ENT

Question 1

What causes stridor?

Answer 1

Extra thoracic airway obstruction

Croup, epiglottis, anaphylaxis, foreign body, sub-glottic stenosis, laryngomalacia

Question 2

What causes stertor?

Answer 2

Very heavy cold or bronchiolitis, sounds like snoring

URTI, bronchiolitis, T21

Question 3

What causes wheeze?

Answer 3

Intrathoracic airway narrowing

Asthma, FB past trachea, anaphylaxis

Question 4

What causes grunting?

Answer 4

Prolonged expiratory noise, trying to keep alveoli open. Indicates severe respiratory distress, but may indicate sepsis with metabolic acidosis, not an infection
bronchiolitis, VIW/asthma, pneumonia, sepsis

Question 5

What are the symptoms of a foreign body obstruction?

Answer 5

Choking, blue, otherwise well. If above trachea will cause wheeze. If below, will cause localized reduced air entry and monophonic wheeze.

Question 6

What causes pharyngitis?

Answer 6

inflammation of pharynx & soft palate with local lymph nodes enlargement and tenderness
Usually due to viral infection (adenovirus, enterovirus, rhinovirus), but in older children group A B-haemolytic strep is common.

Question 7

What causes tonsillitis?

Answer 7

Form of pharyngitis with intense tonsils inflammation, often with purulent exudate. Common pathogens are group A B-haemolytic strep and EBV (infectious mononucleosis

Question 8

What are the symptoms of tonsillitis?

Answer 8

Headache
Apathy
Abdominal pain
White tonsillar exudate
Cervical lymphadenopathy

Question 9

What is the management for tonsillitis?

Answer 9

Penicillin prescribed for severe cases (only 1/3 bacterial)
10 days to eradicate strep and prevent rheumatic fever
Avoid amoxicillin- can cause maculopapular rash if EBV
Hospital admission and IV fluids & analgesia for children unable to swallow solids or liquids

Question 10

What us the presentation for scarlet fever?

Answer 10

Group A strep (children 5-12)
2-3 days history of fever followed by headache and tonsillitis.
‘sandpaper-like’ maculopapular rash that tends to affect cheeks with perioral
sparing. It then spreads across the whole body
white and coated tongue that may be sore or swollen

Question 11

What is the management for scarlet fever?

Answer 11

penicillin V or erythromycin to prevent complications including acute glomerulonephritis or (very rarely) rheumatic fever

Question 12

What is otitis media?

Answer 12

Most common at 6-12 months
Infants & young children are prone to acute otitis media, because their Eustachian tubes are short, horizontal and poorly functioning.
Pathogens include RSV, rhinovirus, pneumococcus, H. influenzae & M.catarrhalis

Question 13

What is the presentation of otitis media?

Answer 13

Pain in the ears (pulling) and fever
Bright red, bulging tympanic membrane with loss of normal light reflection
Occasionally there is acute perforation of the eardrum with puss visible in the external canal

Question 14

What is the management for otitis media?

Answer 14

Regular analgesia
Mostly no need for abx (as they do not reduce hearing loss), but may give parents
prescription for amoxicillin and ask to only use if child remains unwell after 2-3 days.
Recurrent otitis media- grommet insertion.
If it reoccurs after grommet extrusion-grommet reinsertion + adenoidectomy

Question 15

What is viral croup?

Answer 15

Accounts for over 95% laryngotracheal infections
Caused by parainfluenza viruses, but also rhinovirus, RSV and H. influenzae. It typically occurs from 6 months to 6 years of age, but the peak incidence is at 2 years and during autumn.

Question 16

What is the presentation for viral croup?

Answer 16

coryza & fever followed by
Hoarseness (due to vocal cord inflammation)
Barking cough (due to tracheal oedema and collapse)
Harsh inspiratory stridor
Increased WOB
Symptoms begin or are worse at night

Question 17

When is hospital admission considered for viral croup?

Answer 17

Stridor and WOB at rest
Stridor returns
Apnoea
Low threshold of admission for those <12 months old due to narrow airway calibre

Question 18

What is the management for viral croup?

Answer 18

Wesley score
Inhalation of warm moist air
• Shot of oral dexamethasone, prednisolone or nebulized budesonide reduces
severity and duration of croup- Scarlet

Question 19

What is the management for severe viral croup?

Answer 19

Nebulized epinephrine with oxygen by face mask provides rapid, but transient improvement. Observe child closely for 2-3 hours after admission as effects wear off
• Intubation unusual

Question 20

What is bacterial tracheitis?

Answer 20

Rare, but dangerous. Typically caused by S. aureus
High fever, child appears very ill
rapidly progressive airways obstruction with copious thick airway secretions

Question 21

What is the management for bacterial tracheitis?

Answer 21

IV abx and intubation & ventilation if required

Question 22

How does acute epiglottis present?

Answer 22

very acute onset of severe sore throat (prevents child from speaking), drooling of saliva,
poor feeding & drinking and increasing difficulty breathing
Very high fever
Toxic looking child
Drooling of saliva
Soft inspiratory stridor & rapidly increasing respiratory difficulty over hours
The child is sitting immobile & upright to optimize the airway
No cough
Urgent hospital admission as soon as diagnosis is suspected

Question 23

What should you not do when investigating acute epiglottitis?

Answer 23

Do NOT lie the child down or attempt to examine the throat or perform lateral neck X- ray as it may precipitate total airway obstruction and death

Question 24

What is the management for acute epiglottitis?

Answer 24

Summon senior anaesthetist, paediatrician and ENT surgeon
Transfer the child directly to PICU
Intubation under GA. If impossible- urgent tracheostomy. This is usually removed
after 24hrs.
Take bloods for cultures and obtain IV access only AFTER the airway have been secured
IV abx, such as cefuroxime for 3-5 days
Rifampicin prophylaxis to close contacts

Question 25

What are the differences between viral croup and acute epiglottitis?

Answer 25

Viral croup:
Onset over days 
Preceding coryza
Severe barking cough
Able to drink 
NO drooling saliva
Looks unwell
Fever <38.5
Harsh, rasping stridor 
Hoarse voice
Acute Epiglottitis:
Onset over hours
NO preceding coryza
Absent or slight cough
NOT able to drink 
Drooling saliva
Looks toxic, very ill
Fever >38.5
Soft, whispering stridor 
Muffled voice, reluctant to speak

Question 26

What are the features of a retropharyngeal abscess?

Answer 26

Neck stiffness
Malaise
Dysphagia
Fever