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Paediatrics > ENT > Flashcards

ENT Flashcards

1
Q

What is tonsilitis?

A

Inflammation in the tonsils

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2
Q

What commonly causes tonsillitis?

A

Most commonly viral.

Bacterial causes
- Group A Strep (pyogenes)
- streptococcus pneumoniae
- haem influenza

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3
Q

How is tonsillitis managed?

A

If viral - self resolving. Safety net.
Bacterial (fever pain score > 4) - give penicillin V (phenoxymethylpenicillin) for 10 days (or clarithromycin in allergy)

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4
Q

How does tonsillitis present?

A
  • Fever
  • Sore throat
  • swollen erythematous tonsils with white exudate
  • swollen lymph nodes - cervical lymphadenopathy
  • headache
  • vomiting
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5
Q

What is the centor criteria for?

A

A score of 3 or more is suggestive of bacterial tonsillitis - can offer antibiotics.

  • fever over 38
  • tonsillar exudates
  • absence of cough
  • tender anterior lymphadenopathy
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6
Q

What is the FeverPAIN Score?

A

Scoring to determine probability that tonsilitis is bacterial.

  • Fever in last 24 hrs
  • Pus on tonsils
  • Attended within 3 days of onset of symptoms
  • Inflamed tonsils
  • No cough
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7
Q

What are some complications of tonsillitis?

A
  • chronic tonsillitis
  • peritonsillar abscess - quinsy
  • otitis media
  • scarlet fever
  • rheumatic fever
  • post streptococcal glomerulonephritis
  • post streptococcal reactive arthritis
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8
Q

What is quinsy?

A

Peritonsillar abscess

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9
Q

How does quinsy present?

A
  • similarly to tonsillitis - sore throat, fever, lymphadenopathy
  • trismus - unable to open their mouth
  • change in voice - due to pharyngeal swelling
  • swelling and erythema around the enlarged tonsils
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10
Q

What is the management for quinsy?

A
  • refer to ENT for incision and drainage (under general)
  • antibiotics
  • steroids - dexamethasone - to settle inflammation
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11
Q

What are the indications for tonsillectomy?

A

Repeated episodes of tonsillitis
- 7 or more in 1 year
- 5 per year for 2 years
- 3 per year for 3 years

  • recurrent tonsillar abscesses (>2)
  • enlarged tonsils causing obstruction
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12
Q

What are some of the potential complications of tonsillectomy?

A
  • pain (up to 2 weeks)
  • damage to teeth
  • infection
  • bleeding ( if severe can be life threatening due to aspiration of blood)
  • risks of general anaesthetic
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13
Q

How is post tonsillectomy bleeding managed?

A
  • call ENT registar
  • IV access - bloods inc. clotting, group + save and crossmatch
  • analgesia
  • sit up and encourage to spit out blood
  • nil by mouth
  • IV fluids
  • if airway compromise - maintain / intubate
    If not severe can give hydrogen peroxide gargle or adrenalin soaked swab to stop the bleeding.
    If severe = go to theatre
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14
Q

What is otitis media?

A

Infection in the middle ear (between the tympanic membrane and inner ear)

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15
Q

What most commonly causes otitis media?

A
  • often a prior viral URTI.
  • bacteria can travel from the back of the throat through the eustachian tube to the middle ear

Bacteria
- streptococcus pneumoniae
- haemophilus influenza
- moraxella catarrhalis
- staph aureus

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16
Q

How does otitis media present?

A
  • ear pain
  • reduced hearing (unilateral)
  • symptoms of URTI - cough, fever, sore throat, aches, irritablity

If spreads to vestibular system
- balance problems and vertigo

if tympanic membrane perforates - discharge from ear.

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17
Q

How is otitis media diagnosed?

A

Examination of both ears using a otoscope (pull ear up and back).

  • the tympanic membrane of the affected ear will look bulging, red and inflamed. Perforation = discharge in canal.
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18
Q

How is mild otitis media managed?

A
  • simple analgesia for fever and pain
  • can prescribe a delayed prescription of antibiotics (amoxicillin for 5 days) for if symptoms have not improved after 3 days.
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19
Q

When may antibiotics be immediately prescribed for otitis media?

A
  • immunocompromised / co-morbidities
  • < 2 years old
  • otorrhoea - ear discharge
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20
Q

What are the main complications of otitis media?

A
  • otitis media with effusion (glue ear)
  • hearing loss - normally temporary
  • perforated eardrum
  • recurrent infection
  • Mastoiditis (rare)
  • abscess (rare)
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21
Q

What is otitis media with effusion?

A

When the middle ear becomes filled with fluid causing a unilateral conductive hearing loss.

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22
Q

What causes otitis media with effusion?

A

Blockage of the eustachian tube meaning fluid builds up in the middle ear

23
Q

How does otitis media with effusion present?

A

Reduced hearing

24
Q

What is the main complication of otitis media with effusion?

A

Infection (otitis media)

25
Q

What is seen on otoscopy in otitis media with effusion?

A
  • dull tympanic membrane
  • air bubbles
  • visible fluid level
26
Q

How is otitis media with effusion managed?

A
  • do audiometry to help diagnosis
  • normally resolves without treatment in 3 mnths
  • if not can give grommets (small tubes inserted into the tympanic membrane that allows fluid to drain)
27
Q

What is epistaxis?

A

Nosebleeds

28
Q

Where is the most likely source of nosebleeds?

A

Kiesselbach’s plexus in Littles area (anterior)

More severe nosebleeds that don’t stop may be from the sphenopalatine artery (posterior)

29
Q

What can trigger nosebleeds?

A
  • nose picking
  • colds
  • trauma
  • vigorous nose blowing
30
Q

What can bilateral nosebleed indicate?

A

Posterior bleeding.

31
Q

How should nosebleeds be managed?

A

Advise to
- sit up and tilt head forwards
- squeeze soft past of the nose for 10-15 mins
- spit out any blood in the mouth (rather than swallowing)

If it doesn’t stop after 10-15 mins
- anterior nasal packing
- nasal cautery - using silver nitrate
- consider meds such as tranexamic acid to stop bleeding.
- after can prescribe chlorhexidine and neomycin to reduce crusting, inflammation and infection.

32
Q

What is cleft lip?

A

Congenital condition where there is a split or open section of the upper lip that can extend as high as the nose

33
Q

What is cleft lip?

A

Congenital condition where there is a split or open section of the upper lip that can extend as high as the nose

34
Q

What is cleft palate?

A

Congenital defect in the hard or soft palate and the roof of the mouth. Leaves and opening between the mouth and nasal cavity. (can occur alongside cleft lip)

35
Q

What are some of the complications of a cleft lip or palate?

A
  • difficulty feeding and swallowing
  • difficult in speech
  • psycho-social implications
  • more prone to hearing problems, ear infections and otitis media with effusion
36
Q

How are cleft lips and palates managed?

A

Specialised services
- nurses - . ensure nutrition - e.g. through special shaped bottles
- plastic, maxillofacial and ENT surgeons
- dentists
- speech and language therapists

Definitive treatment = surgery between 6 and 12 months.

37
Q

What is ankyloglossia?

A

Tongue tie - when a baby is born with a short and tight lingual frenulum. Means they can’t properly extend their tongue

38
Q

How is tongue tie normally picked up?

A

Due to poor feeding - as it makes it more difficult for them to latch onto the breast

39
Q

How is tongue tie managed?

A

If mild - doesn’t require any managedment.

Frenotomy - cutting of the frenulum - normally can be done on the ward without any anaesthetic.

40
Q

What are complications of frenotomies?

A

Very rare
- excessive bleeding
- scar formation
- infection

41
Q

What is a cystic hygroma?

A

Malformation of the lymphatic system resulting in a fluid filled cyst -most commonly in the neck (left posterior triangle) or the armpits

42
Q

What are the key features of a cystic hygroma?

A
  • lump in the neck or armpit present from birth
  • can be very large
  • soft
  • non tender
  • transilluminates
43
Q

What are the complications of a cystic hygoma?

A

Depending on the size and location - can interfere with
- feeding
- swallowing
- breathing
Can become infection.
Can haemorrhage into the cyst.

44
Q

How are cystic hygomas managed?

A

If small can watch and wait - can regress but do not resolve itself.
Other options
- aspiration (temporary improvement)
- surgical removal
- sclerotherapy

45
Q

How do thyroglossal cysts form?

A

When the thyroid gland descends from the base of the tongue to the throat in fetal development, it leaves behind a tract called the thyroglossal duct. This normally disappears. If it is left behind, it can give rise to a fluid filled cyst.

46
Q

What is the main complication of a thyroglossal cyst?

A

infection

47
Q

Describe thyroglossal cysts

A
  • midline lump
  • mobile
  • non tender
  • soft
  • fluctuant
  • move up and down with movements of the tongue
48
Q

How are thyroglossal cysts investigated?

A

Ultrasound or CT scans

49
Q

How are thyroglossal cysts managed?

A

Normally surgically removed.
(however can recur after surgery unless the full thyroglossal duct is removed)

50
Q

How does a branchial cyst form?

A

Arises from the second branchial cleft if it fails to form properly during development. This leaves and empty space in the lateral neck where fluid can fill

51
Q

Describe branchial cysts

A
  • swelling between the angle of the jaw and the SCM in the anterior triangle of the neck
  • round
  • soft
  • tend to present after 10 y.o or if it becomes infected
52
Q

How are branchial cysts managed?

A

Often conservative management / do nothing.
If recurrent infections or other (e.g. cosmetic) issues - can do a surgical excision

53
Q

Useful links for neck lumps

A

https://www1.racgp.org.au/ajgp/2019/may/paediatric-neck-lumps

54
Q

What are some causes of paediatric neck lumps?

A
  • thyroglossal cyst (midline - moves with tongue)
  • branchial cyst - anterior to SCM
  • dermoid cyst
  • goitre
  • sialadenitis (enlargement of one of the salivary glands)
  • lymphadenitis
  • reactive lymphadenopathy
  • malignant lymphadenopathy
  • salivary gland tumour
  • benign connective tissue tumour

Paediatrics (14 decks)

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