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Paeds > ENT > Flashcards

ENT Flashcards

1
Q

What is tonsillitis

A

Inflammation of the tonsils (mainly palatine)

Usually due to viral infection

Bacterial causes: group A strep, strep pneumoniae, haemophilus influenzae, staphylococcus aureus

Peak ages: 5-10, 15-20

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2
Q

Which lymphoid tissues make up Waldeyer’s tonsillar ring

A

Adenoids

Tubal tonsils

Palatine tonsils

Lingual tonsils

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3
Q

How might a patient with tonsillitis present

A

Fever

Sore throat

Pain swallowing

Non-specific symptoms in children: fever, poor oral intake, headaches, vomiting, abdominal pain

See red, enlarged tonsils (may have white patches of exudate)

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4
Q

What is the centor criteria

A

Estimates probability that tonsillitis is due to bacterial infection (will need antibiotics)

Score 3+ is significant

Fever > 38

Tonsillar exudate

Absent cough

Tender anterior cervical lymph nodes

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5
Q

What is the FeverPAIN score

A

Estimates probability that tonsillitis is due to bacterial infection (will need antibiotics)

Score 4+ is significant

Fever during previous 24 hours

Pus on tonsils

Attended within 3 days of symptom onset

Inflamed tonsils

No cough or coryza

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6
Q

What is the management for tonsillitis

A

Educate

Safety netting (return if not settled in 3 days, fever > 38.3)

Simple analgesia

Consider antibiotics (penicillin V for 10 days, or clarithromycin)

Consider delayed prescription

Admit if: immunocompromised, systemically unwell, dehydrated, stridor, respiratory distress, peritonsillar abscess, cellulitis

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7
Q

What are the complications of tonsillitis

A

Chronic tonsillitis

Peritonsillar abscess (Quinsy)

Otitis media

Scarlet fever

Rheumatic fever

Post-strep glomerulonephritis

Post-strep reactive arthritis

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8
Q

What is Quinsy

A

Aka peritonsillar abscess

Usually a complication of tonsillitis

Due to bacterial infection: group A strep, staph aureus, haemophilus influenzae

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9
Q

How might a patient with Quinsy present

A

Tonsillitis symptoms

Trismus (unable to open mouth)

Changes in voice

Swelling and erythema in area beside tonsils

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10
Q

What is the management for Quinsy

A

Refer to hospital urgently

Need incision and drainage

Antibiotics before and after surgery

Consider steroids (dexamethasone)

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11
Q

When should tonsillectomy be performed for tonsillitis

A

7+ in 1 year

5 per year for 2 years

3 per year for 3 years

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12
Q

Other than for tonsillitis, when should tonsillectomy be performed

A

2+ episodes of tonsillar abscess

Enlarged tonsils causing difficulty breathing or swallowing

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13
Q

What are the complications of tonsillectomy

A

Pain

Sore throat

Damage to teeth

Infection

Post-tonsillar bleeding (up to 2 weeks after surgery, can be life threatening due to aspiration of blood, consider intubation if severe)

Risk of anaesthetic

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14
Q

What is otitis media

A

Inner ear infection

Bacteria enter from back of throat (through eustachian tube) following URTI

Common bacteria: haemophilus influenzae, staph aureus

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15
Q

How might otitis media present

A

Ear pain

Reduced hearing

General URTI symptoms

Balance issues/vertigo (if vestibular system affected)

Discharge (if tympanic membrane ruptured)

Infants: fever, vomiting, irritability, lethargy, poor feeding

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16
Q

What is the management for otitis media

A

Consider admission (< 3 months temp > 38, 3-6 months temp > 39)

Usually resolves without antibiotics

Simple analgesia

Immediate antibiotic prescription: significant comorbidities, < 2 with bilateral infection, discharge

Delayed prescription

Amoxicillin for 5 days

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17
Q

What are the complications of otitis media

A

Otitis media with effusion

Hearing loss

Perforated eardrum

Recurrent infection

Mastoiditis

Abscess

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18
Q

What is glue ear

A

Otitis media with effusion

Middle ear filled with fluid

Get hearing loss

Eustachian tube becomes blocked

19
Q

How might the ear look on examination of a patient with glue ear

A

Dull tympanic membrane

Air bubbles

Visible fluid level

20
Q

What is the management for glue ear

A

Refer for audiometry (establish extent of hearing loss)

Usually resolves without treatment (in 3 months)

Grommets (fall out within a year)

21
Q

What are the congenital causes of hearing loss

A

Maternal infection (rubella, cytomegalovirus)

Genetic deafness

Associated syndromes (Down’s)

22
Q

What are the perinatal causes of hearing loss

A

Prematurity

Hypoxia during/after birth

23
Q

What are the postnatal causes of hearing loss

A

Jaundice

Meningitis

Encephalitis

Otitis media

Glue ear

Chemotherapy

24
Q

Where do nosebleeds usually come from

A

Kiesselbach’s plexus (Little’s area)

Usually unilateral

25
Q

What are the triggers for nose bleeds

A

Nose picking

Colds

Vigorous nose blowing

Trauma

Changes in weather

26
Q

What is the management for nosebleeds

A

Usually spontaneously resolve

If recurrent, look for underlying cause

Tilt head forward

Squeeze soft part of nose for 10-15 mins

Nasal packing

Nasal cautery (silver nitrate)

Naseptin (QDS for 10 days, reduces crusting)

27
Q

What is a cleft lip

A

Split or open section of upper lip

At any point along top lip

Can extend as high as nose

28
Q

What is a cleft palate

A

Defect in hard or soft palate

Opening between mouth and nasal cavity

29
Q

What is the management for cleft lip/palate

A

Refer to cleft lip service

Specially shaped bottles and teats

Surgical correction (lip at 3 months, palate at 6-12 months)

30
Q

What are the complications of cleft lip/palate

A

Problems feeding

Difficulty swallowing

Speech issues

Social impact

Increased risk of: hearing problems, ear infections, glue ear

31
Q

What is tongue tie

A

Aka ankyloglossia

Baby born with short and tight lingual frenulum

Not able to extend tongue out of mouth (difficult to latch on)

Presents with poor feeding

32
Q

What is the management for tongue tie

A

If mild, monitor

Frenotomy (cut through tongue tie, can be in clinic)

33
Q

What is a cystic hygroma

A

Malformation of lymphatic system

Get a cyst filled with lymphatic fluid

Usually in posterior triangle on left

Seen on antenatal scanning, baby checking, incidentally

34
Q

What are the key features of cystic hygroma

A

Can be very large

Soft

Non-tender

Transilluminates

35
Q

What is the management for cystic hygroma

A

Small and not causing issues, watch and wait

Aspiration

Surgical removal

Sclerotherapy

36
Q

What are the complications of cystic hygromas

A

Difficulty feeding

Issues with swallowing

Difficulty breathing

If infected: red, hot, tender

37
Q

What is a thyroglossal cyst

A

Part of thyroglossal duct (where thyroid gland migrates) persists, can fill with fluid

38
Q

What are the features of a thyroglossal cyst

A

In midline

Mobile

Tended

Soft

Fluctuant

Move up and down when moving tongue or swallowing

39
Q

What are the investigations for thyroglossal cyst

A

Ultrasound

CT

40
Q

What is the management for thyroglossal duct cyst

A

Surgical removal

41
Q

What is a branchial cyst

A

Congenital abnormality

Second branchial cleft doesn’t form properly

Have space surrounding epithelial tissue in lateral neck (can be filled with fluid)

Usually presents after age 10

42
Q

What are the features of a branchial cyst

A

Round, soft, cystic swelling

Between angle of jaw and SCM

Transilluminates

43
Q

What is the management for a branchial cyst

A

If recurrent infections, surgical excision

Paeds (17 decks)

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