Show:
(mostly) Nose
Eye
Critical Care
ENT
Beauty and the Beast
100
What should you suspect in a child who presents with a unilateral, foul smelling nasal discharge?
What is foreign body
100
15 month old male presents to clinic for a checkup. He is meeting developmental milestones. During his eye examination, you notice a while reflex with strabismus. What is this indicative of?
What is Retinoblastoma, the most common malignant eye tumor in children. Emergent ophthalmology referral is warranted, can rapidly spread, most commonly along optic nerve into CNS. May be familial RB1 gene or spontaneous
100
A 16 year old presents to after a house fire. He has burns to his right arm, right leg, and stomach. The remainder of his body is intact [including head, chest, back, genitals, and left extremities]. What %BSA is affected?
What is ~36%. Use rule of 9s
100
What is the most common location for a foreign body to enter in an upright child?
What is right mainstem bronchus. Will typically produce unilateral (intermittent) wheezing. Most objects aspirated are radiolucent, and will not show up on CXR, though sometimes will see air trapping. Eval/tx with bronchoscopy for identification and removal of object [flexible laryngoscope is limited to upper airway]
100
What does the footstool turn back into after the curse is lifted?
What is A dog
200
To ablate a nose bleed, apply pressure to this plexus
What is Kiesselbach Plexus (anterior nasal septum)
200
Name two symptoms/signs that would make you more suspicious for orbital vs periorbital cellulitis?
What is Restricted eye movement, pain with ocular movement, proptosis, visual deficits
200
In treating severe status asthmaticus, magnesium infusions are commonly use. What is the mechanism through which this medication is effective?
What is: it causes bronchial smooth muscle cell relaxation by blocking calcium channels
200
Why is it important to drain auricular hematomas?
What is failure to drain may lead to necrosis of the cartilage and subsequent cosmetic deformation of the ear, such as cauliflower ear. Same principle applies to nasal septal hematomas. Recurrence is common with aspiration, therefore I&D is recommended, followed by pressure dressing to prevent reaccumulation.
200
Who is the first character Maurice meets in Beast's castle?
What is Lumiere?
300
How do you confirm the diagnosis of choanal atresia?
What is inability to pass a firm catheter through each nostril to a depth of about 3-4 cm. suspect in an infant who is cyanosic except when its crying [bilateral]
300
A 2 year old is brought to his pediatrician because his mother is concerned about his eyes. For the last week, she has noticed that his eyes seem to be moving around rapidly, randomly, and erratically in all directions and does not stop even when he is focusing on something. Yesterday, she also noted his arms and legs seems to jerk sporadically. He has otherwise been well with no recent illnesses. What should you be concerned about?
What is This patient is exhibiting signs of opsoclonus myoclonus syndrome. 40-50% of patients who presents with this will be diagnosed with neuroblastoma [though only 2-3% of neuroblastoma patients will exhibit these signs]. Evaluate with homovanillic and vanillymandelic acid [catecholamines] in the urine [as 90% of neurobastoma cells will secrete hormones that get broken down into these products], MIBG scan, CT/MRI, U/S, or PET scan can also be performed.
300
Carbon monoxide poisoning is a cause of which type of shock?
What is Dissociative shock, secondary to the inability to deliver/use oxygen. Also seen with methemoglobinemia and cyanide poisoning
300
A 6 year old boy presents with mother concerned he had a stroke. She notes he has had 1 day of fever and right ear pain. Patient denies and headache or neck stiffness. On exam, he is febrile to 101F, well appearing, with a bulging right TM with poor mobility, and the entire right side of his face is paralyzed. There is no rash present. What is going on?
What is Facial nerve paralysis from ipsilateral otitis media. The facial nerve is most commonly affected cranial nerve in otic pathology due to its proximity to the middle ear. Paralysis of the whole face [upper and lower] indicates a peripheral rather than central lesion. Treatment of facial nerve paralysis due to acute otitis medial involves IV antibiotics, myringotomy to allow drainage, and tympanostomy tube placement.
300
What is the name of Belle's horse
What is Phillipe
400
6 month old boy presents with intermittent noisy breathing that has been present since 1 month of age. Mother feels it is worse when lying down, or when he is upset. 34 week infant, uncomplicated post-natal course. Feeding and growing well. No response to a course or antibiotics nor nebulized albuterol and epinephrine prescribed by PCP. On evaluation noted to have inspiratory stridor, no distress, no retractions, otherwise normal exam. What is the most likely diagnosis?
What is Laryngomalacia. Remember, stridor is upper airway obstruction. Inspiratory general suggests obstruction above glottis vs expiratory localizes to lower trachea. Biphasic suggests glottis or subglottic lesion. Laryngomalacia is most common cause of chronic stridor in children less than 2. Related to delayed maturation of supporting cartilaginous structures of the larynx. Airway becomes partially obstructed. Tracheomalacia occurs with expiration. Subglottic stenosis common after intubation, will be biphasic.
400
You are examining a 1 day old female, product of a full term, uncomplicated pregnancy. O exam, there is deep red pigmentation extending from the infant’s hairline to the angle of her mouth on the right side with a distinct line of demarcation midline. Why should this child be followed by ophthalmology?
What is Glaucoma. Seen in up to 50% of patients with Sturge-Weber, can develop any time from birth to adulthood.
400
A child presents to the emergency room after being hit by a car while crossing the street. You are told to assess his Glasgow score. He opens his eyes to pain, withdraws from pain, and is verbally nonresponsive. What is his score?
What is 7. Score less than 9 suggests a severe injury and the loss of airway protection, therefore intubation is indicated Eye opening: spontaneous(4)>to voice>to pain> none (1) Verbal response: Oriented (5)>Confused>inappropriate words> inappropriate sounds>none (1) Motor response: obeys commands (6), localize pain>withdraws from pain> flexor posturing>extensor posturing>none(1)
400
What technique [patient positioning] should be used to most accurately assess the prevertebral space on Xray?
What is Xray should be taken in extension and inspiration. Other positions can demonstrate a falsely widened retropharyngeal space that could be mistaken for retropharyngeal abscess. Quick and dirty rule: the prevertebral space should be no wider than the width of the vertebral body behind it. RPA is most common in children less than 5.
400
How many eggs does Gaston eat in one day?
What is five dozen
500
An 11 yo child is found to have a nasal polyp. His sweat chloride test is negative. What else should you include in your differential?
What is Aspirin use. "aspirin triad" of nasal polyps, asthma, and ASA sensitivity. Treatment includes nasal steroids and possibly surgical removal
500
You are examining a 3 yo who is noted to have coloboma involving the iris, s well as deafness and history of VSD repair. What other findings (name 2) would you expect to be a part of this infant’s syndrome?
What is CHARGE syndrome: coloboma, heart defects, atresia of the nasal chonae, Retardation of growth/development, GU abnormalities, Ear abnormalities and/or deafness
500
A patient presents with methemoglobinemia. What is the appropriate treatment and how does it work?
What is methylene blue, works by converting methmoglobin to hemoglobin. Methemoglobinemia can be congenital [enzyme deficiency] or acquired [exposure to toxin s/a topic anesthetics, moth balls, nail polish remover].
500
A 7 year old male is found to have a white mass behind the tympanic membrane during routine physical exam, with a deep retraction pocket. Audiogram confirms conductive hearing loss in the same ear. No history of previous ear surgery. What is the diagnosis?
What is Congenital cholesteatoma. Unclear etiology.
500
Beast's rose will bloom until his --- Birthday?
What is 21st