Read the following publications:
Randel, A. (2011). AAO-HNS Guidelines for Tonsillectomy in Children and Adolescents. Am Fam Physician, 84(5), 566-73.
Roland, P.S., Rosenfeld, R.M., Brooks, L.J., Friedman, N.R. (2011). Clinical Practice Guideline: Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children. Otolaryngol Head Neck Surg, 145(1), S1-S15.
1.
Anatomy review: blood supply, lymphatics and sensory innervation of tonsils and adenoids. What is Waldyer’s ring?
2.
What is the most common bacterial pathogen in tonsillitis? What complications are associated with this pathogen and how do we test for it? Other pathogens?
3.
What antibiotics are commonly used for treatment of tonsillitis? What are the goals of therapy?
4.
Describe the signs and symptoms of adenoid hypertrophy; diagnostic and management considerations.
5.
What are the current tonsillectomy recommendation for recurrent throat infections? For sleep disordered breathing?
6.
A 6 yo patient is scheduled for T&A. The mother has heard this may effect the child’s immune status. How will you advise her?
7.
Discuss advantages and disadvantages of : Tonsillectomy vs. tonsilotomy. Cold knife vs. cautery vs. radiofrequency. What are potential complications of T&A and would you to avoid them?
8.
Should we screen all kids for bleeding disorders prior to tonsillectomy? What is the most common bleeding disorder? How would you prepare them for surgery?
9.
How do you diagnose and manage a patient with mononucleosis and tonsillar hypertophy? Are they candidates for tonsillectomy?
10.
What are the current recommendations on perioperative steroids and antibiotics post-tonsillectomy?
11.
What post operative pain management instructions will you give to the caregivers? What medications will you prescribe? Is there an increase riske of hemorrhage with NSAIDs? Why may codeine be ineffective?
12.
What is PANDAS? How is it treated?
Reference(s):
Quinn, N. A., Olson, J. A., Meier, J. D., Baskin, H., Schunk, J. E., Thorell, E. A., & Hodo, L. N. (2018). Pediatric lateral neck infections – Computed tomography vs ultrasound on initial evaluation. International Journal of Pediatric Otorhinolaryngology, 109, 149–153.
13.
You suspect OSA in a pediatric patient. Describe the most common presenting symptoms in pediatric OSA. What are some comorbid conditions that should be ilicited on H&P?
14.
Describe the work up of pediatric patients for OSA. When should you order a polysomnogram? When would you consider a DISE?
15.
What treatment options would you offer a pediatric patient with OSA. How do you counsel parents on success rates for sleep apnea and comorbid conditions post-tonsillectomy?
16.
Your first case in practice is a tonsillectomy for sleep apnea. Your partners are surprised that you are not admitting the patient. Educate them on current indications for admission.
17.
What is Prader Willi Syndrome and what is its relationship to OSA.
AcademyU Resource(s):
- Complications of Adenotonsillectomy in Children
- Controversies in the Evaluation and Treatment of Pediatric Sleep Apnea
- Evaluation and Management of Pediatric Sleep Apnea
- Management of Pediatric OSA Post T&A Session 2017
- Management of Post-Tonsillectomy Pain in Children
- Pediatric OSA: An Evidence-Based Approach 2017
- Pediatric Drug-Induced Sleep Endoscopy: Technique and Interpretation
- Pediatric OSA 2016: State-of-the-Art Management
- Weight Gain After Adenotonsilectomy (Podcast)
- Influence of Tonsillar Size on OSA Improvement in Children Undergoing Adenotonsillectomy (Podcast)
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