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Paediatrics > Kidneys And ENT > Flashcards

Kidneys And ENT Flashcards

0
Q

What bacterial pathogens often cause otitis media?

A

Strep pneumoniae
HiB
If under 6 weeks old - E. coli, pseudomonas

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1
Q

Why are kids at increased risk of otitis media?

A

Developmental Eustachian tube alterations
Immature immune system
Frequent URTIs

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2
Q

Presenting symptoms of otitis media?

A

Otalgia, worse when supine
Otorrhoea, through perf TM or pre existent tympanostomy tube
Headache
Coryzal symptoms suggestive of concurrent URTI
Febrile (convulsions)
Irritability and lethargy
Anorexia, n and v, diarrhoea

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3
Q

Features suggestive of OME?

A

Hearing loss
Tinnitus
Vertigo or unsteadiness

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4
Q

What GI condition common in kids is a risk factor for OM?

A

Reflux

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5
Q

4 key things to look for when undertaking otoscopy to diagnose OM?

A

Colour of TM
Position of TM (bulging in OM, normal or retracted with effusion)
Mobility of TM (pneumatic otoscopy only)
Perforation?

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6
Q

Other diagnostic methods for OM?

A

Tympanometry
Acoustic reflectometry
Tympanocentesis and culture

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7
Q

What is it particularly about the ET in kids that makes them susceptible to OM?

A

Short, horizontal and functions improperly

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8
Q

Serious complications of OM?

A

Mastoiditis and meningitis depending on pathogen

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9
Q

What is glue ear otherwise known as?

A

Otitis media with effusion OME

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10
Q

Which antibiotic is widely used for OM and what is it effective/not effective for?

A

Amoxicillin

Good for reducing duration of symptoms, poor at reducing hearing loss

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11
Q

What hearing loss signs does OME precipitate in kids?

A

Conductive hearing loss (PTA)

Flat line on tympanometry

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12
Q

What are the prerequisites for grommet insertion and what is an alternative?

A

Recurrent URTIs
Chronic glue ear

Alternative = adenoidectomy

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13
Q

What urinary factors contribute to UTI susceptibility?

A

Renal calculi
Congenital malformation - obstructive uropathy
Vesico-ureteric reflux (VUR)
Phimosis

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14
Q

What are the classic symptoms of UTI that are more common with age?

A

Dysuria, frequency and loin pain

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15
Q

What is the current recommended method for urine collection in kids?

A

Clean catch method

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16
Q

What 3 imaging studies are recommended for post proven UTI, particularly for younger (<3yrs) kids?

A

US
MCUG or VCUG
DMSA scan

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17
Q

Long term complications of pyelonephritis?

A

Chronic renal failure

Hypertension

18
Q

4 criteria for severe UTI disease?

A

Fever >39
Persistent vomiting
Serious dehydration
Poor treatment compliance

19
Q

What neurological congenital defect can be a risk factor for UTIs?

A

Spina bifida

20
Q

Alternative methods to clean catch for collecting urine?

A

Plastic bag
Nappy pad
Catheter or SPA for really sick kids

21
Q

What investigation is gold standard for VUR?

A

MCUG

22
Q

What investigation is gold standard for renal parenchymal defects?

A

DMSA

23
Q

What antibiotics are commonly used in management of UTI?

A

Trimethoprim
Cefalexin
Amoxicillin, co amoxyclav

24
Q

What antibiotics are used for acute pyelonephritis?

A

Oral cephalosporins

25
Q

What kids are most at risk of HSP?

A

Boys 3-10 yrs old

26
Q

What is HSP commonly preceded by?

A

URTI

27
Q

What is the pathophysiology behind HSP?

A

Infection causing high IgA and low IgG
Complement activation and deposition in organs (autoimmune)
Widespread inflammatory response and vasculitis

28
Q

Describe the rash that is characteristic of HSP

A

Initially macpap/urticarial, quickly becomes purpuric. Palpable
Buttocks down, legs ankles and extensor surfaces (arm)

29
Q

Other features of HSP?

A

Fever
Joint pain/swelling (knees, ankles)
Colicky abdominal pain, haematemesis, malaena, intussusception
Micro/macroscopic haematuria, mild proteinuria

30
Q

Presenting features of tonsillitis other than sore throat?

A

Ear pain, abdominal pain
Headache
Vocal changes
High temperature

31
Q

Which lymph nodes are characteristically swollen and tender in tonsillitis?

A

Anterior cervical nodes

32
Q

What is ‘classic strep tonsillitis’?

A

Acute onset headache, abdo pain and dysphagia

33
Q

Differentials for tonsillitis?

A

Cold/viral URTI
Glandular fever
Coxsackievirus infection - blisters in mouth
Epiglotitis

34
Q

Centor criteria for Group A B-hemolytic Strep infection likelihood?

A 
Hx of fever
Absence of cough
Anterior cervical lymphadenopathy
Tonsillar exudate
3 or more = consider bacterial infection
35
Q

NICE specific indications for antibiotics in tonsillitis? (5)

A 
Marked systemic upset
Unilateral peritonsillitis (?quinsy)
Hx of rheumatic fever
Increased risk from acute infection e.g. DM, immunocompromised
3 or more centor criteria
36
Q

Typical antibiotic for tonsillitis?

A

10 days of phenoxymethylpenicillin

Alternatively clarithromycin if allergic to penicillin

37
Q

SIGN criteria for surgical referral - tonsillectomy

A

7 or more episodes in 1 year
5 or more in each of preceding 2 years
3 or more in each of preceding 3 years

38
Q

4 complications of tonsillitis?

A

Otitis media
Quinsy - peritonsillar abscess
Sleep interference
Exacerbation of guttate psoriasis

39
Q

What can peritonsillar abscess arise as a complication of?

A

Tonsillitis

Glandular fever

40
Q

What bacteria typically causes a peritonsillar abscess?

A

Strep pyogenes, although typically a combination

41
Q

Signs of peritonsillar abscess?

A 
Severe throat and ear pain
Fever, headache, general malaise
Drooling, foul smelling breath, dysphagia
Trismus
Altered voice
Neck stiffness/torticollis
42
Q

IV antibiotics used for peritonsillar abscess?

A

Penicillin, amoxicillin
Clindamycin
Cephalosporins

Paediatrics (9 decks)

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