ENT Flashcards
What causes stridor?
Extra thoracic airway obstruction
Croup, epiglottis, anaphylaxis, foreign body, sub-glottic stenosis, laryngomalacia
What causes stertor?
Very heavy cold or bronchiolitis, sounds like snoring
URTI, bronchiolitis, T21
What causes wheeze?
Intrathoracic airway narrowing
Asthma, FB past trachea, anaphylaxis
What causes grunting?
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
What are the symptoms of a foreign body obstruction?
Choking, blue, otherwise well. If above trachea will cause wheeze. If below, will cause localized reduced air entry and monophonic wheeze.
What causes pharyngitis?
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.
What causes tonsillitis?
Form of pharyngitis with intense tonsils inflammation, often with purulent exudate. Common pathogens are group A B-haemolytic strep and EBV (infectious mononucleosis
What are the symptoms of tonsillitis?
Headache Apathy Abdominal pain White tonsillar exudate Cervical lymphadenopathy
What is the management for tonsillitis?
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
What us the presentation for scarlet fever?
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
What is the management for scarlet fever?
penicillin V or erythromycin to prevent complications including acute glomerulonephritis or (very rarely) rheumatic fever
What is otitis media?
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
What is the presentation of otitis media?
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
What is the management for otitis media?
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
What is viral croup?
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.
What is the presentation for viral croup?
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
When is hospital admission considered for viral croup?
Stridor and WOB at rest
Stridor returns
Apnoea
Low threshold of admission for those <12 months old due to narrow airway calibre
What is the management for viral croup?
Wesley score
Inhalation of warm moist air
• Shot of oral dexamethasone, prednisolone or nebulized budesonide reduces
severity and duration of croup- Scarlet
What is the management for severe viral croup?
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
What is bacterial tracheitis?
Rare, but dangerous. Typically caused by S. aureus
High fever, child appears very ill
rapidly progressive airways obstruction with copious thick airway secretions
What is the management for bacterial tracheitis?
IV abx and intubation & ventilation if required
How does acute epiglottis present?
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
What should you not do when investigating acute epiglottitis?
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
What is the management for acute epiglottitis?
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
What are the differences between viral croup and acute epiglottitis?
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
What are the features of a retropharyngeal abscess?
Neck stiffness
Malaise
Dysphagia
Fever
