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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
What is otitis media with effusion/ glue ear
When fluid builds up behind the ear drum most commonly occurs after an episode of acute otitis media
26
What causes otitis media with effusion
Dysfunction of the Eustachian tubes
27
How may OME present
``` Hearing loss of 25-30 dBs Poor Speech and Listening Language Delay Hearing Fluctuations (there may be no pain) ```
28
How may OME look on examination
May look normal but can be variable presentation: - Drum may be retracted/bulging - Dull/Grey/Yellow - May be air bubbles/fluid level
29
What is the treatment for OME
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
What is Choanal Atresia
• Failure of the nose to canalise – Bony or membranous • Bilateral rare but a neonatal emergency
31
How does Choanal Atresia Present And how can you easily test for it
• Cyclical going blue, crying-going pink, stop crying going blue again * Cold spatula: no misting * Failure to pass an NG tube
32
How do you manage Choanal Atresia
Secure the Airway Tertiary referral for dilatation and stent insertion
33
What causes craniofacial disorders What can it cause What may be required as a last resort
Syndromic e.g Downs Problems with airways - Obstructive Sleep Apnoea - Midfacial Hypoplasia - Tracheostomy
34
What is unilateral discharge until proven otherwise and how should it be managed
Foreign Object (batteries emergency) - Try once at removing it otherwise GA
35
What is the area in nose which is a rich supply of blood vessels and what can this lead to
Littles Area - Epistaxis
36
How are nose bleeds caused
``` Nose picking, inflammation, foreign body, trauma, bleeding diathesis ```
37
How are nose bleeds managed
``` • ABC • Medical treatment: – Topical naseptin, silver nitrate cautery • Surgical treatment – Electrocautery ```
38
A teenage boy presents with recurrent nosebleeds and nasal congestion what should you be aware of
Juvenile Nasopharnygeal angiofibroma
39
Is sinusitis common in children
No its RARE
40
Sinusitis with nasal polyps what may be the diagnosis
CF
41
What is the most common complication Sinusitis
Periorbital Cellulitis - can progress to orbital cellulitis
42
What is Periorbital Cellulitis What is Orbital Cellulits Which ones more serious
Infection of the soft tissues anterior to orbital septum - Medical Emergency Infection of soft tissues posterior to orbital septum Orbital cellulitis
43
How does orbital cellulitis present How does Periorbital Cellulitis present
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
What is red colour vision a sign of in orbital cellulitis
Sign of optic nerve compromise
45
How is orbital cellulitis managed How is periorbital cellulitis managed
Joint care of paeds, opthalomology and ENT IV Abx - amoxicillin Surgery - incision and drainage of abscess Amoxicillin
46
How is laryngeal atresia managed
EXIT procedure
47
What is the most common abnormality of the larynx
Laryngomalacia - floppy malformed larynx due to softening of the larynx tissues causing tissues to fall over airways blocking them
48
How does laryngomalacia present
* Normal voice, stridor worse on feeding and exertion • Worse when supine * Failure to thrive * Increased work of breathing
49
How will Larngomalacia look in examination and how is it examined
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
How is Larngomalacia managed
``` Often resolves on its own • Close monitoring • Weigh (?daily/weekly at first) • Antireflux • If not coping NG tube • ?surgery – microlaryngobronchoscopy + aryepiglottoplasty ```
51
What high risk groups is hearing monitored in long term
``` Cystic Fibrosos Chemotherapy CMV Head Trauma Cleft lip/pallet Downs syndrome ```
52
What are the four types of strabismus
Esotropia Exotropia Hypertropia Hypotropia
53
What are the most common causes of strabismus
- Hereditary - Refractive Errors - most commonly uncorrected hypermetropia and accommodative esotropia - Secondary to vision loss - Neurological defects e.g cerebral palsy - Anatomical/Mechical defects
54
How are strabismus investigated
- 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
what hearing test is used for neonates
Otoacoustic Emissions
56
What is the hearing test used in 3+
Pure Tone Audiometry
57
What is pseudostrabisus
False appearance of cross eyes | Due to e.g. - facial asymmetry, unilateral ptosis, deep set or prominent squint
58
What is amblyopia
Defective visual acuity which persists after correction of refractive error (with glasses/contacts) and removal of any pathology - Lazy Eye
59
What should all patients with amblyopia have and what is the management
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
What is it important to rule out when investigations strabismus
Paralytic Strabismus - check eye movements
61
How do you manage strabismus
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
What is it important to understand about transient eye misalignments
- 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
What is it important to note about sudden onset childhood strabismus
- Most don't have sudden onset may be present with other neurological signs - Urgent Referral
64
What are two complications of Strabismus
Ambylopia | Diplopia

Paediatrics (13 decks)

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