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Phase 3a - Paediatrics > ENT and Ophthalmology > Flashcards

ENT and Ophthalmology Flashcards

1
Q

What are common bacterial causes of tonsillitis?

A

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

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2
Q

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

A
  • 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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3
Q

What are the four criteria of the Centor Criteria?

A
  1. Fever >38oC
  2. Tonsillar exudate
  3. Absence of cough
  4. Lymphadenopathy of anterior cervical lymph nodes (tender)
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4
Q

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

A

3

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5
Q

What are the criteria for the FeverPAIN score?

A
  1. Fever during previous 24 hours
  2. P - Purulence; pus on tonsils
  3. A - Attended within 3 days of symptoms onset
  4. I - Inflamed tonsils
  5. N - No cough or coryza
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6
Q

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

A

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

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7
Q

Centor and FeverPAIN scores above what then consider antibiotics?

A

3 and 4 respectively

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8
Q

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

A

Phenoxymethylpenicillin (10 days)

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9
Q

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

A

Clarithromycin

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10
Q

What are the complications of tonsillitis in paediatrics?

A

Chronic
Otis media (spreads to inner ear)
Quinsy

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11
Q

What is quinsy?

A

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

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12
Q

What are the common bacterial causes of quinsy?

A

GAS (pyogenes)
Staphylococcus aureus, Hib

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13
Q

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

A

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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14
Q

Antibiotic of choice for quinsy?

A

Co-amoxiclav (broad spectrum)

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15
Q

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

A

Steroids (dexamethasone), incision and drain, abx

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16
Q

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

A

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

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17
Q

Other than frequency what are two indications for tonsillectomy?

A

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

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18
Q

What is otitis media?

A

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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19
Q

How does otitis media come about?

A

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

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20
Q

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

A

Most common: strep pneumoniae
Haemophilius influenzae
Moraxella catarrhalis
Staphyloccocus aureus

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21
Q

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?

A

Otitis media

Discharge is due to the perforation of the tympanic membrane

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22
Q

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

A

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

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23
Q

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

A

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

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24
Q

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

A

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

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25
Q

What is glue ear?

A

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

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26
Q

What is the investigation of choice for glue ear?

A

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

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26
Q

What is the management for glue ear?

A
  • Conservative support (resolve within 3 months)
  • Hearing aids
  • Refer for audiometry
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26
Q

What are grommets?

A

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

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27
Q

What is the passage of grommet fluid drainage?

A

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

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28
Q

What are congenital causes of hearing loss?

A

Maternal rubella or CMV during pregnancy
Genetic conditions

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29
Q

What is Wardenbergs Syndrome?

A

Congenital sensorineural hearing loss

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30
Q

What is the genetic pattern of Treacher Collins hearing loss?

A

Autosomal dominant conductive hearing loss

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31
Q

What are the characteristics of Treacher Collins?

A

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

32
Q

What are two perinatal causes of hearing loss?

A

Prematurity
Hypoxia during/after birth

33
Q

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

A
  • Jaundice
  • Meningitis and Encephalitis
  • Otitis media or glue ear
  • Chemotherapy
34
Q

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

A

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

35
Q

What is an audiogram?

A

Chart documenting the volume patients can hear different tones

36
Q

What are the readings for normal hearing?

A

All readings between 0 and 20dB on top of chart

37
Q

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

A
  • Bone conduction: 0-20dB
  • Air conduction: >20dB (plot below 20dB line)
38
Q

What is the pathophysiology of the conductive hearing loss?

A

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

39
Q

What will be the audiogram readings for sensorineural hearing loss?

A

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

40
Q

What is the pattern of sensorineural hearing loss?

A

Will affect both the ears equally

41
Q

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

A

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

42
Q

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

A

Bone conduction will be >15dB higher than air conduction

43
Q

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

A

Inner ear

44
Q

Management for conductive hearing loss?

A

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

45
Q

Management for sensorineural hearing loss?

A

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

46
Q

What is the management of mixed hearing loss?

A

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

47
Q

What is strabismus?

A

Misalignment of the eyes causing double vision.

48
Q

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

A

Amblyopia - permanent loss of visual acuity in one eye

49
Q

What are the causes of amblyopia?

A

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

50
Q

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

A

Large risk the vision on the lazy eye will not improve

51
Q

What is esotropia?

A

Inwards pointing squint towards the nose

52
Q

What is exotropia?

A

Outward pointing squint towards the ear

53
Q

What is hypertropia?

A

Upward moving affected eye

54
Q

What is hypotropia?

A

Downward moving affected eye

55
Q

Name some causes of strabismus? (+most common)

A
  • Idiopathic (large majority)
  • Hydrocephalus
  • Cerebral palsy
  • Space occupying lesion (e.g. retinoblastoma)
56
Q

What are simple tests to test the presence of strabismus?

A

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

57
Q

What are potential managements for strabismus?

A

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

58
Q

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

A

Atropine drops

59
Q

What is blepharitis?

A

Inflammation of the eyelid margins

60
Q

What are the clinical features of blepharitis?

A

Gritty, itchy, dry sensation in the eyes

61
Q

What cause blepharitis?

A

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

62
Q

What is the management of blepharitis?

A

Lubricating eye drops:
- Hypromellose
- Polyvinyl alcohol
- Carbomer

63
Q

What is a stye?

A

Tender red lump around the eyelid that may contain pus

64
Q

What is hordeolum externum?

A

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

65
Q

What is hordeolum internum?

A

Infection of meibomian glands - deeper and more painful

66
Q

What is the management for styes?

A

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

67
Q

What is a Chalazion?

A

Meibomian cyst - gland blocked and swells

68
Q

What are the clinical features of chalazion?

A

Swelling in the eyelid; tend to not be tender

69
Q

What antibiotic should be considered for chalazion?

A

Chloramphenicol
Also should be hot compress and analgesia

70
Q

What is entropion?

A

Eyelid turns inwards with lashes against eye

71
Q

What are the clinical features of entropion?

A

Pain and potential corneal damage/ulceration

72
Q

What is the management of entropion?

A

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

73
Q

What is ectropion?

A

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

74
Q

What are the clinical features of ectropion?

A

Exposure keratopathy (eyeball exposed and inadequately lubricated and protected)

75
Q

What is the management for ectropion?

A

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

76
Q

What is trichiasis?

A

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

77
Q

What is the management of trichiasis?

A

Epilation, electrolysis and cryotherapy

78
Q

What is orbital cellulitis?

A

Infection around the eyeball that involves tissues behind the orbital septum

79
Q

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

A

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

80
Q

What is the treatment for orbital cellulitis?

A

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

Phase 3a - Paediatrics (11 decks)

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