Paediatrics ENT Flashcards
What is tonsillitis ? usually bacteria or virus ?
inflam of the tonsils
- often caused by viral infection - do not respond to Abx
What is the most common bacterial cause of tonsillitis ? 2nd ?
group A strep (strep progenies)
steroptoccus pnemoiae
tonsillitis presentaiton ?
fever, sore throat, painful swallowing (5-10 yrs)
tonsillitis OE ? where else would you check ? (2)
- red, enflamed + enlarged tonsils +/- exudate
- also inspect ears + cervical lymph nodes
What criteria can be used to determine whether to give Abx for tonsillitis ? (2)
- Cenotr criteria
- Fever pain score
Describe centor criteria. what for ? how many needed ?
probability that tonsillitis is due to bacteria (>3 => indicate Abx use)
- Fever (>38)
- tonsillar exudates
- absence of cough
- lymphadenopathy
Describe fever pain criteria. what for ? how many needed ?
probability that tonsillitis is due to bacteria (4-5 => indicate Abx use)
- Fever
- Purulence
- attended within 3 days of Sx onset
- Inflamed tonsil
- No cough/coryza
Tonsillitis Mx ?
exclude meningitis, epiglottis
- Fever pain/epiglottis
- Abx: Penecillin V (GAStrep)
Tonsillitis complications ? (2)
- peritonsilar abscess
- post strep glomerulonephritis
What is quinsy ?
aka peritonsilar abscess (tonsillitis complication)
- bacterial infection with trapped pus => abscess in tonsil region
Quinsy mangment ?
pertonsillar abscess
incision + drainage, Abx (broad spec: co-amoxiclav)
What is a tonsillectomy ?
surgical removal of tonsils (prevent further eps of tonsillitis)
indications for tonsillectomy ? frequency ? (3)
> 7 in 1 yr
5 per yr for 2 yrs
3 per yr for 3 yrs
tonsillectomy main complication ?
post tonsillectomy bleeding
- can be life threatening due to blood aspiration
What is otitis Media ? where is it ?
infection of the middle ear (space between the tympanic memebrae + inner ear)
What structures are in the middle ear ? (3)
- cochlear
- vestibular apparatus
- Nerves
Where might bacteria enter to cause otitis media ?
bacteria enter form back of throat through eustachian tube
(associated with viral URTI)
what is the most common cause of otitis media ?
strep pneumonia
(common cause of tonsillitis and rhino sinusitis too)
Otitis media presentation ? (3)
- ear pain
- reduced hearing
- general symptoms of URTI (fever, cough, coryza, malaise)
otitis media OE ?
otoscope to visualise tympanic membrane
- bulging red, inflamed
otitis media Mx ?
most cases resolve without Abx
(usually viral cause)
otitis media complications ?
- otitis media with effusion (glue ear)
(this can also cause otitis media) - hearing loss
what is glue ear ?
otitis media with effusion: middle ear become full of fluid => loss of hearing in that ear
glue ear Mx ?
- audiometry
- usually resolves within 3 months
- grommets (inserted into tympanic membrane)
What two categories can hearing loss be split into ? (2)
- congential
- acquired (as result of illness in childhood)
causes of congenital hearing loss ? (4)
- maternal rubella
- maternal cytomegalovirus
- genetic deafness
- Downs syndrome
perinatal causes of hearing loss ? (2)
- prematurity
- hypoxia during/after birth
causes of hearing loss after birth ? (4)
- jaundice
- meningitis/encephalitis
- otitis media/glue ear
- chemotherapy
hearing loss presentation ?
Newborn hearing screening programme (NHSP)
- parental concern
hearing loss Mx
audiometry
- MDT approach
What is the blood source of most nose bleeds ?
littles area (after by little fingers)
(kiesselbach’s plexus)
what can epistaxis be triggered by ? (5)
- nose picking
- colds
- vigorous nose blowing
- trauma
- change in weather
epistaxis Mx ?
usually resolve without medical assitance
- sit up + tilt forwards
- Squeeze soft part of nostrils
- spit out excess blood
What is cleft lip
congenital condition here there is split or opening of upper lip
what is cleft palate ?
defect exits in hard of soft palate => opening between mouth + nasal cavity
(cleft lip or palate can present together or separately)
cleft lip and palate cause ?
most cases are just random
cleft lip and palate complication ?
- feedin, swallowing, speech, psychosocial
cleft lip + palate Mx ?
MDT
- definitive: surgical correction (leaves subtle scar)
What is tongue tie ? aka ?
ankaloglossia: baby born with short + tight inguinal frenulum => difficult to latch to breast
tongue tie Mx ?
if affecting feeding : frenotomy
What is squint ? aka ?
malalignment of the eyes
- strabismus
what happens when eyes maligned ? how eyes develop from this ?
when eyes no aligned => images on retina don’t match => double vision
- during childhood (dev): brain copes with misalignment by reducing signal from less dominant eye => dominant + lazy eye (with gets progressively worse)
causes of a squint ? most common ?
usually idiopathic
- hydopcephalus
- CP
- space occupying lesion
- trauma
squint Ix ?
Hirschbergs test
squint Mx ? by when ?
treatment needs to be started before 8 yrs (visual fields still developing)
- occlusive patch to cover good eye + force weak eye to develop
What is hydrocephalus ? due to ? (2)
CSF building up abnormally (excessively) within brain + spinal cord
- due to CSF over production or issue with draining + absorbing CSF
congenital causes of hydrocephalus ? (3) most common
- aqueduct stenosis (most common)
- arachnoid cysts
- chromosomal abnormailites
hydrocephalus presentation ? in babes
enlarged head circumference (cranial bone in babies don’t fuse till 2 yrs so increase pressure => head expand)
- bulging anterior fontanelle
- poor feeding
- Vomiting
- Poort tone
- Sleepiness
hydrocephalus Mx ?
VP shunt
Was is peri orbital cellulitis ? where affected ?
eyelid + skin infection in front of orbital septum (in front of eye)
peri orbital cellulitis presentaiton ?
swollen, red, hot skin around eye lid + eye
periorbital cellulitis Ix ?
must be differentiated from orbital cellulitis
- urent opthal assessment
- CT scan to distinguish
periorbital cellulitis Mx ?
- abx
- can dev to orbital cellulitis so soldier admission
what is orbital cellulitis ? sx ?
sign and life threatening emergency
- infection around eyeball involving tissue behind orbital septum
- pain with eye movement, reduce eye movement , vision changes, proptosis
orbital cellulitis Mx ? (3)
emergency admission + IV Abx + surgical draining (if abscess)
