ENT Upper Airway

Question 1

Allergic Rhinitis starts age 3-4 and then increases with age

Answer 1

True

Question 2

Adenoids increase in size gradually max size by 3-4 yrs then shrink inoculation by age 12years

Answer 2

True

Question 3

3 symptoms of nasal obstruction

Answer 3

1 snoring
2 mouth breathing
3 hyponasality

Question 4

Causes of snoring

Answer 4

Hypertrophied adenoids ( commonest causes)
2 allergic rhinitis
3 septal devion
4 others FB magroglossia maxillary hypoplasia
Trenchers Collins syndrome

Question 5

Signs of chronic nasal obstruction

Answer 5

Chronic mouth breathing
High arched palate
Ix can do a lateral airway X-ray but often UNDERESTIMATE problem and size of A

Question 6

Management of snoring

Answer 6

1 do nothing most kids grow out of it
2 conservative nasal cortisol or a low dose antibiotic
3 Surgery adneoidesomy +/- tonsillectomy ( OSA and chronic mouth breathers)

Question 7

Symptoms and treatment of Allergic Rhinitis

Answer 7

1 mucus’s++ sneezing itch and atopy

Treatment reduce the triggers
Inhaled CS
Fess washes the thick mucus away
Surgery

Question 8

OSA incidence
Symptoms and effects
Ex

Answer 8

2-3 % of children at 5years of age
T/A cure
Symptoms are snoring aponea./ Nocturnal enuresis/ restless / coughs gags/ wakes I refreshed/ paradoxical chest movements
Severe cyanosis effects growth
Daytime performance
Cardiac hypoxia RV strain /pul hypertension /
Neuro restless irritable shy kids
OSA and face adenoidal face. High arched palate

Question 9

When to treat OSA

What is the treatment of OSA

Answer 9

Microarousals. Sleep fragments
Aponea >50% decrease in airflow
aponea index >5
OSA >6sec

Treatment of OSA = T/A and +/- CPAP

Question 10

Tonsillitis

Answer 10

Viral / bacterial no way on Examination to dd
?EBV look for HSM/LN THIN mb on the tonsils
Monospot not <3 years atypical lymphocytes LFTS for adolescents alcohol
Petiche on the palate Coxsaxi virus or EBV

PEAKS AGE 5-8 YEARS

Question 11

Complications of tonsillitis

Answer 11

Quinsy
Retropharyngeal abscess
Cervical amenities
Subacute BE

Question 12

Indications for tonsillectomy

Answer 12

1OSA
2 Malignancy 
3 recurrent Tonsillits >6 attacks /yr , 4-5 each year for 2 years 3 attacks in 3 years 
4chronic T 
5 pertonsillar abscess 20% recurrence

Question 13

Indications for Tonsillectomy

Answer 13

1 bleeding disorder
2 infection
3 poorly trained hospital staff

Question 14

Stridor 3 types

Answer 14

1 inspiration (Supraglottis / glottis eg laryngomalacia
2 Biphasic FB/ SubGlottic subGlottic haemangioma
3 expiration FB tracheomalcia ( its in the chest)

Question 15

Laryngomalacia

Answer 15

Inspiratory stridor ( esp when crying or upset)
Onset 1-2/12 of age and grow out by 18/12
Not present at birth
Management reassurance
(Unless FTT, cyanosis then Ix

DD of Stridor
1. Ant Vocal cord web stridor is present from birth
Stridor can be insp or biphasic
Present form birth
2. Vocal cord palsy stridor present from birth
3 FB sudden onset of S inspiratory EMERGENCY
4 resp paplloma history of increase Striodor