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Phase 3A > Paediatric - ENT > Flashcards

Paediatric - ENT Flashcards

1
Q

URTI

Name 3 causes of the common cold

A

rhinovirus
RSV
Coronavirus

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2
Q

URTI

What is the presentation of pharyngitis

A

pharynx and soft palate are inflamed

enlarged and tender local lymph nodes

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3
Q

URTI

Name 2 viral and 1 bacterial cause of pharyngitis

A

viral

  • common cold
  • adenovirus
  • EBV

Bacterial
- Group A beta haemolytic strep (common in older children)

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4
Q

URTI

What age group is tonsillitis common in

A

5 - 10

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5
Q

URTI

Name 4 causes of tonsillitis

A

Viral - most common
- EBV

Bacterial

  • Group A strep - strep pyogenes
  • Step pneumonia
  • H.influenzae
  • S.aureus
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6
Q

URTI

What is viral tonsillitis associated with

A

headache
apathy
abdominal pain

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7
Q

URTI

what is bacterial tonsillitis associated with

A

cervical lymphadenopathy

tonsillar exudate

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8
Q

URTI

What is the presentation of tonsillitis

A 
fever 
sore throat 
painful swallowing 
poor feeding 
headache 
abdominal pain 
vomiting
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9
Q

URTI

Describe the examination required for suspected tonsillitis

A

look in mouth
- red / inflamed / enlarged tonsils

Otoscopy

palpate for cervical lymphadenopathy

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10
Q

URTI

What are the 2 criteria used in suspected tonsillitis and what are they used for

A

CENTOR

FEVER PAIN

estimate probability tonsillitis is due to bacterial infection and will benefit from Abx

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11
Q

URTI

Describe the criteria used in CENTOR score

A

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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12
Q

URTI

Describe the criteria used in FEVER PAIN score

A 
fever > 38 
Purulence - exudate 
Attend rapidly - < 3 days 
Inflamed tonsils 
No cough or coryza

score > 4

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13
Q

URTI

What is the management of symptomatic tonsillitis

A

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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14
Q

URTI

When should you consider Abx in tonsillitis

A 
centor score > 3
Fever pain > 4
immunocompromised 
significant co-morbidity 
Hx of rheumatic fever
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15
Q

URTI

What Abx are required in bacterial tonsillitis

A

1st line - Penicillin
If allergic:
Clarithromycin

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16
Q

URTI

What is otitis media and when is it common

A

Infection of middle ear resulting in fluid build up

6 - 12m

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17
Q

URTI

Why is otitis media common in children

A

Eustachian tube is short, horizontal and functions poorly

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18
Q

URTI

what often preceeds an otitis media infection

A

Viral URTI

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19
Q

URTI

What bacteria commonly cause otitis media

A

Strep pneumonia - Most common
H. Influenzae
S. aureus
Strep penumoniae

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20
Q

URTI

How does otitis media present

A 
Ear pain - tugging 
reduced hearing 
fever 
irritability 
sx or URTI 
- fever 
- cough 
- coryzal sx 
balance issues and vertigo
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21
Q

URTI

How does a drum perforation in otitis media present

A

Easing of pain

purulent discharge

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22
Q

URTI

What examinations are required for suspected otitis media

A

Hearing
- loss of conductive hearing

Otoscopy

  • bright red and bulging
  • loss of light reflex
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23
Q

URTI

What is the management of otitis media

A

Pain - Analgesia
- Paracetamol +/- Ibuprofen

most resolve without Abx

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24
Q

URTI

When should you consider Abx in otitis media

A 
Systemically unwell 
Immunocompromised 
> 4 days with no sx improvement 
< 2 years old and bilateral 
< 3 months old 
Perforated ear drum
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25
Q

URTI

What Abx are used in otitis media

A

Amoxicillin

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26
Q

URTI

What are the complications of otitis media

A

Mastoiditis
meningitis
Glue ear if recurrent

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27
Q

URTI

How does mastoiditis present and how is it managed

A

Pain on palpation of mastoid process

Laterally and inferiorly displaced pinna - protrudes forwards

thick purulent discharge

  • Urgent ENT referral
  • IV Abx
  • Mastoidectomy
28
Q

URTI

What are the risk factors for otitis media

A

anatomical abnormalities - clef palate

older siblings

URTI

29
Q

URTI

What is glue ear and what age groups is it common in

A

otitis media with effusion

2 - 7 years old

30
Q

URTI

What causes glue ear

A

blockage of eustachian tube

eustachian tube connects back of the throat to the ear
- usually drains secretions from middle ear

31
Q

URTI

How does glue ear present

A

reduction in hearing

conductive hearing loss - Rhinne’s

32
Q

URTI

What does examination of the ear show in glue ear

A

Otoscopy

dull and retracted tympanic membrane

  • with air bubbles
  • visible fluid level
33
Q

URTI

What investigations should be performed in suspected glue ear

A

Audiogram - conductive deficits

Tympanometry - flat tympanogram

34
Q

URTI

What is the management of glue ear

A

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.

35
Q

URTI

What are grommets and how long do they last

A

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

36
Q

URTI

what advice should be given to children with grommets

A

Avoid diving but can swim

37
Q

URTI

What should be done if problems reoccur after grommet insertion

A

reinsertion of grommet with adjuvant adenoidectomy

38
Q

DEAFNESS

What are the 2 broad categories of deafness

A

Sensorineural

  • lesion in cochlea / nerve
  • present at birth

Conductive

  • abnormalities in ear canal or middle ear
  • often glue ear
39
Q

URTI

What is the main complication of glue ear

A

otitis media

40
Q

DEAFNESS

Name 5 causes of sensorineural deafness

A 
genetic 
congenital infection 
- rubella 
- CMV 
- Syphilis 
Hyperbilirubinemia 
Menilites 
head injury 
drugs 
- aminoglyclasides (gentamicin)
- furosemide
41
Q

DEAFNESS

What is the management of sensorineural deafness

A

hearing aids

cochlear implants

42
Q

DEAFNESS

Name 5 causes of conductive hearing loss

A 
Glue ear 
eustachian tube dysfunction 
downs syndrome 
cleft palate 
wax
43
Q

URT

What is the other name for a floppy larynx and when does it commonly present

A

laryngomalacia

4 weeks

44
Q

URT

How does laryngomalacia present

A 
congenital stridor 
- worse on feeding / exertion / crying 
failure to thrive 
IWB 
Normal voice
45
Q

URT

What are the investigations for laryngomalacia

A

bronchoscopy

  • omega shaped epiglottis
  • short aryepiglottic folds
  • prolapsing arytenoids
46
Q

URT

What is the management of laryngomalacia

A

resolves naturally in 18m

47
Q

CELLULITIS

What causes periorbital cellulitis

A

local trauma to skin

spread from paranasal sinus infection or dental abscess

48
Q

CELLULITIS

what is the presentation of periorbital cellulitis

A

fever

erythema, tenderness, oedema of eyelid

unilateral signs

49
Q

CELLULITIS

what is a red flag sign in periorbital cellulitis

A

loss of red colour vision

- sign of optic nerve compromise

50
Q

CELLULITIS

what is the management of periorbital cellulitis

A

ENT referral

Iv Abx - ceftriaxone

51
Q

CELLULITIS

how does orbital cellulitis present

A

proptosis
painful / limited eye movements
double vision
reduced visual acuity

52
Q

CELLULITIS

what is the investigation of choice for orbital cellulitis

A

CT/MRI - Assess posterior spread of infection

53
Q

CELLULITIS

what is the management of of orbital cellulitis

A

IV Abx

surgical decompression

54
Q

CELLULITIS

what are the complications associated with

A

meningitis
abscess formation
cavernous sinus thrombosis

55
Q

CELLULITIS

How do you differentiate between orbital and periorbital cellulitis

A

NOT PERIORBITAL

  • Reduced visual acuity
  • Proptosis
  • Ophthalmoplegia
56
Q

SQUINT

what is a squint

A

occurs due to misalignment of visual axis

57
Q

SQUINT

What are the causes of a squint

A 
refractive error - most common 
cataracts 
retinoblastoma 
visual loss 
opthamolplegia
58
Q

SQUINT

What are the 2 types of squint

A

Concomitant
- Imbalance in extraocular muscles

paralytic squint
- paralysis of extraocular muscles

59
Q

SQUINT

Name 1 causes of a concomitant squint and how is it managed

A

refractive error

correct with glasses

60
Q

SQUINT

Name 1 cause of a paralytic squint

A

motor nerve palsy

Intracranial palsy

61
Q

SQUINT

What 2 tests are used in squints

A

detect - corneal light

nature - cover test

62
Q

SQUINT

What must be checked in an infant with a squint

A

red reflexes

63
Q

SQUINT

What is the criteria for ophthalmology review in a child

A

divergent squint
paralytic squint
squint persistent beyond 3m

64
Q

SQUINT

What is the rule of thumb for lenses

A

long sight - convex
Hypermetropia

short sight - concave
Myopia

65
Q

SQUINT

What is amblyopia

A

Reduction of visual acuity in an eye that has not received a clear image
Usually unilateral

66
Q

SQUINT

Name 3 causes of amblyopia

A

squint
refractive errors
cataracts

67
Q

SQUINT

What is the management of amblyopia

A

patching of good eye

early treatment before 7

Phase 3A (12 decks)

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