Kidneys And ENT Flashcards
What bacterial pathogens often cause otitis media?
Strep pneumoniae
HiB
If under 6 weeks old - E. coli, pseudomonas
Why are kids at increased risk of otitis media?
Developmental Eustachian tube alterations
Immature immune system
Frequent URTIs
Presenting symptoms of otitis media?
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
Features suggestive of OME?
Hearing loss
Tinnitus
Vertigo or unsteadiness
What GI condition common in kids is a risk factor for OM?
Reflux
4 key things to look for when undertaking otoscopy to diagnose OM?
Colour of TM
Position of TM (bulging in OM, normal or retracted with effusion)
Mobility of TM (pneumatic otoscopy only)
Perforation?
Other diagnostic methods for OM?
Tympanometry
Acoustic reflectometry
Tympanocentesis and culture
What is it particularly about the ET in kids that makes them susceptible to OM?
Short, horizontal and functions improperly
Serious complications of OM?
Mastoiditis and meningitis depending on pathogen
What is glue ear otherwise known as?
Otitis media with effusion OME
Which antibiotic is widely used for OM and what is it effective/not effective for?
Amoxicillin
Good for reducing duration of symptoms, poor at reducing hearing loss
What hearing loss signs does OME precipitate in kids?
Conductive hearing loss (PTA)
Flat line on tympanometry
What are the prerequisites for grommet insertion and what is an alternative?
Recurrent URTIs
Chronic glue ear
Alternative = adenoidectomy
What urinary factors contribute to UTI susceptibility?
Renal calculi
Congenital malformation - obstructive uropathy
Vesico-ureteric reflux (VUR)
Phimosis
What are the classic symptoms of UTI that are more common with age?
Dysuria, frequency and loin pain
What is the current recommended method for urine collection in kids?
Clean catch method
What 3 imaging studies are recommended for post proven UTI, particularly for younger (<3yrs) kids?
US
MCUG or VCUG
DMSA scan
Long term complications of pyelonephritis?
Chronic renal failure
Hypertension
4 criteria for severe UTI disease?
Fever >39
Persistent vomiting
Serious dehydration
Poor treatment compliance
What neurological congenital defect can be a risk factor for UTIs?
Spina bifida
Alternative methods to clean catch for collecting urine?
Plastic bag
Nappy pad
Catheter or SPA for really sick kids
What investigation is gold standard for VUR?
MCUG
What investigation is gold standard for renal parenchymal defects?
DMSA
What antibiotics are commonly used in management of UTI?
Trimethoprim
Cefalexin
Amoxicillin, co amoxyclav
What antibiotics are used for acute pyelonephritis?
Oral cephalosporins
What kids are most at risk of HSP?
Boys 3-10 yrs old
What is HSP commonly preceded by?
URTI
What is the pathophysiology behind HSP?
Infection causing high IgA and low IgG
Complement activation and deposition in organs (autoimmune)
Widespread inflammatory response and vasculitis
Describe the rash that is characteristic of HSP
Initially macpap/urticarial, quickly becomes purpuric. Palpable
Buttocks down, legs ankles and extensor surfaces (arm)
Other features of HSP?
Fever
Joint pain/swelling (knees, ankles)
Colicky abdominal pain, haematemesis, malaena, intussusception
Micro/macroscopic haematuria, mild proteinuria
Presenting features of tonsillitis other than sore throat?
Ear pain, abdominal pain
Headache
Vocal changes
High temperature
Which lymph nodes are characteristically swollen and tender in tonsillitis?
Anterior cervical nodes
What is ‘classic strep tonsillitis’?
Acute onset headache, abdo pain and dysphagia
Differentials for tonsillitis?
Cold/viral URTI
Glandular fever
Coxsackievirus infection - blisters in mouth
Epiglotitis
Centor criteria for Group A B-hemolytic Strep infection likelihood?
Hx of fever Absence of cough Anterior cervical lymphadenopathy Tonsillar exudate 3 or more = consider bacterial infection
NICE specific indications for antibiotics in tonsillitis? (5)
Marked systemic upset Unilateral peritonsillitis (?quinsy) Hx of rheumatic fever Increased risk from acute infection e.g. DM, immunocompromised 3 or more centor criteria
Typical antibiotic for tonsillitis?
10 days of phenoxymethylpenicillin
Alternatively clarithromycin if allergic to penicillin
SIGN criteria for surgical referral - tonsillectomy
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
4 complications of tonsillitis?
Otitis media
Quinsy - peritonsillar abscess
Sleep interference
Exacerbation of guttate psoriasis
What can peritonsillar abscess arise as a complication of?
Tonsillitis
Glandular fever
What bacteria typically causes a peritonsillar abscess?
Strep pyogenes, although typically a combination
Signs of peritonsillar abscess?
Severe throat and ear pain Fever, headache, general malaise Drooling, foul smelling breath, dysphagia Trismus Altered voice Neck stiffness/torticollis
IV antibiotics used for peritonsillar abscess?
Penicillin, amoxicillin
Clindamycin
Cephalosporins
