EENT Flashcards
Viral/bacterial versus allergic conjunctivits presentation
Viral/bacterial= PAINFUL red eyes, gritty eyes no visual change
Allergic= always bilateral, itching
Presentation of chlamydial versus gonoccal opthalmia neonatorum
Gonococcal- within 48 hours get discharge, conjunctivits and swelling eyelids
Chlamydia- 1-2 weeks of life get discharge, conjunctivitis, swelling eyelids and !pneumonia!
Gold standard investigations for different conjunctivitis
- viral
- bacterial
- gonoccoal
- chlamydia
Viral- adenovirus immunoassay
Bacterial- swab MC&S
Gonoccal- gram stain and culture
Chlamydia- immunofluorescent staining
First investigation when swollen eyes
Urine dip to check for protein
Complications of otitis media
Perforation
Mastoiditis
Meningitis
Abscesses
Recurrences
Most common causes of AOM
RSV or rhinoviruses
Strep p
Hib
Management of AOM
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
When admit for AOM
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
Antibiotics for AOM
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
Management of AOM with tympanic membrance perforation
Oral amoxicillin and review in 6 weeks to check healing
If downs or cleft palate refer
What is choanal atresia
When nasal passages fail to form
Can be unilateral or bilateral
Management of choanal atresia
Unilateral- none
Bilateral- surgical
Difference in presentation of unilateral versus bilateral choanal atresia
Unilateral- asymptomatic or rhinorrhoea
Bilateral- choking when feeding, cyanosis when feeding, relieved by crying
What presents with choking on feeding, cyanosis on feeding and relieved by crying
Choanal atresia
Most common cause of stridor in infants
Laryngomalacia
What hearing test is done in newborns
Otoacoustic emission test- can be done up to 3 months
What is hearing test do if otoacoustic emission test shows problem
Brainstem auditory response
What is a squint
Misalignment of the eyes- common up to 3 months of age
Management of squint
Check red reflex
If over 3 months refer to opthalmologist
What are the 2 types of squint
Concomitant- one eye diverges typically inwards
Paralytic- varies with gaze direction
Which type of squint are most concerned about
Paralytic- varies with gaze direction due to paralysis of motor nerves
Suggests SOL
What covers outer middle and inner ear
Outer ear- outside and most of ear canal
Middle- tympanic membrance
Inner- eustachian tube
Presentation of otitis externa
Irritable
Otalgia getting worse
Ottorhoea
Ear fullness with hearing loss
Tinnitus
Itchy
RIsk factors for otitis externa
Females
Swimmer
Eczema and psoriasis
Foreign body in ear