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Medicine, Year 4, Paediatrics > Ear, Nose, Throat > Flashcards

Ear, Nose, Throat Flashcards

1
Q

What is Tonsillitis and what is the most common cause?

A

Inflammation of the tonsils, commonly caused by a viral infection

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2
Q

What strains commonly cause Viral Tonsillitis?

A 
*Epstein-Barr virus*
Adenovirus
Rhinovirus
Respiratory Syncytial Virus
Influenzae
Parainfluenzae
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3
Q

What strains commonly cause Bacterial Tonsillitis?

A 
*Group A Streptococcus (Streptoccocus pyogenes)*
Streptococcus pneumoniae
Haemophilus influenzae
Morazella catarrhalis
Staphylococcus aureus
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4
Q

What are the features of Tonsilitis?

A 
Pyrexia
Pharyngitis (sore throat)
Dysphagia
Malaise
Lymphadenopathy
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5
Q

Until what age are the tonsils hyperplastic? Why?

A

Age 6, due to exposure of many micro-organisms

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6
Q

Until what age do tonsils begin to regress?

A

Age 12

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7
Q

On examination what may you find to help diagnose Tonsillitis?

A
  • Throat exam → Red, inflamed and enlarged tonsils with / without exudates
  • Ear exam to assess tympanic membrane
  • Lymph node exam to assess lymphadenopathy
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8
Q

What is the Centor Criteria used for?

A

Used to estimate whether a sore throat is caused by a bacterial infection and will benefit from antibiotics

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9
Q

Outline the points of the Centor Criteria and score is required?

A
  1. Fever over 38 degrees
  2. Tonsillar exudates
  3. Absence of cough
  4. Tender anterior cervical lymph nodes
    - If score is 3 or more, 40-60% likelihood of bacterial tonsillitis, so offer ABX
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10
Q

What is an alternative to the Centor Criteria?

A

FeverPAIN score

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11
Q

Talk through the FeverPAIN Score. What are the criteria and what score is required?

A
  1. Fever - Fever in the last 24 hours
  2. P - Purulence (pus on tonsils)
  3. A - Attendance within 3 days of symptom onset
  4. I - Inflamed tonsils
  5. N - No cough or coryzal
    - Consider ABX prescription if score is 4 or greater
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12
Q

How do you treat Bacterial and Viral Tonsillitis?

A
  • Viral → Supportive management, simple analgesia

- Bacterial → Penicillin V (Phenoxymethylbenzypenicillin) for 10 days

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13
Q

What is the problem with the drug used to treat Bacterial Tonsilitis?

A

Not well tolerated due to taste

Amoxicillin is an alternative (Not mandated by NICE)

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14
Q

If patient has a Pencillin allergy, what is the alternative medication to treat Bacterial Tonsillitis?

A

Clarithomycin

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15
Q

How many Tonsillitis episodes must occur for a Tonsillectomy to be indicated?

A
  • 7 or more significant sore throats in the preceding 12 months
  • 5 or more episodes in each of the preceding two years
  • 3 or more in each of the preceding three years
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16
Q

Aside from Tonsillitis episode count, what are other indications are there for a Tonsillectomy?

A
  • Recurrent febrile convulsions secondary to episodes of tonsillitis
  • Obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
  • Peritonsillar abscess (quinsy) if unresponsive to standard treatment
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17
Q

Why is there a large risk of bleeding associated with Tonsillectomy?

A

The lymphoid tissue has a very strong vascular supply from five vessels

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18
Q

What are the complications of Tonsillitis?

A
  • Chronic Tonsillitis
  • Peritonsillar Abscess (Quincy)
  • Otitis media (if infection spreads to inner ear)
  • Scarlet fever
  • Rheumatic fever
  • PSGN
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19
Q

What are the main complications of Tonsillectomy?

A
  • Pain → For upto 6 days post tonsillectomy
  • Haemorrhage → Primary and secondary
    Primary → Occurs 6-8 hours after surgery → MUST RETURN TO THEATRE
    Secondary → Occurs 5-10 days after surgery → ADMISSION AND ANTIBIOTICS
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20
Q

What is Waldeyer’s Tonsillar Ring?

A

A ring of lymphoid tissue in the larynx

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21
Q

What tissue comprises Waldeyer’s Ring?

A
  • Adenoid
  • Tubal x 2
  • Palatine x 2
  • Lingual
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22
Q

What section of Waldeyer’s Ring is affected by Tonsillitis?

A
  • Palatine tonsils
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23
Q

What is Quincy also known as, outline what it is?

A
  • Peritonsillar abscess, typically a complication of tonsillitis of trapped exudate → abscess
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24
Q

What are the clinical features of Peritonsillar Abscess?

A
  • Pharyngitis, dysphagia, pyrexia, neck pain, referred ear pain, lymphadenopathy
  • Trismus → muscle spasms in the muscles of mastication (lockjaw)
  • “Hot potato voice” → pharyngeal swelling causing change in voice
  • Deviation of the uvula to the unaffected side
  • Swelling and erythema in area at the base of tonsils O/E
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25
Q

In Peritonsillar Abscess, in which direction does the uvula deviate?

A

Towards the unaffected side

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26
Q

What is Quincy commonly caused by?

A

Bacterial infection i.e. Group A Strep

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27
Q

What is the management of Quincy?

A
  • Urgent referral to ENT specialist
  • Antibiotics before & after surgery (broad spectrum i.e. co-amoxiclav)
  • Needle aspiration, or incision & drainage under GA
  • Steroids i.e. Dexamethasone to reduce inflammation
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28
Q

What is Glue Ear also known as?

A

Otitis media with effusion

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29
Q

What is the pathophysiology of Glue Ear?

A

The eustachian tube which connects the middle ear and throat to help drain secretions become blocked. This causes fluid backup in the middle ear

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30
Q

When does Glue Ear occur?

A

Peaks at 2 years of age

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31
Q

What is the main presenting feature of Glue Ear?

A

Reduction of hearing in that side of ear (conductive hearing loss)

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32
Q

What may be visualised on Otoscopy in a patient with Glue Ear?

A
  • May look normal

- Dull tympanic membrane with air bubbles, or visible fluid level

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33
Q

How is Glue Ear managed?

A
  • Referral to audiometry
  • Conservative management → Resolves within 3 months
  • If co-morbidities → Grommet insertion under GA
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34
Q

What is the pathophysiology of Otitis Media?

A

Caused by a bacterial infection, usually entering through the back of the throat and up the eustachian tube and into the middle ear

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35
Q

What is the most common cause of Otitis Media?

A

Haemophilus Influenzae

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36
Q

What is the presentation of Otitis Media?

A
  • Ear pain, reduced hearing in affected ear, discharge of tympanum perforated
  • Upper airway symptoms → fever, cough, sore throat, feeling unwell
  • Vesticular system → Vertigo, balance issues
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37
Q

What may be observed on Otoscopy for Otitis Media?

A

Bulging, red, inflamed tympanic membrane. May have discharge and a hole in membrane

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38
Q

How is Otitis Media managed?

A
  • If child under 3-6 months + fever → Admit to hospital
  • Immediate antibiotics → symptoms > 4 days, If less than 2 y/o with bilateral otitis media, or has otorrhoea, or is systemically unwell, or is immunocompromised
  • No antibiotics → Majority resolve without ABX within 3 days. Can take upto a week
  • Delayed antibiotics → If symptoms have not resolved by day 3 or have worsened
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39
Q

What is the choice of antibiotic for Otitis Media?

A

Amoxicillin for 5 days

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40
Q

Aside from Amoxicillin, what are alternatives of antibiotic for Otitis Media?

A

Erythromycin / Clarithomycin

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41
Q

What are complications of Otitis Media?

A
  • Otitis media with effusion (Glue ear)
  • Hearing loss (usually temporary)
  • Perforated eardrum
  • Recurrent infection
  • Mastoiditis (rare)
  • Abscess (rare)
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42
Q

What are signs of Mastoiditis?

A

Otitis media symptoms plus +

  • Swelling, erythema and tenderness over the mastoid process
  • The external ear may protrude forwards
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43
Q

Why is mastoiditis a medical emergency?

A
  • Intracranial spread → Meningitis
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44
Q

What are causes of Otitis Externa?

A
  • Infection i.e. Bacterial / Fungal
  • Seborrhoeic Dermatitis
  • Contact Dermatitis
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45
Q

What are features of Otitis Externa?

What may you see on Otoscopy?

A
  • Ear pain, itch, discharge

- On Otoscopy → red, swollen, eczematous canal

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46
Q

What is the first-line management for Otitis Externa?

A
  • Topical antibiotic OR Combined topical antibiotic with steroid
  • If tympanic membrane perforated → Do not use aminoglycoside i.e. Gentamicin
  • If canal is extensively swollen → Ear wick
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47
Q

What is the second-line management for Otitis Externa?

A
  • Oral antibiotics (flucloxacillin) if the infection is spreading
  • Taking a swab inside the ear canal
  • Empirical use of an antifungal agent
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48
Q

What are causes of a Perforated Tympanic Membrane?

A
  • Infection (most common)

- Barotrauma, direct trauma

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49
Q

What are complications of a Perforated Tympanic Membrane?

A
  • Hearing loss

- Increased risk of Otitis Media

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50
Q

What is the management of a Perforated Tympanic Membrane?

A
  • No treatment usually → Will heal on its own
    • If does not heal → Myringoplasty
  • Avoid getting water into the ear
  • Prescribe antibiotics if perforation is secondary to ear infection
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51
Q

What is an acoustic neuroma also known as?

A

Vestibular Schwannoma

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52
Q

What the classical features in the history of Acoustic Neuroma?

A

Vertigo, Hearing loss, Tinnitus, Absent Corneal Reflex

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53
Q

What specific symptom(s) would a patient present with if CNVIII was involved in an Acoustic Neuroma?

A

Vertigo, unilateral sensorineural hearing loss, unilateral tinnitus

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54
Q

What specific symptom(s) would a patient present with if CNV was involved in an Acoustic Neuroma?

A

Absent corneal reflex

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55
Q

What specific symptom(s) would a patient present with if CNVII was involved in an Acoustic Neuroma?

A

Facial palsy

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56
Q

What is a bilateral acoustic neuroma associated with?

A

Neurofibromatosis Type 2

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57
Q

What is the management of an Acoustic Neuroma?

A

Urgent ENT Referral
MRI of cerebellopontine angle
Audiometry

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58
Q

What is Otosclerosis?

A

Describes the replacement of normal bone by vascular spongy bone in the ear

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59
Q

What is the treatment of Impacted Ear Wax?

A
  • Olive oil, Sodium Bicarbonate 5%, Almond oil

- Ear irrigation / ear syringing

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60
Q

Why is there conductive hearing loss in Otosclerosis?

A

Because the stapes fixes onto the oval window

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61
Q

What event may precipitate Otosclerosis?

A

Pregnancy

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62
Q

What is the inheritance pattern of Otosclerosis?

A

Autosomal dominant

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63
Q

What is the management of Otosclerosis?

A

Hearing aid

Stapedectomy

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64
Q

What are symptoms of Impacted Earwax?

A

Pain
Conductive hearing loss
Tinnitus
Vertigo

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65
Q

What is a Cholesteatoma?

A

Non-cancerous growth of squamous epithelium, trapped within the skull base, causing local destruction

66
Q

What is the prognosis of a Pre-auricular sinus

A
  • If small → Require no treatment

- If large → May become blocked, require surgical excision → but risk of recurrence

67
Q

What are the main features of Cholesteatoma?

A

Foul-smelling, non-resolving discharge

Hearing loss

68
Q

What is Meniere’s Disease?

A
  • A disorder of the inner ear with an unknown cause

- Characterised by excessive pressure and progressive dilatation of endolymphatic system

69
Q

What are the clinical features of Meniere’s Disease?

A
  • Recurrent episodes of vertigo, tinnitus, sensorineural hearing loss
  • Sensation of aural fullness
  • Nystagmus
70
Q

What is a pre-auricular sinus?

A

Commonly congenital condition, due to defect in 1st and 2nd pharyngeal arches

71
Q

What is Romberg’s test used to assess?

What does a positive Romberg’s and a negative Romberg’s mean?

A

Used to assess the cause of a patient’s ataxia

  • If ataxic and Romberg’s positive - Sensory ataxia
  • If ataxic and Romberg’s negative - Cerebellar ataxia
72
Q

How do you perform Romberg’s test?

A
  1. The subject stands with feet together, eyes open and hands by the sides
  2. The subject closes the eyes while the examiner observes for a full minute

If patient falls over when eyes are closed, Romberg’s positive

73
Q

What is the prognosis of Meniere’s Disease?

A
  • Symptoms resolve in between 5-10 years

- Majority of patients will be left with a degree of hearing loss

74
Q

What test can be used to confirm Meniere’s Disease?

A

Romberg’s test

75
Q

How is Meniere’s Disease managed?

A
  • ENT assessment required for diagnosis
  • Acute attacks → Buccal / IM Prochlorperazine
  • Prevention → Betahistine / Vestibular rehabilitation
76
Q

What would you find on a HINTS exam for Labyrinthitis?

Any other features?

What may you find on Otoscopy?

A
  • Abnormal head impulse test: signifies an impaired vestibulo-ocular reflex
  • Unidirectional horizontal nystagmus → unaffected side
  • Normal skew test
  • Gait disturbance: the patient may fall towards the affected side
  • Sensorineural hearing loss: shown by Rinne’s test and Weber test
  • Abnormality on inspection of the external ear canal and the tympanic membrane e.g. vesicles in herpes simplex infection
77
Q

What is Vestibular Neuronitis?

A

A cause of vertigo that develops after a viral infection

78
Q

How can Vestibular Neuritis be differed to Labyrinthitis?

A
  • Vestibular neuritis → Only vestibular nerve involved → No hearing impairment
  • Labyrinthitis → Both Vestibular nerve and Labyrinth involved → Vertigo and hearing impairment
79
Q

What are the features of Labyrinthritis?

A
  • Vertigo (not triggered by, but EXACERBATED BY movement)
  • Hearing loss (may be bilateral or unilateral)
  • Tinnitus
  • Previous or current symptoms of viral infection
80
Q

What are the features of Vestibular Neuronitis?

A
  • Vertigo attacks
  • Nausea and vomiting may be present
  • Horizontal nystagmus
  • NO HEARING LOSS OR TINNITUS
81
Q

What is a differential for Vestibular Neuronitis?

A
  • Viral labyrinthitis

- Posterior circulation stroke

82
Q

What is the management for patients with severe vestibular neuronitis symptoms?

A

Buccal / IM Prochlorperazine

83
Q

What is the management for patients with mild Vestibular Neuronitis symptoms?

A
  • Short course of oral prochlorperazine

- Anti-histamine

84
Q

What is the most common cause of Vertigo experienced?

A

Benign Positional Paroxsymal Vertigo

85
Q

Features of BPPV?

A
  • Vertigo triggered by change in head position (e.g. rolling over in bed)
  • Nausea
  • Each episode typically lasts 10-20 seconds
86
Q

What is the management of BPPV?

A
  • Usually resolves spontaneously after a few weeks - months
  • Epley manoeuvre (successful in 80% of cases)
  • Vestibular rehabilitation exercises i.e. Brandt-Daroff exercises
  • Betahistine is of limited benefit
87
Q

What is Ramsay Hunt Syndrome?

A

Reactivation of VZV in the geniculate ganglion of CNVII

88
Q

How is Ramsay Hunt Syndrome managed?

A

Oral acyclovir

Corticosteroids

89
Q

What is Presbycusis?

A

A form of sensorineural hearing loss which affects the elderly population. Typically affects high frequencies bilaterally

90
Q

What are the features of Presbycusis?

A
  • Speech becoming difficult to understand
  • Need for increased volume on the television or radio
  • Difficulty using the telephone
  • Loss of directionality of sound
  • Worsening of symptoms in noisy environments
  • Hyperacusis: Heightened sensitivity to certain frequencies of sound (Less common)
  • Tinnitus (Uncommon)
91
Q

What is Tongue Tie also known as?

A

Ankyglossia

92
Q

What is Tongue Tie?

A

When a baby is born with a short and tight lingual frenulum

93
Q

What are problems associated with Tongue Tie?

A

Problems feeding i.e. latching onto breast

94
Q

What is the management of Tongue Tie?

95
Q

What is Labyrinthitis?

A

Inflammation of the membraneous labyrinth affecting both the vestibular and cochlear end organs

96
Q

What is the test which is used to help diagnose BPPV?

A

Dix-Halpike Manoeuvre

97
Q

What are the features of Ramsay Hunt Syndrome?

A
  • Otalgia (usually first symptom)
  • Facial nerve palsy
  • Vesicular rash around ear
  • Other features i.e. tinnitus / vertigo
98
Q

What may be visualised on Otoscopy in a patient with Ramsay Hunt Syndrome?

A

Vesicles in Tympanic Membrane

99
Q

If a patient mentions they feel dizzy, what questions can you ask to clarify it better?

A
  • Is it a spinning sensation (vertigo)?
  • Is it a feeling of imbalance (disequilibrium)?
  • Is it a light-headedness (giddiness)?
  • Is it a feeling of faint (pre-syncope)?
100
Q

How can Vertigo be categorised?

A
  • Central → arising from pathology in the brainstem or cerebellum
  • Peripheral → arising from pathology in the vestibular nerve or inner ear
101
Q

Give examples of peripheral vertigo disorders

A
  • Benign paroxysmal positional vertigo (BPPV)
  • Vestibular neuronitis
  • Labyrinthitis
  • Ménière’s disease
102
Q

Give examples of central vertigo disorders

A
  • Stroke of the posterior circulation
  • Multiple Sclerosis
  • Medication toxicity
  • Trauma
  • Posterior fossa brain tumours
  • Migraine
103
Q

What exam differentiates between a peripheral and central vertigo?

A

HINTS exam

104
Q

What are the three components of the HINTS exam?

A
  1. Head Impulse test
  2. Nystagmus test
  3. Test of Skew
105
Q

On what set of patients can the HINTS exam be performed?

A
  • If persistent vertigo over hours or days
  • Nystagmus
  • A normal full neurological examination
106
Q

Outline the HEAD IMPULSE TEST component of the HINTS exam

A
  • Whilst they’re focusing on your nose, move the patient’s head side-to-side rapidly and then back to the midline
  • If there is a disruption to the vestibular-ocular reflex, so eyes move with head and then saccade back, this is called “corrective saccade” and POSITIVE HEAD IMPULSE TEST
  • If there is NO disruption to the vestibular-ocular reflection, this is termed a “normal” and in a patient with vertigo this would suggest a central cause
107
Q

Outline the NYSTAGMUS component of the HINTS exam

A
  • Observe the patient’s gaze when they are looking directly ahead, and then ask the patient to left and right without fixating on an object
  • If unidirectional nystagmus → Peripheral cause (reassuring)
  • If bidirectional nystagmus → Central cause, highly specific for stroke
108
Q

Outline the TEST OF SKEW component of the HINTS exam

A
  • Telling the patient to focus on your nose, cover and uncover the patient’s eyes
  • If there is no vertical skew → Reassuring → Peripheral vertigo
  • If there is vertical skew → Worrisome → Central vertigo
109
Q

What is an Acoustic Neuroma?

A
  • A slow growing, benign intra-cranial tumour of the myelin forming cells of CNVIII
110
Q

Are symptoms of Meniere’s Disease bilateral or unilateral? How long do episodes last for?

A

Usually unilateral, however will progress to bilateral in a few years. Episodes last for minutes to hours

111
Q

What is the first hearing test performed on a newborn called?

A

Otoacoustic emissions test

112
Q

Outline the Otoemissions acoustic test?

A

A computer generated click is played through a small earpiece. The presence of a soft echo indicates a healthy cochlea

113
Q

If the Otoacoustic emissions test is abnormal, what may be performed?

A

Audiometry brainstem response test (ABRT)

114
Q

How do you perform Rinne’s Test? What is a normal result?

A
  • With a 512Hz tuning fork, strike it and place it on the mastoid process
  • Instruct the patient to tell you once they can no longer hear it. After they say they cannot, place it close to the pinna. They should be able to hear it again
115
Q

Rinne’s test is a test of what?

A
  • Conductive hearing
116
Q
  • With respect to the Rinne, what is normal with respect to air and bone conduction and would suggest conductive hearing loss?
A
  • Whereby air conduction > bone conduction

- Conductive hearing loss: When bone conduction > air conduction

117
Q

How do you perform Weber’s test? What is a normal result?

A
  • Strike a 512Hz tuning fork, and place it in the centre of the forehead. Instruct the patient tell you whether they hear it best in the centre or left or right
  • They should be able to hear it in the centre
118
Q

Weber’s test is a test of what?

A
  • Sensorineural hearing loss
119
Q
  • What does it mean in Weber’s, when the patient says they hear it better on the right hand side?
A
  • Sensorineural hearing loss on the left hand side, or conductive hearing loss on the right hand side
120
Q

What is plotted on the X and Y axis of Audiometry?

A
  • X axis: Frequency (Hz)

- Y axis: Hearing threshold level (dB)

121
Q

If a patient has normal hearing, their readings for each frequency will plot at which dB?

A
  • All readings will plot between 0 and 20 dB
122
Q

What symbols are used in audiometry to denote bone and air conduction in the left and right ears?

A
  • X– Left sided air conduction
  • ]– Left sided bone conduction
  • O– Right sided air conduction
  • [– Right sided bone conduction
123
Q

In a patient with sensorineural hearing loss, what are the air and bone conduction recordings on audiometry?

A
  • In sensorineural hearing loss, both air and bone conduction readings will be above 20 dB (plotted below 20 dB on chart)
124
Q

In a patient with conductive hearing loss, what are the air and bone conduction recordings on audiometry?

A

Bone conduction readings will be normal (between 0 and 20 dB), however air conduction readings will be greater than 20 dB

125
Q

In a patient with mixed hearing loss, what are the air and bone conduction recordings on audiometry?

A
  • In patients with mixed hearing loss, both air and bone conduction readings will be more than 20 dB, however there will be a difference of more than 15 dB between the two (bone conduction > air conduction)
126
Q

Give examples of drugs which are Ototoxic?

A
  • Aminoglycosides i.e. Gentamicin, Tobramycin, Streptomycin
  • Loop diuretics i.e. Furosemide
  • Platinum based Chemotherapy i.e. Carboplatin, Cisplatin, Vincristine
  • NSAIDs (some), Aspirin
  • Quinine
127
Q

What is a Cystic Hygroma?

A

A cystic hygroma is a malformation of the lymphatic system that results in a cyst filled with lymphatic fluid

128
Q

Where is a Cystic Hygroma commonly found?

Where else can they present?

A
  • Typically located in the posterior triangle of the neck on the left side
  • May also present in the armpit
129
Q

What are the features of a Cystic Hygroma?

A

Large, soft, non-tender, transilluminates

130
Q

When do Cystic Hygromas present?

A

90% before the age of 2

131
Q

What is the management of a Cystic Hygroma?

A
  • Aspiration can provide temporary relief

- Surgical removal or sclerotherapy

132
Q

What is a Thyroglossal Cyst, and how does it form?

A
  • During fetal development, the thyroid gland starts at base of tongue. It then travels down the neck to its final position in front of the trachea, beneath the larynx. It leaves a track behind called the thyroglossal duct, which then disappears
  • When part of the thyroglossal duct persists it can give rise to a fluid filled cyst. This is called a thyroglossal cyst
133
Q

What is a differential for a Thyroglossal Cyst?

A

Ectopic thyroid tissue

134
Q

Where is a Thyroglossal Cyst commonly found?

A
  • Located along the path of the thyroglossal duct

- Usually midline, between the isthmus of the thyroid and the hyoid bone

135
Q

What are the features of a Thyroglossal Cyst?

A
  • Moves upwards on protrusion of tongue

- Mobile, non-tender, soft, non-fluctuant

136
Q

What are the investigations / management of a Thyroglossal Cyst?

A
  • CT / Ultrasound for diagnose

- Surgical removal

137
Q

What is a Branchial Cyst?

A
  • A branchial cyst is a benign, developmental defect of the branchial arches (usually the second arch)
138
Q

Where are Branchial Cysts commonly found?

A

Angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck

139
Q

What is a branchial cyst made up of? What is it filled up with?

A

Acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium

140
Q

What are the features of a Branchial Cyst? What are important non-features?

A
  • Unilateral, typically on the left side, slowly enlarging, smooth, soft, fluctuant, non-tender
  • NO movement on swallowing, NO transillumination
141
Q

What is a Dermoid Cyst?

A

A cyst which develops at the site of embryonic developmental fusion

142
Q

Where are Dermoid cysts commonly found?

A

Midline of the neck, external angle of the eye, posterior pinna of the ear

143
Q

What is a Dermoid cyst made up of?

A
  • Structures such as hair, fluid, teeth, or skin glands

- Heterogeneous appearances on imaging and contain variable amounts of calcium and fat

144
Q

Compare and contrast anterior and posterior nose-bleeds

A
  • Anterior → More common, originates from Kiesselbach’s plexus (Little’s area), and will be unilateral, will bleed less profusely, more common in children / adults
  • Posterior → Less common, originates posteriorly, lesser risk of aspiration, may be bilateral, will bleed more profusely, more common in elderly
145
Q

If the nasal septum appears atrophied / abraded, what should you ask and why?

A
  • Enquire about drug use because cocaine is a potent vasoconstrictor
146
Q

What congenital conditions / conditions of the young are associated with Epistaxis?

A
  • Thrombocytopaenia
  • Splenomegaly
  • Leukaemia
  • Waldenstrom’s macroglobulinaemia
  • ITP
147
Q

What adolescent conditions are associated with Epistaxis?

A
  • Juvenile angiofibroma
148
Q

What adult conditions are associated with Epistaxis?

A
  • Pyogenic granuloma
  • Hereditary haemorrhagic telangiectasia
  • Granulomatosis with polyangiitis (Wegener’s)
149
Q

How do you manage a nose bleed in a patient who is haemodynamically stable?

A
  • Sit up and tilt the head forwards. Tilting the head backwards is not advised as blood will flow towards the airway
  • Squeeze the soft part of the nostrils together for 10 – 15 minutes
  • Spit any blood in the mouth out rather than swallowing
  • After treating a nosebleed consider prescribing naseptin (chlorhexidine and neomycin) four times daily for 10 days to reduce any crusting, inflammation and infection
150
Q

What do you do if a nose bleed persists after 15 mins, or they are hemodynamically unstable?

A
  • Consider hospital admission

- Consider nasal cautery (nasal tampons / inflatable packs) or nasal packing (silver nitrate stick)

151
Q

When might nasal packing be used over nasal cautery and vice versa?

A
  • Use cautery when source of bleeding is visible and is well tolerated
  • Use nasal packing when cautery is not possible or source of bleeding cannot be found
152
Q

What is an Infantile / Strawberry Haemangioma?

A

A vascular, benign tumour which present in the first few weeks - months of life in babies

153
Q

Describe an Infantile Haemangioma?

A

Multi-lobular, raised, erythematous

154
Q

Where do Infantile Haemangiomas present?

A
  • Commonly on the face, neck, back
155
Q

What is the prognosis of Infantile Haemangiomas?

A

Typically they increase in size until around 6-9 months before regressing over the next few years (95% resolve before 10 years old)

156
Q
  • What are complications of Infantile Haemangiomas?
A
  • Mechanical i.e. can physically obstruct airways or visual fields
  • Bleeding
  • Ulceration
  • Thrombocytopenia
157
Q

What are risk factors which increase the likelihood of Infantile Haemangiomas?

A
  • White ethnicity, female, premature infants

- Mothers who’ve undergone CVS

158
Q

If the Infantile Haemangioma is obstructing, what is the management?

A

Topical beta-blocker such as Timolol

159
Q

What is the name given to a Deep Capillary Haemangioma?

A

Cavernous Haemangioma

160
Q

Naseptin (Chlorhexidine and Neomycin) is contraindicated in which sets of patients?

A

Those with peanut or soya allergy

Medicine, Year 4, Paediatrics (16 decks)

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