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Finals > Paediatric ENT > Flashcards

Paediatric ENT Flashcards

1
Q

What is the most common cause of tonsillitis

A

-> viral infection : EBV

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2
Q

What is the most common cause of bacterial tonsilitis

A

-> Group A strep (streptococcus pyogenes) : treated with penicillin V for 10 days
-> Clarithromycin if penicllin allergy

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3
Q

What is used to estimate the probability that tonsitilits is due to a bacterial infection

A

FeverPain score

  • Fever in previpus 24 hrs
  • P : purulence on the tonsils
  • A : attened within 3 days of symptom onset
  • I : inflamed tonsils
  • N : no cough or coryza

4-5 = 62-65% probablility of bacterial tonsilitis

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4
Q

What is the most common bacterial cause of otitis media and what is it ?

A
  • > Streptococcus pneumoniae
  • > Infection of the middle ear
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5
Q

How does otitis media commonly present ?

A

-Ear pain +/- sore throat
-Reduced hearing
-Preceding viral URTI : fever, cough, coryzal symptoms, sore throat
-Otoscopy : red, inflamed, bulging tymopanic membrane -> loss of light reflex

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6
Q

What is glue ear and how is present and how does does it look when using an otoscopy ?

A

-> Otitis media with effusion
- > Fluid build up in the middle ear due to blockage of the eustachian tube
- > Reduction in hearing
- > Dull / cloudy tympanic membrane with air bubbles or visual fluid level

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7
Q

What is a complication of tonsilitis

A

Peritonsillar abscess (quincy)

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8
Q

Hx suggest tonsilitis
Uvular deviation
Tonsillar bulge
Trismus = unable to open mouth
Change in voice = ‘hot potato voice’

A

Quincy
Referral to ENT
Incision and drainage of abscess
Abx : co-amoxicla and dexamethosone

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9
Q

What are 2 complications of otitis media

A
  • Acute mastoiditis : tender, boggy swelling behind ear
  • Intracranial abscess
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10
Q

How would otitis media with effusion present

A
  • Smelly or gunky discharge from the ear + hearing loss
  • Grey tympanic membrane
  • Loss of cone light reflex
  • Visible fluid behind tympanic membrane
    = glue ear, peaks at 2 yrs
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11
Q

How is otitis media with effusion managed

A
  • Urgent referral
  • Hearing formally tested
  • Managed with Grommet insertion
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12
Q

what 2 conditions would require urgent ENT referral if they present with recurrent otitis media ?

A
  • Cleft palate
  • Down’s syndrome
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13
Q

give 5 risk factors for glue ear

A

male
siblings with glue ear
bottle feeding
nursery
parental smoking

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14
Q

How is glue ear managed

A

Grommet insertion

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15
Q

Give 7 complications of tonsilitis

A
  • Chronic tonsillitis
  • Quinsy
  • Otitis media
  • Scarlet fever
  • Rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Post-streptococcal reactive arthritis
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16
Q

when are antibiotics given for acute otitis media ?

A
  • Symptoms lasting more than 4 days or not improving
  • Systemically unwell but not requiring admission
  • Immunocompromised or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
  • Younger than 2 years with bilateral otitis media
  • Otitis media with perforation and/or discharge in the canal
17
Q

what is the Abx treatment of otitis media when required ?

A
  • > 5-7 day course amoxacillin
  • > Erythromycin or clarithryomycin if penicillin allergy
18
Q

Give 3 congenital causes of hearing loss

A
  • Maternal rubella or cytomegalovirus infection during pregnancy
  • Genetic deafness
  • Associated syndromes, for example Down’s syndrome
19
Q

Give 2 perinatal and 4 postnatal causes of hearing loss

A
  • > Perinatal = prematurity, hypoxia during or after birth
  • > Postnatal = jaundice, meningitis and encephalitis, otitis media or glue ear, chemotherapy
20
Q

what is the most likley location of the bleeding in epistaxis in children

A

Little’s area (Kiesselbach’s plexus)

21
Q

When would admission to hospital be considered for epistaxis ?

A
  • Doesn’t stop after 10-15 mins
  • Severe
  • Bilateral
  • Management : nasal packing, nasal cautery with silver nitrate stick
22
Q

what is given post treatment for epistaxis ?

A
  • Naseptin 4x daily for 10 days
  • Reduce crusting, inflammation and infection
  • CI in peanut or soya allergy
23
Q

what is tongue tie ?

A
  • > Baby is born with short and tight lingual frenulum (attachment of tongue to floor of mouth)
  • > Makes it hard for them to latch onto breast
24
Q

What is a cystic hygroma amnd where are they most commonly found ?

A
  • Malformation of lymphatic system = cyst filled with lymphatic fluid
  • Typically located in posterior triangle of neck on left hand side
25
Q

How do cystic hygromas present and how can they be managed if necessary ?

A
  • Can be very large
  • Are soft
  • Are non-tender
  • Transilluminate
  • Aspiration, surgical removal, sclerotherapy
26
Q

What are the key features of a thyroglossal cyst ?

A
  • Mobile, non tender, soft, fluctuant swelling in the midline of the neck
  • MOVE UP AND DOWN WITH TONGUE MOVEMENT
27
Q

How are thyroglossal cysts confirmed and then managed ?

A
  • USS or CT
  • Surgically removed
28
Q

What is the common presentation of a brachial cyst ?

A
  • Pt >10 yrs
  • Round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle of the anterior triangle
  • Do not transluminate
29
Q

Where is the most likely origin of a brachial cyst ?

A

Second brachial cleft

30
Q

What are the indications for a tonsillectomy ?

A

7 or more in 1 year
5 per year for 2 years
3 per year for 3 years

31
Q

What is the most significant complication of a tonsillectomy and when would you immediately return to theatre

A
  • Post tonsillectomy bleeding.
  • Primary bleeding (within 24 hrs).
32
Q

what are the two options for stopping severe bleedings from a tonsillectomy prior to going back to theatre

A

Hydrogen peroxide gargle
Adrenalin soaked swab applied topically

33
Q

What is a secondary haemorrhage following a tonsillectomy and how is it managed ?

A
  • Occurs between 5 and 20 days after surgery
  • Treatment with admission and antibiotics.
34
Q

Management of a child with their first presentation of glue ear

A

Active observation for 3 mnths

35
Q

Management of glue ear in a pt with a background of Down’s syndrome or cleft palate

A

Refer to ENT

36
Q

Presentation of mastoiditis

A
  • Fever
  • Patient is typically very unwell
  • Swelling, erythema and tenderness over the mastoid process
  • External ear may protrude forwards
  • Ear discharge may be present if the eardrum has perforated
37
Q

Management of mastoiditis

A

IV antibiotics

38
Q

When would a child without a background of Down’s or cleft palate be referred to ENT for glue ear ?

A

Persisting significant hearing loss on two separate occasions (usually 6-12 wks apart)

39
Q
A

Finals (92 decks)

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