=noid or adenoid enlargement S=soft cartilage (laryngomalacia) P=pharyngeal and hypopharyngeal masses. |
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What is the most common extra thoracic cause of airway obstruction and inspiratory stridor?
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Laryngomalacea
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A 3 week old infant presents with stridor that worsens with agitation, and when the baby is laid supine. Symptoms improve with exhalation and over time. What is your diagnosis?
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Laryngomalaceaq
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An infant is noted to have a traumatic birth and now has a weak high-pitched cry. What is your diagnosis?
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Vocal cord paralysis
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What does unilateral vocal cord paralysis present with?
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Persistant hoarseness
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How do you distinguish laryngeal web, larygomalacea and vocal cord paralysis?
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Laryngeal web does not change with position.
Laryngomalacea has a varied type of cry Vocal cord paralysis has high pitched cry |
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Do kids with laryngomalacea have trouble feeding?
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No.
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A 9yo boy comes in after his mom has noted that the boy has progressive hoarseness which worsens over the course of the day. He does not have any trouble swallowing and nor does he have any fever. His exam is normal. What is his diagnosis?
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Vocal cord nodule.
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What are the two major causes of expiratory stridor?
Remember these are below the thoracic inlet. |
Tracheomalacia and Bronchomalacia.
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What occurs in tracheomalacia?
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The tracheal wall rings collapse during exhalation.
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What kind of breath sounds would you hear upon external tracheal compression?
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Expiratory stridor and Fixed Wheezing
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A child with stridor has relief upon exhalation. What is the lesion?
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Laryngomalacia because they are no longer been blown downward. Think walking with wind blowing at your larynx and then trying to talk. Tracheomalacia would be worsened with exhalation because the air is no longer holding the trachea open.
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A child who has had a history of TEF repair in infancy comes in with expiratory stridor. What is her likely diagnosis?
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Tracheomalacea
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An infant is noted to have feeding difficulties and expiratory stridor. What should you check for?
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Vascular Ring around trachea and esophagus.
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A 5yo boy who recently immigrated from Mexico, comes in with fever, dysphonia, dysphagia, drooling and respiratory distress. On exam you note inspiratory stridor. The child prefers to lean forward. This is the x-ray. What is your next step?
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Call anesthesia for intubation.
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What is the empiric choice of antibiotics for epiglottitis?
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Lateral radiograph of the neck demonstrates and enlarged epiglottis (red arrow) and thickening of the aryepiglottic folds (yellow arrow). There is also reversal of the normal lordotic curve in the cervical spine and slight dilatation of the hypopharynx.
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True or False.
S.aureus causes bacterial tracheitis. |
False. It is a superinfection.
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A child has a barky cough, especially at night. He also has atopic dermatitis. He does not have any fever. What is this?
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Non-infectious or spasmodic croup.
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What are the three viruses that cause croup?
Think of a dog RIPping apart the virus. |
RSV
Influenzae Parainfluenza |
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True or False.
Laryngotracheitis is aka viral croup. |
True
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True or False.
Measles may also cause croup. |
True
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Match the following diagnostic techniques with subglottic stenosis, vocal cord function and vascular ring.
1. Direct laryngoscopy and bronchoscopy. 2. Flexible nasolaryngosocopy OR direct laryngoscopy + CXR + barium swallow. 3. Barium Swallow |
1. Direct laryngoscopy and bronchoscopy = subglottic stenosis
2. Flexible nasolaryngosocopy OR direct laryngoscopy + CXR + barium swallow. = vocal cord function 3. Barium Swallow = vascular ring. |
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What is the treatment for viral croup?
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Racemic epineprine, cool mist hood and inhaled budesonide and/or IV decadron
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Besides cervical cancer, which other cancer is associated with HPV?
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Laryngeal papilloma.
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A patient has a bifid uvula. What is the next test you order?
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Tympanometry to assess TM mobility. Think submucous cleft palate...remember that cleft palate and CHARGE are associated with hearing loss!
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How do you differentiate viral cervical LAD and bacterial lymphadenitis?
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Lymphadenitis is unilateral and has more inflammation.
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A 15yo has chronic cervical LAD. What do you suspect?
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HIV
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A patient has preauricular adenopathy and conjunctivitis. What do you suspect?
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Adenovirus infection
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A child has acute cervical lymphadenitis on the left side of her neck. What are the key labs?
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CBC, Blood Culture, PPD, ESR
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What is the empiric antibiotic choice for lymphadenitis?
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Augmentin or Clinda or erythromycin
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A patient turns out to have atypical mycobacteria as the cause of the cervical adenopathy. What is the next step?
A) PO Augmentin B) IV Clinda C) Needle excision D) Surgical excision E) CT in 3 months |
D.
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So, how do you diagnose cervical lymphadenitis due to atypical mycobacteria?
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The PPD! It will be positive but less than 10mm.
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A patient has a cervical adenitis that is not responding to treatment. She is otherwise asymptomatic. What is your next step?
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PPD
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A patient flies in from a farm because all the doctors went on strike in the town where she lives. She has chronic adenopathy AND hepatosplenomegaly. What is her most likely diagnosis?
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Brucellosis.
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A preschooler has parotid swelling and erythema near Stensen's duct, but no pus can be expressed. There is no erythema of the overlying skin. What are the two possible etiologies?
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Mumps and HIV
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A school age child appears toxic with very high temperature and swollen parotid gland. What is most likely etiology?
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S. aureus
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A patient has recurrent swelling of BOTH parotid glands. What is the etiology?
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Salivary gland stone.
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A patient comes from Afghanistan and has parotid swelling of a few weeks duration that is resistant to antibiotic therapy. She was brought from a refugee camp where she received some vaccines but records have been lost and there is no family contact. What is the best study to make a diagnosis on the etiology of the parotitis?
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Check for HIV.
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What is the appropriate treatment for a dental abscess if allergic to PCN?
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Clindamycin or erythromycin
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What is the most common craniofacial malformation?
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Cleft lip
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True or False.
Cleft lip/palate is more common than cleft palate alone. |
True.
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Indicate whether the following statements are true or false.
1. Cleft lip/palate can occur as a single gene defect or in conjunction with other chromosomal abnormalities from teratogens in utero 2. Cleft palate is more likely to be associated with other abnormalities 3. Cleft lip/palate is more common in girls 4. Cleft palate alone is more common in boys. |
1. T
2. T 3. F. Boys prefer the combo. 4. F. Girls just want the plate. |
