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Paediatrics > Eyes and ENT > Flashcards

Eyes and ENT Flashcards

1
Q

What is the outer ear made up of

A

Auricle: made up of bone and cartilage

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2
Q

What is the middle ear made up of

A 
Ossicles: Malleus, Staples and Incus 
Eustachian tube 
Promontory 
Facial Nerve 
Chordates Tympani
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3
Q

What is the inner ear made up of

A

Hearing and Balance organs

  • Cochlear
  • Vestibule
  • Utricle
  • Saccule
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4
Q

What are congenital abnormalities of the outer ear

A
  • Absence of auricle/ microtia
  • Atresia of outer ear canal
  • Pre auricular sinus
  • Accessory auricles
  • Prominent ears
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5
Q

What are congenital abnormalities of the middle ear

A
  • Abnormal Ossicles

- Craniofacial Syndrome

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6
Q

What are the congenital abnormalities of the inner ear

A
  • cochleosaccular dysplasia
  • cochlear dysplasia
  • Vestibulocochlear dysplasia
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7
Q

What are risk factors in the Hx for hearing problems?

How are hearing problems detected?

How are the managed?

A

Risk factors for Hx:

  • Family Hx (AD ans AR disorders)
  • Maternal illness (TORCH infections)
  • Jaundice
  • Prematurity
  • Anatomical Abnormalities

Newborn Hearing Screening Programme
Early referral to audiology for help and support
Early Cochlear implant/ Hearing aids

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8
Q

What instrument can be used to detect the function of the cochlear/ inner ear

A

Otoacoustic Emissions

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9
Q

What is infection if the outer ear called

A

Otitis Externa

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10
Q

How does otitis externa present

A

Painful and Inflamed enteral acoustic meatus
+/- Auricle
May see discharge

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11
Q

What is the most common cause of otitis externa

A

Excess canal moisture

Others: Trauma, Absence of wax, narrow ear canal

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12
Q

How do you treat otitis externa

A

Microsuction

Topical Abx

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13
Q

What is infection of the inner ear

A

Otitis Media

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14
Q

What causes otitis media usually

A

Usually URTI - (pnemococcus, haemophillus)

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15
Q

What are the differentials for otitis media

A

Infection

Eustachian tube Dsyfunction

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16
Q

How does otitis media present

A

Self Limiting!!!

  • Earache
  • Fever +/- irritability
  • Young children: holding/tugging ear, crying, restlessness
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17
Q

What will be seen on examination

A

Otoscopy - Erythema/ Yellow tympanic membrane

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18
Q

How is otitis media treated

A

Analgesia

Only give Abx if systemically unwell or no improvement >4 days or immunocomprimised
- Amoxicillin

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19
Q

What is a complication of Otitis Media

A

Perforation

Mastoiditis - rare but serious

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20
Q

What is chronic otitis media

A

Perforation of the tympanic membrane from chronic/ recurrent infections

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21
Q

How does chronic suppurative otitis media present

A

Ottorhea: Persistent purulent discharge through perforation
Hearing loss
Otalgia

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22
Q

What are complications of chronic suppurative otitis media

A

Retraction pockets (part of the ear drum collapses inwards) this can lead to Cholesteatoma

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23
Q

How does Cholesteatoma present

A

Presents after recurrent infections
- Offensive discharge +/- gradual hearing loss

Otoscopy: White material discharging from defect in tympanic membrane

Can cause hearing loss, meningitis

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24
Q

How do you treat Chronic Suppuritive Otitis Media

A

Aim is to make a dry safe ear

Perforation: Close it - Myringoplasty

Cholesteatoma: Mastoidectomy - to remove it but trying to preserve hearing as much as possible

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25
Q

What is otitis media with effusion/ glue ear

A

When fluid builds up behind the ear drum

most commonly occurs after an episode of acute otitis media

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26
Q

What causes otitis media with effusion

A

Dysfunction of the Eustachian tubes

27
Q

How may OME present

A 
Hearing loss of 25-30 dBs 
Poor Speech and Listening 
Language Delay 
Hearing Fluctuations 
(there may be no pain)
28
Q

How may OME look on examination

A

May look normal but can be variable presentation:

  • Drum may be retracted/bulging
  • Dull/Grey/Yellow
  • May be air bubbles/fluid level
29
Q

What is the treatment for OME

A

50% with bilateral hearing loss of 20dB will resolve in 3 months

  1. Conservative: Do nothing just observation, Eustachian tube autoinflation may help during
  2. Ventilation Tubes - Grommets
  3. Hearing aids if surgery contraindicated
30
Q

What is Choanal Atresia

A

• Failure of the nose to canalise
– Bony or membranous

• Bilateral rare but a neonatal emergency

31
Q

How does Choanal Atresia Present

And how can you easily test for it

A

• Cyclical going blue, crying-going pink, stop crying going blue again

  • Cold spatula: no misting
  • Failure to pass an NG tube
32
Q

How do you manage Choanal Atresia

A

Secure the Airway

Tertiary referral for dilatation and stent insertion

33
Q

What causes craniofacial disorders

What can it cause

What may be required as a last resort

A

Syndromic e.g Downs

Problems with airways

  • Obstructive Sleep Apnoea
  • Midfacial Hypoplasia
  • Tracheostomy
34
Q

What is unilateral discharge until proven otherwise and how should it be managed

A

Foreign Object (batteries emergency)

  • Try once at removing it otherwise GA
35
Q

What is the area in nose which is a rich supply of blood vessels and what can this lead to

A

Littles Area - Epistaxis

36
Q

How are nose bleeds caused

A 
Nose picking, 
inflammation, 
foreign body, 
trauma, 
bleeding diathesis
37
Q

How are nose bleeds managed

A 
• ABC
• Medical treatment:
– Topical naseptin, silver nitrate cautery
• Surgical treatment
– Electrocautery
38
Q

A teenage boy presents with recurrent nosebleeds and nasal congestion what should you be aware of

A

Juvenile Nasopharnygeal angiofibroma

39
Q

Is sinusitis common in children

A

No its RARE

40
Q

Sinusitis with nasal polyps what may be the diagnosis

A

CF

41
Q

What is the most common complication Sinusitis

A

Periorbital Cellulitis - can progress to orbital cellulitis

42
Q

What is Periorbital Cellulitis

What is Orbital Cellulits

Which ones more serious

A

Infection of the soft tissues anterior to orbital septum - Medical Emergency

Infection of soft tissues posterior to orbital septum

Orbital cellulitis

43
Q

How does orbital cellulitis present

How does Periorbital Cellulitis present

A

Fever, lid swelling, reduced eye movements, painful eye movements, dipoplia, proptosis, red colour vision

Swelling of eyelid and ocular pain, no painful eye movements, no diplopia, no visual impairment

44
Q

What is red colour vision a sign of in orbital cellulitis

A

Sign of optic nerve compromise

45
Q

How is orbital cellulitis managed

How is periorbital cellulitis managed

A

Joint care of paeds, opthalomology and ENT
IV Abx - amoxicillin
Surgery - incision and drainage of abscess

Amoxicillin

46
Q

How is laryngeal atresia managed

A

EXIT procedure

47
Q

What is the most common abnormality of the larynx

A

Laryngomalacia - floppy malformed larynx due to softening of the larynx tissues causing tissues to fall over airways blocking them

48
Q

How does laryngomalacia present

A
  • Normal voice, stridor worse on feeding and exertion • Worse when supine
  • Failure to thrive
  • Increased work of breathing
49
Q

How will Larngomalacia look in examination and how is it examined

A

tools

  • flexible nasoendoscopy
  • More detailed - GA: Microlaryngobronchoscopy
  • Normal Child
  • Stridor
  • WOB, tracheal tug, recessions
  • Flexiblenasendoscopy examination: omega shaped epiglottis, short aryepiglottic folds, bulky, prolapsing arytenoids
50
Q

How is Larngomalacia managed

A 
Often resolves on its own 
• Close monitoring
• Weigh (?daily/weekly at first)
• Antireflux
• If not coping NG tube
• ?surgery – microlaryngobronchoscopy + aryepiglottoplasty
51
Q

What high risk groups is hearing monitored in long term

A 
Cystic Fibrosos 
Chemotherapy 
CMV
Head Trauma 
Cleft lip/pallet 
Downs syndrome
52
Q

What are the four types of strabismus

A

Esotropia
Exotropia
Hypertropia
Hypotropia

53
Q

What are the most common causes of strabismus

A
  • Hereditary
  • Refractive Errors - most commonly uncorrected hypermetropia and accommodative esotropia
  • Secondary to vision loss
  • Neurological defects e.g cerebral palsy
  • Anatomical/Mechical defects
54
Q

How are strabismus investigated

A
  • Hx e.g age of onset etc
  • Corneal Reflection -reflection from bright light falls centrally and symmetrically on each cornea if no suint and asymmetrically if squint present
  • Cover Test - movement of uncovered eye yo take up fixation as other eye is covered
55
Q

what hearing test is used for neonates

A

Otoacoustic Emissions

56
Q

What is the hearing test used in 3+

A

Pure Tone Audiometry

57
Q

What is pseudostrabisus

A

False appearance of cross eyes

Due to e.g. - facial asymmetry, unilateral ptosis, deep set or prominent squint

58
Q

What is amblyopia

A

Defective visual acuity which persists after correction of refractive error (with glasses/contacts) and removal of any pathology - Lazy Eye

59
Q

What should all patients with amblyopia have and what is the management

A

Early Referral important! better outcome!!!

ALL patients need refraction/glasses test and fundus and media check under cyclopegia (paralysis of cillary muscle resulting in loss of accommodation

  • Refractive Adaption - wear appropriate glasses for 16-18 weeks
  • Occlusion of better seeing eye (eye patch)
  • Atropine Drops/ointment in better seeing eye
60
Q

What is it important to rule out when investigations strabismus

A

Paralytic Strabismus - check eye movements

61
Q

How do you manage strabismus

A

Aim: To restore binocular single vision and eliminate diplopia

The 3O’s

  • Optical - assess refractory state with cyclopegia for glasses
  • Orthoptic - patching good eye to encourage exercise of strabismus eye
  • Operations - Resession or Resection of Rectus muscle to help alignment OR Botulinum Toxin can help (medial rectus esotropia and lateral rectus exotropia)
62
Q

What is it important to understand about transient eye misalignments

A
  • They are normal in the first few months of life
  • They should be transient
  • Improve from age 2 mths onwards
  • Gone after 4 mths
63
Q

What is it important to note about sudden onset childhood strabismus

A
  • Most don’t have sudden onset may be present with other neurological signs
  • Urgent Referral
64
Q

What are two complications of Strabismus

A

Ambylopia

Diplopia

Paediatrics (13 decks)

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