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Y4 Paeds > ENT > Flashcards

ENT Flashcards

1
Q

how long does otitis externa have to last to be chronic?

A

3 months

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2
Q

where does localised otitis externa affect?

A

infection of a hair follicle in the ear which can develop into a boil

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3
Q

where does diffuse otitis externa affect?

A

widespread inflammation of the skin and subdermis

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4
Q

what causes malignant otitis externa ?

A

arises when the infection spreads to the mastoid and temporal bones causing osteomyelitis

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5
Q

what bacteria can cause otitis externa ?

A

Pseudomonas Aeruginosa or Staphylococcus Aureus

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6
Q

what are some risk factors of otitis externa ?

A 
hot and humid climates 
swimming 
older age 
DM
eczema 
wax build up 
trauma
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7
Q

what are DD for otitis externa ?

A 
acute otitis media with perforation 
furunculosis 
viral infections 
tumours 
cholesteatoma 
impacted wax
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8
Q

what is the management of otitis externa ?

A

avoid getting ear wet
analgesia
antibiotic or anti fungal ear drops

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9
Q

what complications can occur with otitis externa ?

A 
abscesses
ear canal stenosis
perforated ear drum 
celllulitis 
malignant otitis externa
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10
Q

what age is most affected by acute mastoiditis ?

A

<2yrs

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11
Q

how does the mastoid air cells communicate with the middle ear?

A

via a small canal known as the aditus to mastoid antrum.

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12
Q

what are the 3 locations that an abscess from acute mastoiditis ?

A

Behind the pinna in an area known as Macewen’s triangle, or higher

Superior to the pinna towards the zygomatic process

Over the squamous temporal bone

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13
Q

where is MacEwen’s triangle?

A

area behind the pinna

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14
Q

what are DD for acute mastoiditis ?

A

Infected pre-auricular sinus (located near the front of the ear)
Infected/inflamed post-aural lymph node
Langerhans cell histiocytosis
Rhabdomyosarcoma

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15
Q

what antibiotics are used for acute mastoiditis?

A

high-dose co-amoxiclav or ceftriaxone

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16
Q

what are intracranial complications of acute mastoiditis ?

A

Intracranial infections including meningitis; epidural, temporal lobe or cerebral abscess; subdural empyema
Dural sinus thrombosis

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17
Q

what age is most affected by peri orbital cellulitis?

A

10yrs

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18
Q

what sex is more affected by peri orbital cellulitis ?

A

males

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19
Q

what sinus is most affected during periorbital cellulitis ?

A

ethmoidal sinusitis

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20
Q

what organisms cause periorbital cellulitis

A

Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, group A streptococcus

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21
Q

what vaccine has reduced the numbers of periorbital cellulitis cases?

A

HiB vaccine

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22
Q

what will orbital cellulitis present with?

A 
Proptosis
Ophthalmoplegia
Decreased visual acuity
Loss of red colour vision – first sign of optic neuropathy
Chemosis
Painful diplopia
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23
Q

what classification is used for periorbital cellulitis ?

A

Chandler classification

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24
Q

what blood test is used to measure response to treatment ?

A

CRP and WBC count

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25
Q

what imaging can be done for periorbital cellulitis ?

A

CT scan

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26
Q

what is DD for periorbital cellulitis ?

A 
Vesicles of herpes zoster ophthalmicus
Erythematous irritation of contact dermatitis
Raised, dry plaques of atopic dermatitis
Hordeolum or stye
Chalazion
Dacrocystitis
Blepharitits
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27
Q

what is Chalazion?

A

blocked meibomian gland

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28
Q

what is dacrocystitis ?

A

infection of the lacrimal sac,

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29
Q

when is urgent drainage recommended during peri orbital cellulitis ?

A

when there are intracranial complications at time of presentation and frontal sinusitis

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30
Q

what is chandler classification used for?

A

classifying peri orbital cellulitis

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31
Q

how many stages of chandler classification is there?

A

5

32
Q

what are the 5 stages of the chandler classification?

A 
1 = confined to eyelid 
2 = extends into orbital tissue, no abscess 
3 = abscess forms deep to the periosteum of the orbit 
4 = collection of pus inside or outside muscle cone, intra orbital abscess 
5 = infection into cavernous sinus
33
Q

what cranial nerves could be damaged when the cavernous sinus is involved in periorbital cellulitis ?

A

3rd, 5th, 6th

34
Q

what % of children with sinus related problems with develop peri orbital cellulitis ?

A

35%

35
Q

what % of people with orbital cellulitis will loss their vision?

A

11%

36
Q

infection of which sinus carries the highest risk of intracranial spread?

A

frontal sinus

37
Q

what tonsils are inflamed in tonsillitis ?

A

palatine tonsils

38
Q

what is the commonest bacterial cause of tonsillitis ?

A

streptococcus

- group A strep (strep pyogenes)

39
Q

what viruses commonly cause tonsillitis ?

A

adenovirus and EBV

40
Q

what is a risk factor for tonsillitis in children?

A

smoking

41
Q

how long does tonsillitis usually last for?

A

5-7days

42
Q

if tonsillitis lasts for more than 7 days what might this suggest?

A

glandular fever

43
Q

on examination what might be seen during tonsillitis ?

A

red inflamed tonsils
white exudate spots
cervical lymphadenopathy

44
Q

what two criteria are used to assess what patients require antibiotics for tonsillitis ?

A

centor criteria

feverPAIN criteria

45
Q

what are the four features of Centor criteria ?

A

tonsillar exudate
tender anterior cervical lymphadenopathy
fever
absence of a cough

46
Q

what are the four features of feverPAIN criteria ?

A 
Fever (during previous 24 hours)
Purulence 
Attend rapidly (within 3 days after onset of symptoms)
Severely Inflamed tonsils
No cough or coryza
47
Q

what 6 criteria are used to predict the likeliness of a group A strep infection ?

A 
Age 5-15
Season (between late autumn and early spring)
Fever (>38.3°C)
Cervical lymphadenopathy
Pharyngeal erythema, oedema, or exudate
No viral URTI symptoms
48
Q

for what ENT condition should the child not be examined ?

A

epiglottitis

49
Q

what are some DD for tonsillitis ?

A 
peritonsillar abscess 
pharyngitis 
glandular fever 
tonsillar malignancy 
epiglottitis
50
Q

is tonsillar malignancy usually bilateral or unilateral

A

unilateral

51
Q

what investigations can be done for tonsillitis ?

A

if child is admitted

- FBC, LFTs (glandular fever will have deranged LFTs), U&Es (dehydration may lead to AKI)

52
Q

what signs may indicate a child needs to be admitted?

A

respiratory compromise - tachypnoea, low sats, use of accessory muscles

patients unable to eat or drink

patients who are not getting better on antibiotics in the community

53
Q

what score of the centor criteria is highly suggestive of bacterial infection?

A

3 or more out of 4

54
Q

what antibiotic can be given for tonsillitis ?

A

Benzylpenicillin for 7-10days

- dose according to age

55
Q

when can a pt be offered tonsillectomy ?

number of infections in 1,2 and 3 years ?

A

in 1 year = 7 or more
in 2 years = 5 or more per year
in 3 years = 3 or more per year

56
Q

state 2 post strep conditions ?

A

post streptococcal glomerulonephritis (PSGM)

acute rheumatic fever

57
Q

what is the classic triad of symptoms with post strep glomerulonephritis ?

A

HTN, haematuria, oedema

58
Q

what causes acute rheumatic fever?

A

is an autoimmune response to group A strep that cause prolonged fever, anaemia, arthritis and pancarditis

59
Q

what ages are most affected by peritonsillar abscess?

A

20-40yrs

60
Q

what is another name for peritonsillar abscess?

A

quinsy

61
Q

are complications of tonsillitis common?

A

no

62
Q

what muscle forms the anterior tonsillar pillar?

A

glossopalatine muscle

63
Q

what muscle forms the posterior tonsillar pillar?

A

pharyngopalatine muscle

64
Q

what bacterial infection in peritonsillar abscesses is common in 15-24yrs ?

A

fusobacterium necrophorum

65
Q

what antibiotics are used for peritonsillar abscesses?

A

co-amoxiclav

clindamycin (if penicillin allergic)

66
Q

what clinical features suggest peritonsillar abscess?

A

trismus (muscle spasm preventing jaw opening fully)
deviation of uvula away from affected side
unilateral throat pain
fever
fatigue
drooling

67
Q

what blood tests can be done for peritonsillar abscess?

A

FBC, LFT, U&Es, CRP

ebstein barr virus antibodies

68
Q

can co-amoxiclav be prescribed for tonsillitis ?

A

no

- there is a small risk of permanent skin rash if the tonsillitis is due to glandular fever

69
Q

after IV benpen antibiotics for peritonsillar abscess, what oral antibiotics should be prescribed on discharge?

A

oral penicillin V (Phenoxymethylpenicillin)

70
Q

how can epstein barre virus be transmitted ?

A

exchange of saliva
blood transfusion
organ transplant

71
Q

what clinical signs on examination may be present during infectious mononucleosis ?

A

inflamed tonsils
significant cervical lymphadenopathy
HSM
palatal petechiae

72
Q

what WBC will be raised in infectious mononucleosis ?

A

lymphocytes

73
Q

what specific tests can be done for glandular fever ?

A

monospot test (relies on generation of non specific heterophiles IgM autoantibodies)

ELISA based immunoassays

74
Q

state some complications of infectious mononucleosis ?

A 
post viral fatigue 
malignancy 
guillain barre syndrome 
encephalitis 
splenic rupture
75
Q

what malignancies are associated with Epstein barre virus ?

A

burkitts, Hodgkins, T cell lymphomas and nasopharyngeal carcinoma

76
Q

due to the risk of splenic rupture what advice should be given to infectious mononucleosis patients?

A

avoiding contact sports for 4-6 weeks post treatment

77
Q

a quinsy is a collection of pus in which space?

A

peritonsilllar

Y4 Paeds (15 decks)

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