PNCB Prep: Ear, Nose and Throat (Latest 2022/2023) Correct Answers Shown by

PNCB Prep: Ear, Nose and Throat (Latest 2022/2023) Correct Answers Shown by Which period of gestation does a cleft palate usually occur? 6 to 12 weeks When taking the prenatal history of a baby with a cleft palate, it would be important to ask about: Medications or substance use during pregnancy. Because exposure to toxins may interfere with the developing fetus and be associated with birth defects like cleft palate. What is the average size of the newborn anterior fontanelle? 2.1 cm What is the average size of the newborn posterior fontanelle? 0.5 to 0.7 cm Which visual acuity screening test is appropriate to use with a 4yo child? HOTV matching chart What is used for hearing assessment in children 4 years and older? Audiometry During the cover-uncover test, a normal response, once you uncover the right eye is: No movement in the right eye What tests are used to detect strabismus - Cover-uncover test - Corneal light reflex The red reflex is done in the newborn period to rule out: Congenital cataracts and retinoblastoma The fundoscopic examination allows the NP to : Visualize structures at the back of the eye A child presents to the office with left ear drainage. On exam you see that the external canal has an orange-colored runny substance in it but the tympanic membrane appears normal. The ear canal is not inflamed. This is consistent with: Excessive cerumen On examination of a child, you visualize a slight crease across his nose where the nasal bone ends. This may be a sign of: Allergic rhinitis. The nasal crease (allergic salute) is caused by the child repeatedly wiping the nose with the palm of the hand in an upward manner as with chronic allergic rhinitis Kathryn 6yo, is in the office complaining of sore throat. On exam her tonsils are touching each other. You record this finding as tonsils: +4 Which glands are involved in mumps? Parotid glands. In mumps, this causes significant swelling of the parotid glands. Primary dentition erupts between: 6 and 24 months What is the best position for palpation of the fontanelle? In a sitting position At what age is the anterior fontanelle no longer palpable? 24 to 26 months A flat philtrum and thin upper lip are signs of: Fetal alcohol syndrome Primary diagnostic criteria for otitis media with effusion: Minimal movement of tympanic membrane with pneumatic otoscopy Treatment of otitis externa is best accomplished by: Topical antibiotics are the primary treatment for otitis externa What are the common organisms found to cause otitis externa? - Pseudomonas aeruginosa - Staph aureus - Candida albicans Ototoxicity due to medications results in which type of hearing loss? Sensorineural hearing loss - due to damage of CN VIII Appropriate management of suspected epiglottitis would be: Medical transportation to an emergency facility with anesthesiology notified What is the most appropriate management for a 13yo with strep throat? Penicillin V 500mg BID x 10 days with either acetaminophen or ibuprofen for fever and pain management Which term describes an eye that deviates medially? Esotrophia Complications of meningitis include: - Hearing loss - Hydrocephalus - Blindness Following tympanostomy tube insertion, it is important that the tubes remain patent. Which of the following methods may be used to determine patency? Visual inspection 13yo presents with sore throat for a couple of weeks. He now has severe pharyngeal pain for 2 days, has been sweating and with fever. PE reveals a temperature of 102F and erythematous and edematous pharynx and soft palate. The right tonsil is swollen and uvula is displaced to the left. Right cervical nodes are tender. Lungs are clear to auscultation. These signs and symptoms are suggestive of: Peritonsillar abscess Assessment of the red reflex is used to rule out: - Opacities (e.g. glaucoma) - Intraocular tumor (e.g. Retinoblastoma) - Coloboma A child presents to the clinic with irritation to their eye because they got bathroom cleanser in the eye. What is the initial treatment? Irrigating the eye with copious amounts of normal saline and THEN referral to ophthalmologist A child brought to the clinic for a suspected cold. PE reveals greenish, blood-tinged mucus with a strong, foul odor, draining from the right nostril. This clinical picture is consistent with a diagnosis of: Nasal foreign body A 1 week old infant has been diagnosed with nasolacrimal duct obstruction. A typical initial therapy includes: Nasolacrimal sac massage Conjunctivitis appearing in a 2 day old newborn is likely due to: Chemical irritation from eye drops Confirming a diagnosis of chlamydia conjunctivitis in a newborn is best done by: Obtaining a culture of the conjunctival scrapings What is the most appropriate management of a 5yo with a firm, non-tender nodule in the mid-upper eyelid for 3 weeks? Topical ophthalmic ointment Daily eyelid cleansing with diluted bay shampoo and a cotton-tipped applicator would be appropriate in the treatment of: Blepharitis Concurrent otitis media and conjunctivitis is likely due to which organism? Haemophilus influenzae Fluorescein staining of the eye is used to detect: Corneal abrasion How are corneal abrasions managed? Topical application of ophthalmic antibiotics to prevent infection What is the greatest risk in a patient with a hyphema? Rebleed Anticipatory guidance for the patient with otitis externa should include: Instructing the patient to keep ear dry until symptoms improve A patient with a history of chronic serous otitis media is noted to have a pearly white opacity in the upper outer quadrant of his TM. He currently has no symptoms and appears to hear adequately. What is the most likely diagnosis and appropriate management? Dx - Cholesteatoma Tx - Refer to otolaryngology What nasal foreign bodies often require IMMEDIATE removal? Batteries - because they may release small amounts of chemicals, leading to chemical burns and perforations. What complication of sinusitis are adolescent males more prone to? Intracranial abscess Patients with sinusitis should be instructed not to participate in which activity? Swimming/diving A 9-month-old with a bifed uvula is likely to have increased risk of developing which disorder? Otitis media What is the likely Dx and Tx for a 10yo with a single painful ulcerated lesion on an erythematous base on the inner buccal mucosa? Dx - Aphthous ulcer Tx - triamcinolone in Orabase What is the organism that causes hand, foot and mouth syndrome is what virus? Coxsackie virus Retropharyngeal abscess is seen in what age group? What is the mainstay of treatment? 2-6 year olds; ICU admission and IV antibiotics The incidence of epiglottitis has decreased because of which vaccine? H. influenza B (Hib) vaccine Patients with epiglottitis prefer to sit in which position? Sitting up and leaning forward Constant strabismus is termed.... "tropia" Intermittent strabismus is termed..... "phoria" What classic triad signs and symptoms are seen in glaucoma? i. Photophobia ii. Abnormal overflow of tears (epiphora) iii. Blepharospasm (eyelid spasm) What is often an initial sign of cataracts in a child? Strabismus What is the hallmark physical examination finding in glaucoma? Increased intraocular pressure (IOP) - measured or suspected with firmness to palpation of the eye What is the most common congenital malignancy of the retina/malignant intraocular tumor of childhood? Retinoblastoma What anticipatory guidance would you give to a mother of an infant with dacryostenosis? Spontaneous resolution almost always occurs by 12 months of age What is the primary diagnostic criteria for otitis media WITH effusion? Minimal movement of the tympanic membrane with pneumatic otoscopy. Fluid collection seen in otitis media with effusion interferes with the normal movement of the tympanic membrane. Treatment of otitis externa is BEST accomplished by.... Removal of external ear drainage and application of topical antibiotics with a wick. Common organisms found to cause otitis externa include: Organisms that thrive in warm, moist environments: - Pseudomonas aeruginosa - Staphylococcus aureus - Candida albicans John, 5yo, has been diagnosed with a ruptured tympanic membrane as a result of otitis media 1 week ago that was treated with antibiotics. What should the plan of care be? Education of parents on the use of ear plugs to prevent water from entering the middle ear - Use of cotton swabs with petroleum jelly during bathing OR fitted ear plugs while swimming 4yo is brought to urgent care clinic with report of acute onset of 104 fever and difficulty swallowing. She appears anxious and is drooling. You suspect epiglottitis. What is the immediate management plan? Medical transportation (with skilled professionals who can perform an emergency intubation or tracheostomy) to an emergency facility with anesthesiology notified. What is the most appropriate management plan for a 13yo with confirmed group A beta hemolytic streptococcus Pharyngitis? Penicillin V 500mg BID x 10 days with acetaminophen or ibuprofen for fever/pain management A child previously seen/treated for streptococcal pharyngitis infection 1 month ago, presents to the clinic with a swollen cervical lymph node. What is the appropriate management plan? Document size and characteristics of node and have child return in 2 weeks for reevaluation. Lymphadenopathy post infection is an expected finding and may last for 4-6 weeks. If the node does not resolve, further evaluation is necessary. Chalazions are caused by: obstruction of the meibomian glands of the upper and lower eyelids, causing a painless nodule What term describes an eye that deviates medially? Esotropia Legal blindness Distant visual acuity of less than 20/200 corrected What physical exam finding may be the first clue to blindness (amaurosis) in a child? Nystagmus What is the most common sport/activity that causes eye injuries? BB guns Ocular injuries that require immediate referral include: - Chemical injuries - Globe lacerations, lacerations of the eyelid - Hyphemas - Penetrating intraocular injury What is the most common ocular injury in children? Corneal abrasions What anticipatory guidance should be provided to patient/parent with a corneal abrasion? Most abrasions heal within 24-48 hours Which eye injury is characterized by an accumulation of blood in the anterior chamber? Hyphema Which eye injury is most commonly caused by balls, fists, elbows, rocks and sticks? Hyphema Hyphema Accumulation of blood in anterior chamber What is a sign of rebleed in a patient recently diagnosed/treated for Hyphema? Worsening of vision What is the most common complication of Hyphema? Rebleed - usually 3 to 5 days after initial injury Otitis externa aka "Swimmer's Ear" is most common during: Summer months - due to excessive wetness (e.g. swimming, bathing, increased environmental humidity) Education for prevention of otitis externa should include: Instillation of white vinegar and rubbing alcohol (50:50) in both ear canals after swimming Common pathogenic organisms causing otitis media include: - S. pneumoniae - H. influenzae - M. catarrhalis Diagnosis of otitis media is determined by changes in: - color (erythematous) - contour (bulging; light reflexes and bony landmarks distorted) - mobility of TM (decreased mobility) What is the mainstay of treatment for otitis media? Antibiotic therapy (Amoxicillin is first line) Prevention of otitis media in infants should include what education/anticipatory guidance for children? Eliminate environmental exposure to smoke. Exposure to smoke is highly correlated with ear infections. Clinical guidelines for referrals to ENT/otolaryngologist in the patient with otitis media include: - Persistent AOM resistant to treatment over 1 to 2 months - Frequent recurrent OM; 3 infections in 6 months; 4 to 5 episodes of OM in 1 year - Persistent/chronic OME longer than 3 months - Evidence of hearing deficit or language delay Otitis media with effusion (OME) is caused by: Eustachian tube dysfunction (negative pressure in the middle ear) Which surgical measures are taken to relieve pressure and drain pus/fluid from the middle ear? Surgical placement of Typanostomy tubes/PE tubes/ventilation tubes What anticipatory guidance/education should be provided to the parent with a child who has tympanostomy tubes? Wear fitted earplugs when swimming to prevent water/moisture from entering the ear canal What is the most common cause of cholesteatoma? Chronic serous otitis media Complications of untreated cholesteatoma include: Facial nerve paralysis and intracranial infection What physical exam findings are expected in the patient with a suspected cholesteatoma? - Pearly, white opacity on or behind the tympanic membrane - Foul-smelling purulent otorrhea Management of the patient with a cholesteatoma include: Referral to ENT for surgical excision Hearing loss criteria: MILD - 15 to 30 dB MODERATE - 30 to 50 dB SEVERE - 50 to 70 dB PROFOUND - 70dB and above Signs and symptoms of hearing loss in infants includes: - Failure to elicit startle or blink reflex - Failure to be awakened by loud sounds - General indifference to sound - Lack of babbling by 7 months Signs and symptoms of hearing loss in toddlers/children includes: - Substitute gestures for words (by 15 months) - Failure to develop intelligible speech by 24 months - Inappropriate response to questions - Markedly inattentive What is the most common pediatric allergic disease? Allergic rhinitis What physical findings are expected in the patient with allergic rhinitis? - allergic "shiners" of eyes - allergic "salute" with nasal crease - hypertrophied turbinates - nasal mucosa pale, boggy and edematous with watery/mucoid secretions What is considered first line therapy for allergic rhinitis? Avoidance of allergens Which signs and symptoms are PE findings are always suggestive of a nasal foreign body? Unilateral purulent, malodorous or blood discharge Management of nasal foreign body Prompt removal of foreign body with forceps or nasal suction. If unable to remove in office, referral to otolaryngologist What is the most common site of bleeding in the patient with epistaxis? Anterior nasal septum (Kiesselbach's plexus) Prevention of epistaxis should include: - Use of humidifiers (especially in the bedroom) - Avoid nose picking Management of epistaxis includes: - Apply pressure to anterior nasal septum with patient sitting upright and head tilted forward - Apply ice - Avoid nose blowing immediately after a nosebleed Common pathogens in acute otitis media and acute sinusitis include: - S. pneumoniae - H. influenzae - M. catarrhalis Which sinuses are most frequently involved in sinusitis? Maxillary sinuses Ethmoid sinuses What is the primary diagnostic tool to diagnose sinus disease and complications (if recurrent, uncertain dx, unresponsive tx, or to assess complications) CT scan of the sinuses A child with cystic fibrosis is likely to experience which nasal disorder? Nasal polyps Common findings in nasal polyps include: - Nasal obstruction - Mouth breathing - Mucoid/mucopurulent rhinorrea - Shiny gray, grape-like mass(es) between nasal turbinates and septum What pathogen is associated with Thrush (Oral candidiasis)? Candida albicans (monilial) When considering cross-infection of thrush in the breastfeeding child/mother, what tx interventions should the PCP suggest? Treating mother for candidiasis of the breast; apply nystatin to nipples if breastfeeding. Fluorosis is caused by: HYPERmineralization of the teeth due to OVEREXPOSURE of fluoride Physical findings of fluorosis include: - discolored teeth - stained teeth (yellow to dark brown) - surface irregularities of the teeth - extremely noticeable pits in the teeth Initial physical findings of dental caries may appear as: Initial decalcification of enamel - opaque white spots that turn light light brown, progressing to dark brown with destruction of tooth Prevention of early childhood caries should include: - Avoid repeated or prolonged contact with milk, formula or juice - Do not put baby to bed with bottle - Do not allow baby to sleep at the breast - Do not allow baby to use breast or bottle as a pacifier Which bacteria accounts for the majority of pharyngitis/tonsillitis? Group A beta-hemolytic streptococcus (GABHS) Which diagnostic tests are the best to use in the PCP office for suspected strep throat/tonsillitis? Rapid strep test (90 to 99% sensitive) For the patient treated with GABHS infection, when should they be able to return to school? May return to school after 24 hours on antibiotics - considered noncontagious What is the most common pathogen associated with Acute nasopharyngitis (common cold)? Respiratory Syncytial Virus (RSV) Which physical exam finding confirms a diagnosis of retropharyngeal abscess? Prominent swelling of the posterior pharyngeal wall Common signs and symptoms in the child with a retropharyngeal abscess? - Acute onset high fever and sore throat - Toxic-appearing child - Head and neck hyperextension - Drooling and difficulty swallowing - Neck swelling and torticollis - **Prominent swelling of posterior pharyngeal wall What is the most common physical exam finding in suspected peritonsillar abscess? Unilateral enlargement of tonsils, bulging medially with anterior pillar prominence and uvula displaced towards unaffected side What radiographic finding supports epiglottitis? "Thumb sign" - lateral neck film shows a thickened/swollen epiglottitis The PCP suspects epiglottitis in a child. What interventions should immediately be provided? Arrange emergency transport immediately! While waiting for emergency transport: - Provide oxygen - Keep child calm - Be prepared for emergency CPR