Paediatric - ENT Flashcards
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Name 3 causes of the common cold
rhinovirus
RSV
Coronavirus
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What is the presentation of pharyngitis
pharynx and soft palate are inflamed
enlarged and tender local lymph nodes
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Name 2 viral and 1 bacterial cause of pharyngitis
viral
- common cold
- adenovirus
- EBV
Bacterial
- Group A beta haemolytic strep (common in older children)
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What age group is tonsillitis common in
5 - 10
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Name 4 causes of tonsillitis
Viral - most common
- EBV
Bacterial
- Group A strep - strep pyogenes
- Step pneumonia
- H.influenzae
- S.aureus
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What is viral tonsillitis associated with
headache
apathy
abdominal pain
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what is bacterial tonsillitis associated with
cervical lymphadenopathy
tonsillar exudate
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What is the presentation of tonsillitis
fever sore throat painful swallowing poor feeding headache abdominal pain vomiting
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Describe the examination required for suspected tonsillitis
look in mouth
- red / inflamed / enlarged tonsils
Otoscopy
palpate for cervical lymphadenopathy
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What are the 2 criteria used in suspected tonsillitis and what are they used for
CENTOR
FEVER PAIN
estimate probability tonsillitis is due to bacterial infection and will benefit from Abx
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Describe the criteria used in CENTOR score
Fever > 38
tonsillar exudate
absence of cough
tender anterior cervical lymph nodes
score > 3 suggests Strep infection that would benefit from Abx
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Describe the criteria used in FEVER PAIN score
fever > 38 Purulence - exudate Attend rapidly - < 3 days Inflamed tonsils No cough or coryza
score > 4
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What is the management of symptomatic tonsillitis
paracetamol +/- Ibuprofen
educate if viral tonsillitis and provide safety net
- Pain not settled in 3 days
- fever > 38.3
consider Ddx and start Abx
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When should you consider Abx in tonsillitis
centor score > 3 Fever pain > 4 immunocompromised significant co-morbidity Hx of rheumatic fever
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What Abx are required in bacterial tonsillitis
1st line - Penicillin
If allergic:
Clarithromycin
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What is otitis media and when is it common
Infection of middle ear resulting in fluid build up
6 - 12m
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Why is otitis media common in children
Eustachian tube is short, horizontal and functions poorly
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what often preceeds an otitis media infection
Viral URTI
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What bacteria commonly cause otitis media
Strep pneumonia - Most common
H. Influenzae
S. aureus
Strep penumoniae
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How does otitis media present
Ear pain - tugging reduced hearing fever irritability sx or URTI - fever - cough - coryzal sx balance issues and vertigo
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How does a drum perforation in otitis media present
Easing of pain
purulent discharge
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What examinations are required for suspected otitis media
Hearing
- loss of conductive hearing
Otoscopy
- bright red and bulging
- loss of light reflex
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What is the management of otitis media
Pain - Analgesia
- Paracetamol +/- Ibuprofen
most resolve without Abx
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When should you consider Abx in otitis media
Systemically unwell Immunocompromised > 4 days with no sx improvement < 2 years old and bilateral < 3 months old Perforated ear drum
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What Abx are used in otitis media
Amoxicillin
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What are the complications of otitis media
Mastoiditis
meningitis
Glue ear if recurrent
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How does mastoiditis present and how is it managed
Pain on palpation of mastoid process
Laterally and inferiorly displaced pinna - protrudes forwards
thick purulent discharge
- Urgent ENT referral
- IV Abx
- Mastoidectomy
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What are the risk factors for otitis media
anatomical abnormalities - clef palate
older siblings
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What is glue ear and what age groups is it common in
otitis media with effusion
2 - 7 years old
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What causes glue ear
blockage of eustachian tube
eustachian tube connects back of the throat to the ear
- usually drains secretions from middle ear
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How does glue ear present
reduction in hearing
conductive hearing loss - Rhinne’s
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What does examination of the ear show in glue ear
Otoscopy
dull and retracted tympanic membrane
- with air bubbles
- visible fluid level
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What investigations should be performed in suspected glue ear
Audiogram - conductive deficits
Tympanometry - flat tympanogram
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What is the management of glue ear
referral for audiometry
conservative - resolves in 3m
Children with co-morbidities affecting the structure of the ear, such as Down’s syndrome or cleft palate may require hearing aids or grommets.
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What are grommets and how long do they last
tiny tubes inserted in to tympanic membrane
allows fluid from middle ear to drain through tympanic membrane into outer ear
Fall out in 1 year
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what advice should be given to children with grommets
Avoid diving but can swim
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What should be done if problems reoccur after grommet insertion
reinsertion of grommet with adjuvant adenoidectomy
DEAFNESS
What are the 2 broad categories of deafness
Sensorineural
- lesion in cochlea / nerve
- present at birth
Conductive
- abnormalities in ear canal or middle ear
- often glue ear
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What is the main complication of glue ear
otitis media
DEAFNESS
Name 5 causes of sensorineural deafness
genetic congenital infection - rubella - CMV - Syphilis Hyperbilirubinemia Menilites head injury drugs - aminoglyclasides (gentamicin) - furosemide
DEAFNESS
What is the management of sensorineural deafness
hearing aids
cochlear implants
DEAFNESS
Name 5 causes of conductive hearing loss
Glue ear eustachian tube dysfunction downs syndrome cleft palate wax
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What is the other name for a floppy larynx and when does it commonly present
laryngomalacia
4 weeks
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How does laryngomalacia present
congenital stridor - worse on feeding / exertion / crying failure to thrive IWB Normal voice
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What are the investigations for laryngomalacia
bronchoscopy
- omega shaped epiglottis
- short aryepiglottic folds
- prolapsing arytenoids
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What is the management of laryngomalacia
resolves naturally in 18m
CELLULITIS
What causes periorbital cellulitis
local trauma to skin
spread from paranasal sinus infection or dental abscess
CELLULITIS
what is the presentation of periorbital cellulitis
fever
erythema, tenderness, oedema of eyelid
unilateral signs
CELLULITIS
what is a red flag sign in periorbital cellulitis
loss of red colour vision
- sign of optic nerve compromise
CELLULITIS
what is the management of periorbital cellulitis
ENT referral
Iv Abx - ceftriaxone
CELLULITIS
how does orbital cellulitis present
proptosis
painful / limited eye movements
double vision
reduced visual acuity
CELLULITIS
what is the investigation of choice for orbital cellulitis
CT/MRI - Assess posterior spread of infection
CELLULITIS
what is the management of of orbital cellulitis
IV Abx
surgical decompression
CELLULITIS
what are the complications associated with
meningitis
abscess formation
cavernous sinus thrombosis
CELLULITIS
How do you differentiate between orbital and periorbital cellulitis
NOT PERIORBITAL
- Reduced visual acuity
- Proptosis
- Ophthalmoplegia
SQUINT
what is a squint
occurs due to misalignment of visual axis
SQUINT
What are the causes of a squint
refractive error - most common cataracts retinoblastoma visual loss opthamolplegia
SQUINT
What are the 2 types of squint
Concomitant
- Imbalance in extraocular muscles
paralytic squint
- paralysis of extraocular muscles
SQUINT
Name 1 causes of a concomitant squint and how is it managed
refractive error
correct with glasses
SQUINT
Name 1 cause of a paralytic squint
motor nerve palsy
Intracranial palsy
SQUINT
What 2 tests are used in squints
detect - corneal light
nature - cover test
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What must be checked in an infant with a squint
red reflexes
SQUINT
What is the criteria for ophthalmology review in a child
divergent squint
paralytic squint
squint persistent beyond 3m
SQUINT
What is the rule of thumb for lenses
long sight - convex
Hypermetropia
short sight - concave
Myopia
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What is amblyopia
Reduction of visual acuity in an eye that has not received a clear image
Usually unilateral
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Name 3 causes of amblyopia
squint
refractive errors
cataracts
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What is the management of amblyopia
patching of good eye
early treatment before 7
