ENT

Question 1

Otitis media
Presentation [1]
Etiology [2]
Features of auriscope examination [3]
Complication [1]
Tx [5]

Answer 1

Earache
Primary viral infection causing secondary infection by pneumococcus or H’flu
Redness and bulging drum, loss of light reflex –> Spontaneous rupture
It’s self limiting and generally viral so just analgesia. If it’s bilateral and <2yrs - consider oral amoxicillin

Question 2

How would you investigate a case of tonsillitis?

Answer 2

1) Examine by looking in their mouth

2) Throat swab to ddx viral and bacterial

Question 3

How do you treat tonsillitis? [2]

What not to give [1]

Answer 3

If you confirm its bacterial/strep you can give Penicillin 10d. Otherwise nothing but analgesia.
Do not give amoxicillin causes rash in EBV

Question 4

Tonsilitis presentation
Symptoms [3]
Signs [2]

Answer 4

Odynophagia, referred ear pain
Headache, Fever
Loss/change in voice

Throat: erythematous, oedematous tonsils, may be coated or have flecks of pus or exudates
Tender, enlarged cervical LN

Question 5

OSA in children clinical definition [3]

Answer 5

Characterised by partial or intermittent complete airway obstruction [1] during sleep which affects the child’s ventilation [1] and disrupts their normal sleep patterns [1]

Question 6

Causes of OSA in children [3]

Answer 6

those with adenotonsillar hypertrophy*, those who are obese and those who have congenital abnormalities eg Downs

Question 7

Presentation of OSA
Symptoms [3]
Signs [3]
Immediate management

Answer 7

Snoring
Choking episodes (parents describe)
Enuresis

Open mouthed breathing
BMI
Visible tonsillar hypertrophy

Refer to ENT surgeon, adenotonsillectomy

Question 8

Hearing testing in newborns [2]

Answer 8

Otoacoustic emission test as part of the Newborn hearing screening programme
If abnormal: auditory brainstem response test may be done (in infants too)

Question 9

What is otoacoustic emission testing?

Answer 9

A computer generated click is played through a small earpiece. The presence of a soft echo indicates a healthy cochlea

Question 10

At what intervals are hearing tests conducted in children? [4]

Answer 10

6-9 months
18m -2.5y
>2.5y
<3y

Question 11

How is hearing tested at:
6-9m
18m- 2.5y
>2.5y [2]
>3y

Answer 11

6-9m: distraction test
18m- 2.5y: recognition of familiar objects (ask and show)
>2.5y:
- Performance testing
- Speech discrimination test
>3y: pure tone audiometry (done at school entry)