Term
| What is the appropriate management of atypical mycobacterium in children? |
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Definition
Avoid I and D. PPD may be negative (long time for culture to grow)
1) Observe
2) Prolonged Abx: Azithromycin or Clarithromycin (macrolide) + doxy, rifampicin or ethambutol for 6-12 weeks
3) Surgical excision (most rapid resolution of symptoms). |
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Term
| When is RSV prophylaxis indicated to prevent subglottic stenosis? |
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Definition
Prophylaxis after intubation. Infection within 14 days of intubation is risk factor for subglottic stenosis.
Consider Palivizumab for infants with CLD of prematurity. Also may qualify based upon CHD. |
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Term
| What location is the most troublesome from a treatment perspective for pediatric lymphatic malformations? |
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Definition
| Suprahyoid-->most likely to be microcystic |
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Term
| What developmental and cardiac abnormalities are associated with a non-recurrent right laryngeal nerve? |
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Definition
| Retroesophageal right subclavian, 4th arch abnormality |
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Term
| Where will a third branchial cleft cyst travel relative to the carotid arteries and cranial nerves? |
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Definition
Anterior to SCM and Piriform sinus
Posterior to ECA and ICA
Between CN IX and XII |
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Term
| What are the structures of the first branchial arch? |
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Definition
Mesoderm and Neural Crest
Meckels cartilage (mandible, neural crest)
CN V3, muscles of mastication, mylohyoid, anterior digastric, tensors, Imax, ECA, epitympanic ossicular structures. |
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Term
| what is the appropriate management of pediatric caustic alkali ingestion? |
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Definition
If asymptomatic, supportive care and close observation (no neutralizing agent or milk).
If symptomatic, admit, CXR, upper endoscopy, consideration of intubation or trach
Remember, caustic ingestion raises chance of SCC of esophagus down the line |
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Term
| What are the most common types of rhabdomyosarcoma and the location associated with the best prognosis? |
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Definition
Alveolar is 2nd most common type (bad prognosis)
Orbital (embryonal, most common) and nonparameningeal head and neck are favorable. |
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Term
| Dose of propranolol for infantile hemangioma |
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Definition
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Term
| Nasal dermoid occurs in children because of a defect in which embryologic structure? |
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Definition
Foramen cecum
dura projects through foramen cecum and attaches to skin. Normally it separates from the skin and retracts, but if it doesn't epithelial elements may be pulled into the prenasal space with or without dural connection. |
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Term
| How long after injury with auricular hematoma does fibroneocartilage formation begin? |
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Definition
| 7-10 days-->cauliflower ear |
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Term
| What is the pathology of a pulmonary artery sling and what are its tracheobronchial associations? |
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Definition
Left pulmonary artery takes origin from right pulmonary artery within right mediastinum and then passes over right bronchus and loops through TEG to left lung.
This can cause tracheal compression and is associated with complete tracheal rings and bronchial hypoplasia |
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Term
| Why are alkali solutions more damaging to than acidic solutions in the esophagus? |
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Definition
Esophagus has a higher pH environment, and some antacid properties.
Acid causes coagulative (less depth) necrosis versus liquefactive necrosis from alkali solutions. |
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Term
| What are the immunohistochemical characteristics of hemangioma of infancy. What other screening is necessary? |
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Definition
3 phases of growth. Proliferative, involuting and involuted.
1) 97% are GLUT-1 positive
2) High likelihood of subglottic hemangioma as well.
Not present at birth. Rapidly grow over first 6 months. 50% regress by 5 years. |
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Term
| What is the most common organism in Lemierre syndrome? |
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Definition
Septic thrombophlebitis often preceded by PTA.
Fusobacterium necrophorum, a GNR.
Need a beta-lactamase resistant beta-lactam antibiotic |
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Term
| What is the NPO timing for breast milk consumption? |
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Definition
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Term
| What are the growth phases of hemangioma of infancy? |
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Definition
3 phases of growth. Proliferative, involuting and involuted.
1) Proliferative: rapid growth, <1 year in duration, usually double in size in first 2 months of life. usually 80% of final size at 5 months
2) Involuting
3) Involuted |
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Term
| How is primary ciliary dyskinesia (PCD) diagnosed? |
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Definition
AR disorder of ciliary function.
Nasal nitric oxide levels drop in patients with PCD |
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Term
| Which ossicular structures arise from the second branchial arch? |
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Definition
| Manubrium of malleus and Long process of Incus as well as stapes suprastructre |
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Term
| What are the first sinuses to begin to develop in utero, and the most developed at birth? |
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Definition
Maxillary- utero
Ethmoid- birth
Frontal- begins at age 5
Sphenoid- begins at age 3 |
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Term
| When do you take a child to the OR for esophagoscopy after caustic ingestion? |
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Definition
| 12-24h. Earlier and may miss liquefactive necrosis. Later and you may damage esophagus. |
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Term
| what is the most common organism in mycobacterial pediatric lymphadenitis? |
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Definition
| Mycobacterium avian intracellulare (MAI) (59%) followed by TB (29%) |
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Term
| What do you do if you find a 1) uninfected or 2) infected middle ear effusion during cochlear implantation? |
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Definition
1) Irrigate middle ear with ofloxacin, provide post-op abx and continue
2) If infected, place tympanovstomy tubes and abort until resolved for 2 weeks |
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Term
| What would an advanced case of RRP in children show on chest CT? |
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Definition
| Cavitary peripheral nodules |
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Term
| What is the most common pathogenic organism in a PTA? |
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Definition
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Term
| What is the most common location for congenital laryngeal webs in children? |
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Definition
| Anterior, 1/2 of children will also have other abnormalities (cardiovascular, etc). Most commonly, 65% have DiGeorge |
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