Paediatric

Question 1

Congenital sensorineural risk factors

Answer 1

prematurity
Jaundice
NICU stay
Fhx
Syndromes e.g. Down’s syndrome

Question 2

What is otoacoustic emissions

Answer 2

hearing test where the cochlea itself makes a sound in response to being stimulated- can be used at any age

Question 3

What is auditory brainstem response testing

Answer 3

Measure EEG changes in response to sound
-Can be used at any age
-Useful in those <7 months as can be used without child cooperating

Question 4

When is visual reinforcement audiometry used

Answer 4

Child turns head to sound and is rewarded with a visual reward e.g. dancing toy

Question 5

When is play audiometry used

Answer 5

Carry out play action in response to sound (2-5 years)

Question 6

When is a cochlear implant used instead of a hearing aid

Answer 6

When SNHL is severe or a hearing aid doesn’t work well

Question 7

Tactics for removing foreign bodies
What need immediate removal

Answer 7

Wax hook for circular bodies
Croc forceps (not for beads)
Suction
Oil/alcohol to kill buzzing insects
Syringing best avoided
GA if uncooperative

Batteries need immediate removal

Question 8

What sounds as recurrent AOM

Answer 8

> 3 in 6 months
4 in 12 months

Question 9

Symptoms of acute otitis media in children

Answer 9

Temp
Pulling ear
Discharge if ear drum bursts

Question 10

What is chronic otitis media

Answer 10

Effusion, no symptoms/signs of acute inflammation

Question 11

What is chronic suppurative otitis media

Answer 11

Chronic otitis media with perforated ear drum

Question 12

What is cholesteatoma

Answer 12

Squamous epithelium in middle ear

Question 13

What is otitis media with effusion

Answer 13

Middle ear fluid in absence of symptoms/signs of acute infection
-Causes hearing loss, school problems, speech delay

Question 14

Treatment of otitis media with effusion

Answer 14

Try valsalva or otovent balloon to open Eustachian tube
-If persists >3 months with symptomatic hearing loss, speech, behaviour problems: grommets (ventilation tube= tympanostomy tube) or hearing aids

Question 15

What would an adult with glue ear indicate

Answer 15

Could be a sign of nasopharynx tumour

Question 16

Symptoms of acute otitis media

Answer 16

Pain, deafness, fever, ear tugging, discharge as TM ruptures and pain improves

Question 17

Management of otitis media

Answer 17

Analgesia

Most don’t need abx. Give abx if <6/12 old, at risk of infectious complications, symptoms >4 days, systemically unwell, (consider if bilateral, perf/discharge, <2 yo). Eg PO amoxicillin. Drops work well if discharge

ENT referral if not settling or complication (eg mastoiditis, facial palsy, intracranial sepsis)

Question 18

Recurrent acute otitis media management

Answer 18

Avoid pacifiers
No smoking of all family members
Treat each episode individually
Long term abx?
Grommets
However advise as child gets older it usually resolves itself

Question 19

TM perforation management

Answer 19

Direct trauma, blow or due to AOM
Most heal within 6 weeks
Keep dry
GP follow up after 6 weeks

ENT to see if:
-Severe bleeding
-Significant symptoms (deafness, tinnitus, vertigo, facial palsy)

Give drops

Question 20

Acute mastoiditis examination and symptoms

Answer 20

Otalgia, hearing loss, swelling behind ear, malaise
Pyrexia
Post auricular swelling
Pinna- down and forwards
Loss of post aural sulcus
Watch out for complications e.g. intracranial abscess

Rx: admit, IV abx;grommet =- cortical mastoidectomy if not settling or abscess or intracranial complication

Question 21

Symptoms of foreign body in nose

Answer 21

Unilateral offensive discharge in a child is FB until proven otherwise

Question 22

Management of foreign body in nose

Answer 22

‘Parental kiss’- parent blows fast into child’s mouth while occluding good nostril
Wax hook/suction
May need GA

Question 23

Treatment of rhinosinusitis

Answer 23

Majority need no treatment even if something suspicious shows on CT

Question 24

What to do if see a child under 10yo presenting with polyps

Answer 24

Refer to resp to test them for cystic fibrosis

Question 25

Symptoms of primary ciliary dyskinesia

Answer 25

Rhinitis at birth
Wet cough
Discharging grommets

Question 26

IF a child is immunodeficient what should you be worried about

Answer 26

Fungal sinusitis

Question 27

History of peri-orbital cellulitis

Answer 27

Usually starts with nasal obstruction/ discharge/ URTI
Eye lid trauma
Skin infection
URTI/ sinusitis

UNilateral eyelid swelling, pain, redness, blurred vision

Question 28

Examination of peri-orbital cellulitis
Bad signs

Answer 28

Fever
Invoice ophthalmology
eye red/swollen lid/reduced opening

Bad signs: reduced eye movement, proptosis, vision loss, loss of red colour vision an early sign
Rhinoscopy: pus

Question 29

Chandler periorbital cellulitis classification

Answer 29

1.Pre-septal inflammation. Lid erythema/oedema only, probably with open eye.
2: Orbital cellulitis. More severe symptoms, closed eye.
3: Subperiosteal abscess. Severe symptoms, proptosis, ophthalmoplegia, visual impairment.
4: Orbital abscess.
5: Cavernous sinus thrombosis. Bilateral symptoms, CNS signs.

Question 30

When would you do a CT for a periorbital abscess

Answer 30

CNS symptoms/signs, drowsiness, seizure, cranial nerves
Diplopia/ophthalmoplegia/proptosis/abnormal pupil reflex
Deteriorating acuity or colour vision
Unable to evaluate vision / Unable to open eyeBilateral periorbital oedema
No improvement or deterioration at 24-36
Swinging pyrexia not resolving within 36h

Question 31

Management for periorbital cellulitis

Answer 31

Majority need admission
Analgesia
IV abx
Close observation of eye (red colour desaturation is an early sign of optic compression)
Topical nasal decongestants
Combined ENT/opthalmology/Paeds
Maybe need abscess drainage and sinus washout
Watch for intracranial complications

Question 32

Causes of nasal obstruction in newborn

Answer 32

Choanal atresia (plates at back of the nose prevent air. When born they are blue and when crying they gain colour then when they stop they go blue again)
Pyriform aperture (bony opening at front of nose narrow)