Airway
Pediatric:
-Higher and more anterior
-Overlapping cartilages
-Smallest at subglottis (cricoid)
-Softer trachea
-More U shaped epiglottisOther: larger relative tongue, shorter mandible, large occiput, nasal breathers until 6 months
What are the 3 most frequent bacterias causing an AOM?
What vaccines have helped diminish the incidence of AOM (2)?
Streptococcus pneumonia
Haemophilus influenza
Moraxella catarrhalis
Vaccines: Prevnar13 and Hib vaccine (Pentacel® and Vaxelis)
Non Hodgkin Lymphoma
Non Hodgkin: Multiple groups of pheripheral nodes, non contiguous distribution, Waldeyer’s ringn and mesenteric nodes frequently affected, frequent extra-nodal disease
Hodgkin: More often one group of nodes, contiguous distribution, rarely affects mesenteric nodes and Waldeyer’s ring, rarely extra-nodal
Tell us what is considered a mild, moderate and severe apnea on PSG results in pediatrics.
What are indications to do a PSG before considering T&A according to AAO (5).
AHI: apnea-hypopnea index
Mild: 1-4
Moderate: 5-10
Severe: >10
AAO criterias:
Give 10 complications of T&A.
Classify or die !
Intra-op:
1-General anesthesia
2-Airway fire
3-Teeth/ mucosal injury
Immediate post-op:
4-Bleeding
5-Grisel syndrome
6-Post-obstructive pulmonary edema
7-Dehydration
8-Infection
9-VPI/ voice change
Delayed post-op:
10-Persistent apnea/ Regrowth of adenoids
You are seeing a 13 year old girl doing competitive triathlons. During a competition she started having sudden severe stridor and has to stop. When seen in ED, she does not have stridor anymore and your scope is normal.
What is your most likely diagnosis ?
What are the possible triggers of this pathology?
How do you manage it?
Paradoxical vocal fold movement (Inducible Laryngeal Obstruction, Exercice Induced Laryngeal Obstruction)
Exercice, Acid reflux, Stress, Odors and Irritants
SLP, PPI, Reassurance, Breathing techniques
Sometimes: Psychologists, Respirology
Acutely: Reassurance, Breathing through a straw, Forceful nasal breathing, Benzos
Persistent otorrhea on tubes in a child.
1-What is your approach for management?
2-Name 3 systemic conditions you would like to rule out.
Medical: Prolonged course of drops, Prolonged oral or IV antibiotics, Culture +/- treat fungal, other treatments (vinegar, boric acid)
Surgical: Adenoidectomy, Remove or exchange tube, Mastoidectomy
Immunodeficiency, Cystic fibrosis, Primary ciliar dyskinesia
You do a biopsy of a nasal mass and send it for frozen. The pathologist calls you and says that he sees small round blue cells. What are 7 possible diagnosis ?
MR SLEEP
Melanoma, Merkel cell carcinoma
Rhabdomyosarcoma
Sinonasal undifferentiated carcinoma (SNUC), squamous cell carcinoma
Lymphoma
Estesioneuroblastoma
Ewing sarcoma
Plasmocytoma
Name 3 side effects of Beta-blockers.
Bronchospasm
Bradycardia/hypotension
Hypoglycemia
Basic substances are worse.
Basic: Liquefaction necrosis
Acid: Coagulation necrosis (coagulum formation limits extend of injury)
Juvenile onset RRP. What are 4 maternal risk factors (or 5)?
Bonus: What is the risk of spontaneous malignant degeneration in RRP?
Maternal age < 20 ans
First child
Vaginal delivery with prolonged labour
Active genital condylomas
Low socio-economic status
2-3%
Most common causes of pediatric vertigo at age 2, 5, and 13 years old.
2 years old: AOM
5 years old: BPPV of childhood
13 years old: Migraine-associated vertigo
Describe the course and anatomical path of a 3rd branchial arch fistula.
Anterior border of SCM (inferior) --> Superficial to cranial nerve X-->Superficial to common carotid artery-- > Superficial to cranial nerve XII and deep to cranial nerve IX-- >through thyro-hyoid membrane (above superior laryngeal nerve)-> Opens at the entrance of the piriform sinus
Most often will be abuting with thyroïd gland
What are the diagnostic criterias of PFAPA and the treatment options?
1-Regular reccurent fevers in child < 5 yo
2-Constitutional Sx 1/3 in the absence of URTI :
3-Asx between episodes
4-Normal growth and development
5-Exclusion of other inflammatory and hematologic pathologies (cyclic neutropenia)
Treatment:
Conservative: Supportive during episodes
Medical: Corticosteroids (#1), NSAIDS/Tylenol PRN, Cimetidine PRN (antihistamine)
Surgical: Tonsillectomy
Give 6 head and neck features of Treacher-Collins syndrome. Bonus if you can give us the gene affected.
Coloboma, downslanting palpebrale fissures, malar hypoplasia, micrograthia, malformation of external ear and ossicles, microtia, cleft palate, absent lower eyelids, facial clefts.
TCOF1
What specific finding on bronchoscopy would you suspect with each of these:
1. Velo-cardio-facial syndrome
2.T21
3. Apert syndrome
4.Phaces syndrome
5. Pulmonary artery sling (Left pulmonary artery coming from right pulmonary artery)
6.Opitz-Frias Syndrome
1.Anterior laryngeal web
2.Subglottic stenosis
3.Sleeve trachea
4.Subglottic hemangioma
5.Complete tracheal rings
6. TEF and laryngeal cleft
Give 6 otologic findings in BOR syndrome.
What is the gene associated with the syndrome?
Gene:EYA1, chromosome8q
Internal ear: EVA, cochlear hypoplasia
Middle ear: Ossicular malformations, nerve VII dehiscence / aberrant course
External ear: Preauricular pits / tags (82%), auricular malformation (32%), microtia / EAC narrowing
Hearing loss:
What is a pilomatrixoma ?
Name 2 syndromes associated with pilomatrixoma.
Benign tumor of the hair follicule.
Bonus: Somatic changes in the CTNNB1 gene are found in most isolated Pilomatrixomas
You have a patient with a giant hemangioma of the face and neck. Name 3 possibly fatal complications.
1. Airway compression
2. High output heart failure
3. Kasabach-Merritt phenomenon: thrombopenia with coagulopathy (tuffed hemangiome, hemangioendotheliome kaposiforme)
4.Bleeding
How do you diagnose PCD (Primary ciliary dyskinesia) ? 4 tests
1- Exhaled nasal nitric oxide(screening); Will be reduced
2- Inferior turbinate brushing for: light microscopy or transmission electron microscopy to assess cilia
3- Genetic testing (DNA H5/l1)
4- Saccharine test (nasal mucociliary clearance)
What are pre-op criterias for an anterior cricoid split (7) ?
- Weight > 1500 gm
- O2 requirement < 30%
- No ventilation support for at least 10d
- No antihypertensive medications at least 10d
- No CHF for at least 1mos
- No other airway abnormalities
- No acute respiratory tract infection
What is Mondini malformation?
Which 6 syndromes are associated with it?
Triad:
Abnormal cochlea (1.5 turn instead of 2.5), normal basal turn with cystic apex
Enlarged vestibular aqueduct
Enlarged vestibule with normal SCC
KlippelFeil(Wildervanck)- Waardenburg- Treacher-Collins - Branchiootorenal - Pendred- CHARGE- Mobius syndrome
What is one malignant tumor that can spontaneously regress in neonates ?
Neuroblastoma; tumor that originates from neuroectodermal primitive cells of neural crest (50% at less than 1 year old)
Mostly if in neonate, small primary tumor, hepatic involvement, subcutaneous nodules, patch infiltrates in bone marrow without replacement of hematopoietic cells.
•50% < 1 yo
•80% < 5 yo
Give 4 CT findings of cystic fibrosis.
What gene is associated with cystic fibrosis and what targeted therapy exists now that greatly reduces the polyposis when patients are candidates ?
- Hypopneumatisation of sinusis (mostly frontal)
- Extensive Polyposis (86%)
- Medial bulging of nasal lateral wall
- >75% of maxillary and ethmoid opacification
- Demineralisation of uncinate bilat
- Maxillocentric disease
Gene: CFTR
Treatment: Trikafta (éléxacaftor + tézacaftor+ ivacaftor)
What is Hutchinson’s triad of late congenital syphilis?
Hutchinson teeth (notched incisors & mulberry molars)
Sensorineural hearing loss
Interstitial keratitis