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EENT Flashcards

1
Q

Viral/bacterial versus allergic conjunctivits presentation

A

Viral/bacterial= PAINFUL red eyes, gritty eyes no visual change
Allergic= always bilateral, itching

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2
Q

Presentation of chlamydial versus gonoccal opthalmia neonatorum

A

Gonococcal- within 48 hours get discharge, conjunctivits and swelling eyelids
Chlamydia- 1-2 weeks of life get discharge, conjunctivitis, swelling eyelids and !pneumonia!

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3
Q

Gold standard investigations for different conjunctivitis
- viral
- bacterial
- gonoccoal
- chlamydia

A

Viral- adenovirus immunoassay
Bacterial- swab MC&S
Gonoccal- gram stain and culture
Chlamydia- immunofluorescent staining

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4
Q

First investigation when swollen eyes

A

Urine dip to check for protein

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5
Q

Complications of otitis media

A

Perforation
Mastoiditis
Meningitis
Abscesses
Recurrences

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6
Q

Most common causes of AOM

A

RSV or rhinoviruses
Strep p
Hib

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7
Q

Management of AOM

A

Admit if needed
Paracetamol and NSAID recommendation
Fluids advice
In patients very unwell then give abx
In patients who may benefit from abx (bilateral infection under 2 or otorrhoea) give immediate course, back-up course or no abx
In patients less likely to benefit from abx either back-up course or no abx
MAINLY TREAT IF COURSE GREATER THAN 3 DAYS

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8
Q

When admit for AOM

A

Severe systemic infections
Complications
Younger than 3 months and fever over 38
Consider
- under 3 and fever under 38
- 3-6months with fever over 39

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9
Q

Antibiotics for AOM

A

1st line- amoxicillin
2nd line/penicillin intolerant- macrolide
If does not respond in 2-3 days use co-amox and in this scenario if penicillin allergic seek micro advice

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10
Q

Management of AOM with tympanic membrance perforation

A

Oral amoxicillin and review in 6 weeks to check healing
If downs or cleft palate refer

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11
Q

What is choanal atresia

A

When nasal passages fail to form
Can be unilateral or bilateral

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12
Q

Management of choanal atresia

A

Unilateral- none
Bilateral- surgical

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13
Q

Difference in presentation of unilateral versus bilateral choanal atresia

A

Unilateral- asymptomatic or rhinorrhoea
Bilateral- choking when feeding, cyanosis when feeding, relieved by crying

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14
Q

What presents with choking on feeding, cyanosis on feeding and relieved by crying

A

Choanal atresia

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15
Q

Most common cause of stridor in infants

A

Laryngomalacia

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16
Q

What hearing test is done in newborns

A

Otoacoustic emission test- can be done up to 3 months

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17
Q

What is hearing test do if otoacoustic emission test shows problem

A

Brainstem auditory response

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18
Q

What is a squint

A

Misalignment of the eyes- common up to 3 months of age

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19
Q

Management of squint

A

Check red reflex
If over 3 months refer to opthalmologist

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20
Q

What are the 2 types of squint

A

Concomitant- one eye diverges typically inwards
Paralytic- varies with gaze direction

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21
Q

Which type of squint are most concerned about

A

Paralytic- varies with gaze direction due to paralysis of motor nerves
Suggests SOL

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22
Q

What covers outer middle and inner ear

A

Outer ear- outside and most of ear canal
Middle- tympanic membrance
Inner- eustachian tube

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23
Q

Presentation of otitis externa

A

Irritable
Otalgia getting worse
Ottorhoea
Ear fullness with hearing loss
Tinnitus
Itchy

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24
Q

RIsk factors for otitis externa

A

Females
Swimmer
Eczema and psoriasis
Foreign body in ear

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25
Q

Bacterial otitis externa on otoscopy

A

Narrow ear canal
Tympanic membrane not visible
Swollen and erythematous
Yellow and white crusted edge

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26
Q

Fungal otitis externa on otoscopy

A

Narrow ear canal
Tympanic membrane not visible
Swollen and erythematous
White and grey spores

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27
Q

Most common cause of otitis externa
List some other causes

A

Most common pseudomonas aeruginosa
- s aureus
- s epidermis
- aspergillus

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28
Q

Management of otitis externa

A

If very mild- Hygiene measures
- avoid swimming for 10 days
- dont clean ears
If more severe
- topical antibiotic/antifungal with or without topical corticosteroids
If immunocompromised or severe infection
- oral flucloxacillin

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29
Q

Difference in management of bacterial versus fungal otitis externa

A

Bacterial- neomycin drops for 10-14 days
Fungal- clotrimazole drops for 6 weeks

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30
Q

3 main complications of AOM

A

Tympanic membrance perforation
Mastoiditis
Otitis media with effusion

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31
Q

How will tympanic membrane perforation present

A

Discharge from ear after baby became well

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32
Q

How does mastoiditis present

A

Bulging/protruding ear
Very red behind the ear

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33
Q

Management of acute mastoiditis

A

Refer immediately to ENT for IV abx
Abx ear drops
CT of petrous bone and brain
If very severe consider myringotomy or mastoidectomy

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34
Q

What is guideline for needing grommet in recurrent AOM

A

Grommet tube- allows ventilation between middle and inner ear

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35
Q

Causes of tympanic membrane perforation

A

Loud sounds
Head trauma
Infection
Foreign bodies

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36
Q

Management of tympanic membrane perforation

A

Small perforations- watch and wait
Large- surgical repair

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37
Q

Management of OME

A

Watchful waiting for 3 months recommended but still do hearing tests
- pure tone audiometry 3 months apart
- tympanometry
Determine if need referral to ENT

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38
Q

What is done if referred to ENT with OME

A

Non surgical
- hearing aids
- autoinflation
Surgical
- myringotomy or grommets
- adenoidectomy

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39
Q

Why is OME important

A

Hearing loss can cause speech development delay

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40
Q

If a child over 4 has a grommet tube put in what is done for them

A

Adenoidectomy too

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41
Q

What is a cholesteatoma

A

A granuloma
Where squamous epithelium migrates in the middle ear eating away at the bone and soft tissue

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42
Q

Presentation of cholesteatoma

A

Persistent smelly discharge which antibiotics do not help
Progressive hearing loss
Dizziness
Facial palsy

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43
Q

Cholesteatoma on otoscopy

A

Perforated ear drum
Dry skin like webs

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44
Q

How to investigate a cholesteatoma

A

Otoscopy
Diffusion weighted MRI

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45
Q

How is cholesteatoma managed

A

Mastoidectomy

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46
Q

Risks of cholesteatoma

A

Facial nerve palsy
Hearing loss
Spread of infection

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47
Q

How should foreign bodies be removed in ear

A

First try to remove self- is best chance
If not refer to ENT for removal with ENT microscope
If unsuccessful will need general anaesthetic as children can become very agitated

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48
Q

What things should be removed from ear immediately within 6 hours

A

Battery
Glue
Corrosive material

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49
Q

What things should be removed from ear on same day

A

Food matter
Insects

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50
Q

What things can be removed at next available appointment

A

Cotton buds
Beads
Inorganic harmless objects essentially

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51
Q

How does pinna haematoma present

A

Boggy bluish swelling of the pinna after contact sport or piercing

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52
Q

Management of pinna haematoma and why important

A

Urgent drainage under GA
Apply pressure dressing
Long term will lead to cauliflower ear

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53
Q

How are otoacoustic emission and auditory brainstem response carried out

A

Automated otoacoustic emission
- earpiece inserted and echo measured in microphone
Automated brainstem response
- electrodes on band aids placed on the babies head and sound played into babies ears, computer measures response

54
Q

When would you be concerned about nose bleeds in children

A

Under 2s as very rare then
Suggest abuse

55
Q

Risk factors for nose bleeds

A

Clotting disorders
Trauma
Male
Winter
Nasal allergies

56
Q

Mangement of nose bleed

A

ABCDE
Position with head held forward
If persists beyond 15 mins use topical lidocaine, adrenaline or transamic acid
If does not control can cauterise

57
Q

What is adenoidal hypertrophy

A

Adenoidal tissue sits at back of the nasal cavity
When exposed to allergens get hypertrophy

58
Q

Presentation of adenoidal hypertrophy

A

Persistent mouthy breathing
Hyponasal speech
OSA
Recurrent otitis media or OME

59
Q

Complication of adenoidal hypertrophy

A

Recurrent AOM and OME

60
Q

Management of adenoidal hypertrophy

A

If severe adenoidectomy
With or without tonsillectomy and grommet insertion

61
Q

presentation of allergic rhinitis

A

Swollen and itchy eyes
Runny nose
Tickly throat

62
Q

Allergens to allergic rhinitis

A

Pollen
Smoke
Dust
Spores

63
Q

What type of reaction is allergic rhinitis

A

Type 1 hypersensitivity- associated with being first born child, asthma and atopy

64
Q

Problems of allergic rhinitis

A

Concentration at school
Sleep affected

65
Q

How is diagnosis of allergic rhinitis confirmed

A

Skin prick test
Patch test

66
Q

What is rhinosinusitis

A

Acute inflammation of the nose and paranasal sinuses from rhinovirus

67
Q

How does rhinosinusitis present

A

Headache
Nasal obstruction
Rhinorrhoea with post nasal drip
Fever

68
Q

How is sinusitis diagnosed in children

A

Nasal blockage
Discoloured nasal drip anteriorly or posteriorly
Pain in face or headache

69
Q

When suspect bacterial sinusitis

A

Severe unilateral pain
Prurulent nasal discharge with unilateral predominance
Fever over 38

70
Q

What are causative agents of sinusitis

A

Rhinovirus
Coronavirus
Bacterial infection in 2% of cases

71
Q

When admit for sinusitis

A

Signs of meningitis
Focal neurology
Systemic infection
Intraorbital/periorbital infection

72
Q

Management of sinusitis if less than 10 days

A

No antibiotics
Use paracetamol or ibubrofen
Can consider nasal decongestant or washing with salt water

73
Q

Management of sinusitis if over 10 days

A

If over 12 prescribe high dose nasal corticosteroids (mometasone)
Consider back up antibiotics to be used if symptoms do not improve within 10 days
If severe illness or comlpications prescribe oral coamoxiclav

74
Q

Antibiotics given in sinusitis first line

A

Phenoxymethicillin for 5 days
If allergic or intolerant clarithomycin but can use doxy if over 12

75
Q

Second line abx if not responsive in first few days of sinusitis antiobtics

A

Co-amoxiclav

76
Q

What is difference between periorbital and orbital cellulitis

A

Orbital (also known as post septal) orginates from infection from frontal or ethmoid sinuses
Periorbital (preseptal) arises from infection of eye lids or nearby skin

77
Q

Complications of orbital and periorbital cellulitis

A

Cavernous sinus thrombosis
Erosion of orbital bones
Brain abscess
Meningitis

78
Q

What worried about especially in orbital cellulitis

A

Can result in compartment syndrome leading to optic nerve compression

79
Q

Management of orbital versus preiorbital cellulitis in terms of referral

A

Orbital- ENT
Peri- derm

80
Q

Presentation of orbital cellulitis

A

Prodrome URTI
Proptosis
Acute swelling of eye
Restricted eye movement- important to document throughout

81
Q

How should periorbital cellulitis be investigated

A

Swab
CT head

82
Q

Management of orbital cellulitis

A

Contrast CT scan of face
IV co-amoxiclav

83
Q

Management of periorbital cellulitis

A

Refer immediately
IV abx

84
Q

Management of nasal foreign body

A

Must be done in the same day as risk of lung inhalation
If cant be done in ED need to do under GA

85
Q

Pharyngitis versus tonsillitis examination

A

Pharyngitis- pharyngeal exudate and cervical lympahdenopathy
Tonsilitis- anterior cervical enlargement and tonsil exudate

86
Q

When to treat tonsilitis/pharyngitis

A

Do fever pain or centor
If FPAIN over 4 or centor over 3
Consider antibiotics- phenoxymethicillin
Lower threshold if increased risk of rheumatic fever, immunosuppressed or compromised

87
Q

Antibiotics for tonsillitis/pharyngitis

A

Phenoxymethicillin for 5 days
Clarithomycin if allergic for 5 days
Erythomycin if pregnant

88
Q

When refer with sore throat

A

Breathing difficulty
Abscesses or cellulitis
Suspected sepsis or kawasaki or diptheria

89
Q

What do in sore throat if on DMARD and carbimazole

A

Work out FBC
Withold drug until available

90
Q

When refer for tonsillectomy

A

7 episodes in a year
5 a year over 2 years
3 a year over 3 years

91
Q

Complications of tonsillitis

A

Local spread
- quinsy
- retropharyngeal abscess (under 5)
- parapharyngeal abscess
Rheumatic fever
Glomerulonephritis

92
Q

Complications of parapharyngeal abscesses

A

Mediastinitis
Venous thrombosis

93
Q

What is quincy and how identify on patient

A

Peritonsilar abscess

94
Q

How are parapharyngeal abscesses identified

A

Unilateral neck swelling

95
Q

Causes of pharyngitis

A

Viral diseases- flu and measles
EBV
Strep A
Typhoid
Cocksackie- HFM
Diphteria

96
Q

What do if post tonsillectomy bleed

A

Admit everyone to ENT
As risk of airway obstruction and shock
A-E
- lean head forward
- lidocaine/transexamic acid/adrenaline
- hydrogen peroxide gargles

97
Q

Classification of post tonsillectomy bleeds

A

Primary- within 10 days
Secondary- after 10 days

98
Q

Presentation of foreign body aspiration

A

Short sudden episode of resp distress, cyanosis then alright
Stridor
Unilateral wheezing

99
Q

Comlpications of foreign body aspiration

A

Airway obstruction
Lung abscess
Fistula formation

100
Q

What is stertor

A

Snoring
Much harsher compared to stridor

101
Q

How to diagnose foreign body inhalatoin

A

Lateral and AP chest X-ray
Ideally lateral

102
Q

Management of foreign body ingestion

A

Admit for period of observation then let go with safety net
- fever
- pain
- constipation over 24 hrs
- poor sleep, crying
Some objects will pass naturally but others will require surgical removal

103
Q

How does laryngomalacia present

A

Stridor worse when lying down
Difficulty breathnig
Poor oral intake/choking

104
Q

What is laryngomalacia

A

When larynx floppy or malformed
Usually present in first month of life and will resolve by 2 years

105
Q

When is laryngomalacia referred urgently

A

Neck and chest retractions
Apnoea events
Failure to thrive
Secondary heart or lung problems
Blue spells

106
Q

What is lymphadenitis

A

Enlargement of cervical lymph nodes secondary to inflam condition

107
Q

Presentation of lymphadenitis

A

Tired child off food
Enalrging neck lump
Tender
Hot erythematous

108
Q

What does fluctuant neck lump suggest

A

Abscess secondary to lymphadenitis

109
Q

Difference between sensorineural and conductive hearing loss

A

Sensorineural- lesion in cochlear or auditory nerve
Conductive- abnormalities of the middle ear

110
Q

Sensorineural causes of hearing loss

A

Genetic
Antenatal
- kernicterus
- congenital infection
- HIE
Post natal
- meningitis
- head injury

111
Q

Causes of conductive hearing loss

A

OME
Eustachian tube dysfunction
- downs
- cleft palate
Wax very rarely

112
Q

Prognosis of conductive versus sensorineural hearing loss

A

Sensorineural- does not improve and may progress
Conductive- intermittent or resolves

113
Q

Management of sensorineural hearing loss

A

Hearing aids
If does not work can use cochlear implant

114
Q

School management of hearing loss

A

If moderate impairment can be educated in school system but advised to sit at front
If profound will need to attend school for deaf children

115
Q

Management of allergic rhinitis

A

Avoid allergen and cetirizine
If very severe encourage desensitisation through graded exposure

116
Q

What is a myringotomy and grommet insertion

A

Myringotomy involves piercing hole through tympanic membrane and allowing fluid out
Grommet physical tube to allow fluid out

117
Q

Managment of a burst eardrum

A

Will heal by self
Advise about
- hot towels
- avoiding loud sounds
- blowing nose too hard
Safety net about signs of infection

118
Q

Side of neck swelling differentials in a child

A

Mumps- bilateral
Lymphadenitis
Lymphoma
Parapharyngeal abscess from tonsillitis

119
Q

When refer to opthal with conjunctivitis

A

Suspect herpetic
Opthalmia neonatorum
Unresponsive to treatment after a week
Suspect orbital or periorbital cellulitis

120
Q

Management of bacterial conjunctivits

A

Advise about handwashing
If severe chloramphenicol or fusidic acid drops
If not that bad can give back-up

121
Q

Management if re-attend with conjunctivitis symptoms not disappearing

A

Send swabs for adenovirus, herpes and cultures

122
Q

Management of suspected viral conjunctivits

A

Will resolve in 2 weeks
Warm dress with saline for symptoms
Send swabs if return to GP with symptoms

123
Q

When suspect herpetic conjunctivits

A

It causes a blepharoconjunctivitis typically
Ulcers on periocular skin
Refer to opthal

124
Q

Differentials for loss of red reflex

A

Cataracts
ROP
Retinoblastoma

125
Q

What do if OME persists beyond 12 weeks

A

Refer to ENT

126
Q

What is in fever pain

A

F- fever in last 24 hours
A- absence of cough
P- prurulent discharge
S- symptoms over 3 days
S- severe inflammation

127
Q

Management of different F-Pain scores

A

Under 2 do nothing
2-3- delayed antibiotics
4 or more- give abx

128
Q

What is otitis media with effusion

A

Where after infection get build up of fluid in middle ear space

129
Q

When can chemo be used instead of enucleation in retinoblastoma

A

No anterior chamber involvement
No glaucoma
No inflammation

130
Q

Main indications for giving antibiotics for AOM

A

under 2 and bilateral
Under 3 months
For over 3 days
Immunocompromised

Paeds (17 decks)

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