Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MODULE 1: NEONATES + INFANCY > ENT > Flashcards

ENT Flashcards

1
Q

OSA symptoms in children? ALWAYS ask these symptoms in SNORERS

A

snoring paradoxical chest movement apnoeas (usually hypopnoeas ) restlessness cough / choking / gagging (esp in sleep) / reflux enuresis waking frequently daytime tiredness SEVERE Sx - cyanotic episodes, failure to thrive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

normal physiology of adenoids in children

A

adenoids located at back of nose - enlarge age 3-4 then involute by age 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are nasal obstructive symptoms + causes

A

SNORING (normal ~10% habitually, 20% intermittently - largely due to adenoids - other causes: allergic rhinitis, septal deviation - rarely: FB, macroglossia, max hypoplasia etc - will improve as child grows + adenoid involutes - HOWEVER, chronic nasal obstruction will affect maxillary growth → high arched palate + narrow dental arch CHRONIC MOUTH BREATHING HYPONASALITY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SNORING Mx?

A

Do nothing - most kids outgrow it if due to adenoids CONSERVATIVE - trial 1 month of topical steroid eg: Rhinocort - trial 1 month of low dose ABx (incase due to adenoiditis) SURGICAL - adenoidectomy if loud + chronic + due to large adenoids (could be the turbinates!) IF due to inferior turbinates (snuffly nose of newborn) - Rx w saline drops, vasoconstrictor drops (eg: Drixine) + topical steroids eg: Rhinocort ALTERNATING for 3 - 6 weeks w tapering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Allergic rhinitis Sx/Mx

A

snoring, itch, sneezing associated strongly w asthma - most allergic to house dust mites (worse in mane) Mx - house dust mite protectors for pillow +/- other bedding - rhinocort/nasonex - De-mister (for children >12 yo) - has anti-histamine + steroid - salt water spray (FESS) - gets rid of some of the histamine +/- anti-histamine nasal spray (often added initially to gain control then stopped) +/- oral anti-histamine (esp if children dont tolerate nasal spray) eg: clarytine SURGERY - for reduction of inferior turbinates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

OSA in children features + Ix

A

a more common reason for T&A prevalence 2%, peak age 2 - 5yo T&A cure for most, but w complex craniofacial issues etc → it improves it SEVERE Sx - cyanotic episodes, failure to thrive RF - 63% of Downs syndrome children have OSA (recommend annual sleep studies in these children due to risk on heart/neurological) O/E - FTT vs obesity - cold metal fogging pattern either nasal opening - tonsil size OSA consequences - growth (sleep effects disordered GH release → FTT) - daytime performance (school issues, 40% behaviour changes either end of spectrum, developmental delay) - cardiac (eg: cor pulmonale) - neurological VIDEO (eg: crescendo snoring then stops ) hyperextending neck Ix +/- lateral XR (for adenoids) +/- has-endoscopy (adenoid size) +/- sleep study – borderline Sx, possible central component (eg <2yo), other abnormalities, at parents request – apnoea >1/hypopnea >5 index is abnormal in children (for 6 seconds or 1.5 to 2 breaths), O2 <92%, highest CO2 lvl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When to refer to ENT re: OSA

A

Snoring - if loud and chronic mouth breather if OSA symptoms or suspected if sleep study shows OSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

OSA Mx

A

OSA tonsillectomy + adenoidectomy - cures majority of children - helps kids w other issues eg: craniofacial abnormalities post tonsillectomy care - pain relief - up to 4% bleeding risk in first 2 weeks post op (need to not be far away from hospital) Other - CPAP - craniofacial surgery, palate surgery - septoplasty/tracheostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tonsilitis features

A

peak incidence age 5-8 yo Predisposed if - prev recurrence, Lowrys resistance, viral phargynitis ETIOLOGY Viral (50 -85%) - EBV, adenovirus, echovirus, simplex, coxsacie, measles, varicella etc Bacterial (15- 50%) - Beta haemolytic strep - staph aureus - pneumococci - H.influenza etc (corynaebacterium diphtheriae) SYMPTOMS - sore throat - fever - dysphagia - odynophagia - hot potato voice - malaise in young kids - ear ache, stomach ache, vomiting Pseudomembrane (grey fishy) - diphtheria + EBV (IMN) Other signs - cellulitis uf uvula/soft palate - petechiae (coxackie/IMN) - lymphadenopathy (hepatosplenomegaly in IMN) inflamed lingual tonsils - hot potato voice (painful if protrude tongue)

-trismus if quinsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MODIFIED CENTAUR score for if tonsillitis due to GBS

A

one point for:

temp >38

tender cervical lympadenopathy

enlarged tonsils or exudate

NO cough age 3 to 14 (age = minus if over 44)

score 4 or more = >50% chance GBS score 2-3 = 20 - 35% GBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tonsilitis complications

A

OSA quinsy - abscess outside tonsil btw phargyngeal muscles + tonsil - extremely painful - 20% 1st recurrence rate, 50% 2nd recurrence rate - so offer tonsillectomy Retro or para-phargyneal abscess (as spreads to LNs) Suppurative cervical adenitis subacute bacterial endocarditis Lemierre’s syndrome (anaerobes w symptoms of tonsillitis but can get thrombosis of internal jugular vein) Tonsilloliths Tonsil cyst tonsil haemorrhage Scarlet fever rheumatic fever (0.5/100,00 in western society vs 650/100,000 in aboriginal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tonsilitis Ix

A

usually none THROAT SWAB - tells us if bacterial BUT may not show causative organism (INSIDE tonsil) strep carrier rate 40% pop surface organism dont necessarily represent core BLOODS - FBE, monosopt, serology for EBV (LFTs) ASOT (antistreptolysis O titre) Rapid strep test - 75 - 80% sensitive, Dx within 5-10 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tonsilitis Mx

A

TLC - bed rest, fluids, panadol antibiotics - penicillin, if failed, augmentin - if allergic erythromycin, or clindamycin (has good anaerobic cover) steroids if IMN (1-2 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

infectious mononucleosis (IMN) features + Mx

A

often presents w tonsilitis lymphadenopathy, palpable spleen/liver monospot/FBE w differential (+/- EBV IgM + IgG tires) Rx - TLC - steroids stat dose - penicillin for secondary bacterial infection (amoxil causes a rash w IMN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

INDICATIONS FOR TONSILLECTOMY + C/I

A

OSA Suspected malignancy (unilateral enlargement) recurrent tonsilitis - 6 attacks in 1 year - 4-5 attacks per year for 2 years - 3 attacks per year for 3 years NB: consider severity off attacks, response to treatment, complications of episodes, general health chronic tonsilitis peritonsilar abscess/quinsy (20% recurrence risk w 1st) systemic infection a/w tonsilitis C/I bleeding diathesis acute infection (higher bleeding risk) lack of facilities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Complications of tonsillectomy

A

Haemorrhage - 1-4% chance within 1st 2 weeks voice change (resonance chamber) eg: if professional singer

17
Q

Types of stridor

A
18
Q

Largynomalacia

A

very common in children

FEATURES

  • inspiratory stridor
    • as get excited or at rest or constant
  • onset: 1-2 months, outgrow @ 18 months
  • most parents just need reassurance
  • if FTT, cyanotic episodes, difficulty feeding - then surgery

tall, omega shaped epiglottis

short aryglottic folds + tal areutenoids

posteriorly placed epiglottis

19
Q
A
20
Q
A

all of the above

21
Q
A
22
Q
A
23
Q

definition recurrent AOM + Rx

A

3+ AOM in 6 months

or 4 AOM in 1 year

or complications

Rx

if recurrent within 1 month → Rx broader spectrum ABx (likely to be resistant)

if 3+ episodes or complications

  • Abx: low dose for 1 month, if STILL recurrent → grommets
24
Q
A
25
Q

Causes of conductive hearing loss?

A

wax

exostoses

otitis externa

FB

atresia

stenosis

26
Q

Tell me about otitis externa

A

Swimmers ear

common organisms - pseudomonas, staph aureus

features

very painful, smelly ear

swelling of skin external aud cannal

Ix

swab MCS + fungal culture

Rx

keep ear dry when washing/swimming (cotton wool + vasaline or blue tack)

clean debris (tissue spears, Ear Clear- has peroxide component which bubbles ear wax ot)

topical ear drops ciloxin or ciproxin HC (steroid component)

if suspect concurrent otitis media → Rx w PO ABx (augmentin)

NB: if suspect perforation OR pt has grommets in situ → dont use ciproxin HC as preservative can be toxic to middle/inner ear. Ciloxin safe.

if fungal otitis media

black spores - aspergillus nigra

wet blotting paper - candida

itchy, generally not very painful

conductive hearing loss

Rx

topical antifungals

  • IF EAR DRUM INTACT:locacortin-viofrom drops, nilstrat, kenacomb (antifungal, candida, bacterial, steroid)

keep ear dry, can take ~1 month to settles

27
Q

What pathologies in the middle ear cause conductive hearing loss (CHL)?

A
  • glue ear (otitis media w effusion)
  • perforation
  • ossicular chain disruption or fixation eg: tympanosclerosis
  • mass in middle ear
  • acquired cholesteatoma
28
Q

OME - features, Ix, when to treat, Cx, Mx

A

OME

  • very common, esp daycare ~80% preschool children
  • 50% get OME post episode of AOM
  • most resolve spontaneously - 60% cleared by 1 month, 90% cleared by 3 months
  • if OME >3 months = chronic and needs Mx
    • biofim created, often polymicrobial

RF

  • season
  • FHx
  • URTI
  • cleft palate/downs syndrome, muscopolysaccharidoses
  • childcare centres

O/E

dull drum, amer fluid behind, airlfuid lvlsdrum retraction or bulging

pneumatico-otoscopy useful to see if drum moves (absent movment)

or tympanometry (flat line)

Chronic OME = > 3 months → risk of complications

  • hearing loss
    • behavioural difficulties
    • speech delay *controversial
  • damage to drum → secondary damage to ossicles/erosion
  • drum retraction (precursor to cholesteatoma)

Mx

antibiotics - full orlow dose (daily dose of abx) for 1 month to remove biofilm

DONT use steroids

otovent to drain ET

if drum retraction = atelectasis

  • grommets if drum retracted but not stuck down
  • surgery: exploration, dissection of drum off ossicles
29
Q

When to treat OME?

A

persistent bilateral OME w effusion present for >3 months

WITH

bilateral hearing loss OR damage to drum or ossicles

30
Q

How do grommets work?

A

allow aeration of middle ear

  • stops negative middle ear pressure
    • stops bugs tracking up from nose (as vacuum removed)
    • stops TM retraction + Cx from this
  • aeration reverses metaplasia
    • ie: 80% goblet cells (creating mucoid) return to 20% goblet cells
  • O2 tension, disrupts biofilm

20% of kids will need second set of gromets

last 6-18mo

keep dry

small chance perforation + retention

they will come out themselves

shouldnt have discharge through grommet

31
Q
A
32
Q

Cx of AOM

A

Cx of AOM

  • facial palsy (need to drain middle ear + insert grommet + ABx)
  • mastoiditis → abx if early, surgery
  • TM perforation
  • labrynthitis
  • abscesses (brain, sub+extradurral)
  • lateral sinus thrombosis
  • meningitis
33
Q

AOM features + Mx

A

AOM

peak incidence: 6 - 12 months, smaller peak 4 to 5yo

common (2/3 of children by age 3, 50% have 3+ episodes by age 3)

cant tell if bacterial or viral, but most are bacterial ( s.pneumo, Hib, moraxella, 25% viral

features (can progress VERY quickly)

  • fever
  • erythema in TM w bulging pus behind it

painful → 60% painfree in 24hrs w/o Abx

hearing loss

Rx

watch an wait w most pt before Rx, EXCEPT FOR

children <2 yo (complications hrder to pick up)

if pt unlikely to come back for F/U in next few datys

cochlear implant children

Abx choice

  • amoxil, augmentin, ceclor (shorter courses <5 days have more treatment failures.relapses = re-infections than longer 8 to 10 day courses)

less AOM -. chronic OME w conjugate penumococcal vaccine (prevenar) - ;)

34
Q

TM perforation

A

better outcomes if in middle of TM

per

If acute perf - likely to heal on own

  • keep dry to prevent contamination
  • F/U in 1-3 months

Myringoplasty (patch hole)

hearing aid (if conductive loss)

35
Q

When to refer OME/ recurrent AOM to ENT?

A
  • OME - bilateral for >3 months, w hearing loss or drum changes
  • Speech/language delay or cognitive issues w OME
  • Frequent episodes AOM 3-4 per 6 months
  • chronic ear discharge (needs cholesteatoma ruled out)
  • unusual otoscopic findings eg: atelectasis of drim or if suspect cholesteatoma
  • hearing loss w possile sensori-neural component
36
Q

cholesteatoma

A

often occurs at ant-sup segment

presenting features

  • CHL
  • chronic ear discharge
  • polyp
  • scaly skin from one area of drum
  • deep retraction pocket that cant see edges of

recurrent ear infections

O/E old dry skin, attic retraction

Ix: CT scan (specific slices), audiogram

Mx: surgical removal (tympanoplasty, mastoidectomy)

37
Q
A

all of the above

MODULE 1: NEONATES + INFANCY (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions