ENT and Ophthalmology Flashcards by Anon T

What are common bacterial causes of tonsillitis?

Group A streptococcus (pyogenes most common)
Strep. pneumoniae
HiB
Morazella catarrhalis
Staphylococcus aureus

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Consider the clinical presentation of a child with tonsillitis - what would their signs and symptoms be?

Fever, sore throat, painful swallow
Swollen lymph nodes (cervical)
Red, inflamed tonsils with or without exudate
Younger patients - Sx are less specific

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What are the four criteria of the Centor Criteria?

Fever >38oC
Tonsillar exudate
Absence of cough
Lymphadenopathy of anterior cervical lymph nodes (tender)

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How many of the Centor Criteria are required to be met for antibiotics to be advised (tonsillitis)?

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What are the criteria for the FeverPAIN score?

Fever during previous 24 hours
P - Purulence; pus on tonsils
A - Attended within 3 days of symptoms onset
I - Inflamed tonsils
N - No cough or coryza

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Taking into account the patient’s FeverPAIN score following a tonsillitis diagnosis, what should a physicians action be?

2-3 - middling probability of bacterial tonsillitis; consider watchful waiting
4-5 - higher (65%) chance of bacterial tonsillitis

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Centor and FeverPAIN scores above what then consider antibiotics?

3 and 4 respectively

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What is the antibiotic of choice for bacterial tonsillitis and for how long?

Phenoxymethylpenicillin (10 days)

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What is an alternative antibiotic for tonsillitis should the patient have a penicillin allergy?

Clarithromycin

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What are the complications of tonsillitis in paediatrics?

Chronic
Otis media (spreads to inner ear)
Quinsy

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What is quinsy?

Peritonsillar abscess arising should a bacterial infection form an abscess in the tonsillar region

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What are the common bacterial causes of quinsy?

GAS (pyogenes)
Staphylococcus aureus, Hib

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What are the signs of quinsy that would make one think that it might not just be limited tonsillitis?

Sore throat, painful swallow, fever
Swollen, tender lymph nodes
Trismus (can’t open mouth), hot potato voice, swelling and erythema behind tonsils

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Antibiotic of choice for quinsy?

Co-amoxiclav (broad spectrum)

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Alongside antibiotics what may be prescribed for a patient with quinsy?

Steroids (dexamethasone), incision and drain, abx

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What are the number of episodes of tonsillitis per year required for a tonsillectomy (think one year, two year, three year)?

One year: 7/yr
2 year: 5/yr
3 year: 3/yr

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Other than frequency what are two indications for tonsillectomy?

Recurrent tonsillar abscess (2 episodes)
Enlarged tonsils leading to issues breathing, sleeping, swallowing

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What is otitis media?

Infection of the middle ear (space between tympanic membrane and inner ear) where the cochlea, vestibular apparatus and nerves are found

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How does otitis media come about?

Bacteria enter from the back of the throat through the eustachian tube (often preceded by a viral URTI)

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What are the bacterial causes of otitis media (+most common)?

Most common: strep pneumoniae
Haemophilius influenzae
Moraxella catarrhalis
Staphyloccocus aureus

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A child presents with ear pain with reduced hearing. They have a fever, cough and sough throat and have been feeling unwell since last night. Their mother reports that there was some discharge coming from their ear. What is a possible diagnosis?

Otitis media

Discharge is due to the perforation of the tympanic membrane

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What is a normal examination in a patient (suspect otitis media)?

Pearly-grey, translucent, shiny, reflecting cone of light

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What is a pathological examination in a patient (suspect otitis media)?

Bulging, red, inflamed looking membrane, discharge in the ear canal and hole in the tympanic membrane.

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What is the treatment for otitis media (1st line abx and length)?

1st line - Amoxicillin for 5 days (alternatively erythromycin and clarithromycin)

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What is glue ear?

Middle ear is full of fluid so there is hearing loss in that ear (could be due to blockage of the Eustachian tube)

What is the investigation of choice for glue ear?

Otoscopy: shows dull tympanic membrane w/ air bubbles or visible fluid level

What is the management for glue ear?

- Conservative support (resolve within 3 months) - Hearing aids - Refer for audiometry

What are grommets?

Small tubes inserted into the tympanic membrane by ENT surgeon allowing fluid drainage

What is the passage of grommet fluid drainage?

Out of the middle ear through the tympanic membrane to the ear canal

What are congenital causes of hearing loss?

Maternal rubella or CMV during pregnancy Genetic conditions

What is Wardenbergs Syndrome?

Congenital sensorineural hearing loss

What is the genetic pattern of Treacher Collins hearing loss?

Autosomal dominant conductive hearing loss

What are the characteristics of Treacher Collins?

Abnormal outer and middle ear with cheek bone underdevelopment (and hearing loss)

What are two perinatal causes of hearing loss?

Prematurity Hypoxia during/after birth

What are causes of hearing loss after birth (x4)/?

- Jaundice - Meningitis and Encephalitis - Otitis media or glue ear - Chemotherapy

What may a concerned parent report about a child with hearing problems?

Ignore calls/sounds Poor speech/language development Poor school performance Frustration or bad behaviour

What is an audiogram?

Chart documenting the volume patients can hear different tones

What are the readings for normal hearing?

All readings between 0 and 20dB on top of chart

What will be the audiogram readings for conductive hearing loss (problem with the middle ear)?

- Bone conduction: 0-20dB - Air conduction: >20dB (plot below 20dB line)

What is the pathophysiology of the conductive hearing loss?

Sound is not conducted through the air due to pathology along route into the ear.

What will be the audiogram readings for sensorineural hearing loss?

Both air and bone conduction readings >20dB (plot below the 20 dB line)

What is the pattern of sensorineural hearing loss?

Will affect both the ears equally

What will be the audiogram readings for mixed hearing loss be?

Bone and air conduction readings of >20dB (plot below the 20dB line)

Which will be higher and to what degree on audiogram for mixed hearing loss?

Bone conduction will be >15dB higher than air conduction

Which area of the ear is affected in sensorineural hearing loss?

Inner ear

Management for conductive hearing loss?

Hearing aid offered for persistent loss Can spontaneously resolve over time/operable.

Management for sensorineural hearing loss?

Usually permanent --> aim is to raise the level of hearing with cochlear implants recommended

What is the management of mixed hearing loss?

Hearing aid issued to help make all parts of speech audible (especially high Hz).

What is strabismus?

Misalignment of the eyes causing double vision.

What is the risk of an untreated squint (strabismus) in 2-3% of children?

Amblyopia - permanent loss of visual acuity in one eye

What are the causes of amblyopia?

Refractive error, squints, visual deprivation (cataracts, ptosis)

What will happen if treatment is delayed beyond 7 years (for strabismus)?

Large risk the vision on the lazy eye will not improve

What is esotropia?

Inwards pointing squint towards the nose

What is exotropia?

Outward pointing squint towards the ear

What is hypertropia?

Upward moving affected eye

What is hypotropia?

Downward moving affected eye

Name some causes of strabismus? (+most common)

- Idiopathic (large majority) - Hydrocephalus - Cerebral palsy - Space occupying lesion (e.g. retinoblastoma)

What are simple tests to test the presence of strabismus?

Hirschberg's test Cover tests Corneal light reflex (non-specific)

What are potential managements for strabismus?

Treat early Occlusive patch of good eye Corrective lenses if refractive error

What can be used to cause vision blurring in strabismus treatment?

Atropine drops

What is blepharitis?

Inflammation of the eyelid margins

What are the clinical features of blepharitis?

Gritty, itchy, dry sensation in the eyes

What cause blepharitis?

Meibomian gland dysfunction --> Gland that secreted oil onto the eye surface

What is the management of blepharitis?

Lubricating eye drops: - Hypromellose - Polyvinyl alcohol - Carbomer

What is a stye?

Tender red lump around the eyelid that may contain pus

What is hordeolum externum?

Infection of the gland of Zeis (sweat glands at base of eyelashes) or glands of Moll (sebaceous glands at base of eyelash)

What is hordeolum internum?

Infection of meibomian glands - deeper and more painful

What is the management for styes?

Hot compresses and analgesia Topical antibiotics (choramphenicol) if associated with conjunctivities

What is a Chalazion?

Meibomian cyst - gland blocked and swells

What are the clinical features of chalazion?

Swelling in the eyelid; tend to not be tender

What antibiotic should be considered for chalazion?

Chloramphenicol Also should be hot compress and analgesia

What is entropion?

Eyelid turns inwards with lashes against eye

What are the clinical features of entropion?

Pain and potential corneal damage/ulceration

What is the management of entropion?

Same day referral to ophthalmology. Tape down eyelid; lubricating eye drops Surgical intervention

What is ectropion?

Eyelid turning outwards with the inner aspect of the eyelid exposed (usually bottom)

What are the clinical features of ectropion?

Exposure keratopathy (eyeball exposed and inadequately lubricated and protected)

What is the management for ectropion?

Lubricating eyedrops to protect eye surface (surgery to correct defect)

What is trichiasis?

Inward growth of eyelashes resulting in pain and corneal damage and ulceration

What is the management of trichiasis?

Epilation, electrolysis and cryotherapy

What is orbital cellulitis?

Infection around the eyeball that involves tissues behind the orbital septum

What are the clinical features of orbital cellulitis? Think to differentiate it from periorbital cellulitis

Pain on eye movement Reduced eye movement Visual changes Abnormal pupillary reaction Proptosis

What is the treatment for orbital cellulitis?

Medical emergency - prompt admission and treat with broad spectrum antibiotics with surgical drainage