Paediatric ENT Flashcards
A 5 yr old girl is brought to ED because of a red, swollen, painful eyelid. She has a tempterature of 37.8. What is your differential diagnosis and how would you assess her?
DDx: preseptal cellulitis or orbital cellulitis.
Assessment:
- obs
- ophthalmic exam
- observe: proptosis? chemosis? red eye?
- eyemovements: ophthalmoplegia? pain on eye movement?
- VA: reduced? blurring?
- colour vision: disurbed?
- RAPD? - if systemically unwell: FBC, CRP, blood cultures
- if indicated: orbital/sinus/brain cCT
- proptosis, RAPD, ophthamoplegia, reduced VA/blurring, disturbed colour vision, severe swelling, neuro signs/symptoms, no improvement after 48hrs IV Abx
A 5 yr old girl is brought to ED because of a red, swollen, painful eyelid. She has a temperature of 37.8. She is diagnosed with mild preseptal cellulitis. How would you manage her?
- PO co-amoxiclav for 5/7
- discharge from ED with no f/u but safety net
A 5 yr old girl is brought to ED because of a red, swollen, painful eyelid. She has a temperature of 37.8. She is diagnosed with orbital cellulitis. How would you manage her?
- admit, IV access, FBC + CRP +/- blood cultures
- IV ceftriaxone then PO co-amoxiclav when improved (total 10/7)
- ophthalmology + ENT review
A 6 yr old boy is then to the GP because of an acute sore throat over the last 2 days. On examination, he has inflammed purulent tonsils. How would you assess + manage this patient?
Assess using feverPAIN score:
- fever >38
- Purulence
- Attends within 3 days
- severely Inflammed tonsils
- No coryza/cough
If score 2-3: consider Abx. If score 4-5: Abx.
Abx = 5-10/7 PO phenoxymethylpenicillin
An 18mth old is brought to the GP because of irritability, runny nose + tugging at ear, How would you assess this patient? When would you consider Abx?
Assessment:
- otoscopy: look for erythematous, bulging TM
- assess for cervical lymphadenopathy
- assess facial n. function
- if ear discharge: send swab for culture
Consider PO amoxicillin for 5/7 if:
- systemically unwell (not requiring admission)
- risk factors for complications e.g. CHD, immunosuppression
- unwell for 4+ days without improvement
- TM perforation or ear discharge
An 18mth old was recently seen by the GP who diagnosed AOM and discharged them home with reassurance + analgesia. They now present to ED systemically unwell with a red boggy swelling behind the ear. How would you assess + manage them?
Assessment:
- bloods: FBC, CRP, blood cultures
- send middle ear fluid (from discharge or via tympanocentsis) for gram stain + culture
- CT/MRI head: to assess for intracranial complications
- LP: if intracranial spread suspected
Management:
- admit for IV ceftriaxone + IV metronidazole
- consider mastoidectomy +/- tympanoplasty if intracranial spread/other complications
A 10yr old boy presents with recurrent sore throats resulting in significant absence from school. Which criteria should be used to guide management decisions?
SIGN criteria - consider tonsillectomy if:
- 7+ significant sore throats (with impact to patient and family) in preceding 12 mths OR
- 5+ in each of preceding 2 yrs OR
- 3+ in each of preceding 3 yrs
(A fixed no. of episodes may not be appropriate if severe symptoms or complications e.g. quinsy have developed)
If SIGN criteria not met, refer back to primary care for active monitoring.
A 6yr old girl is brought to the GP due to loud snoring at night. This is interspersed with gasps at which point snoring stops before starting again. She also has behavioural issues at school. What is the likely diagnosis and how would you confirm this?
Obstructive sleep apnoea
Sleep studies: overnight pulse oximetry or overnight polysomnogram
What are the treatment options for OSA in children?
- Consider role of obesity: advise heavy lifestyle +/- refer to weight management service
- Mild-moderate OSA (6+ yrs): trial of nasal saline irrigation or intranasal steroids for 6-8 weeks
- Moderate OSA: active monitoring with secondary care f/u
- Severe OSA: tonsillectomy or CPAP if surgery not indicated
