Paediatrics ENT

Question 1

What is tonsillitis ? usually bacteria or virus ?

Answer 1

inflam of the tonsils
- often caused by viral infection - do not respond to Abx

Question 2

What is the most common bacterial cause of tonsillitis ? 2nd ?

Answer 2

group A strep (strep progenies)
steroptoccus pnemoiae

Question 3

tonsillitis presentaiton ?

Answer 3

fever, sore throat, painful swallowing (5-10 yrs)

Question 4

tonsillitis OE ? where else would you check ? (2)

Answer 4

• red, enflamed + enlarged tonsils +/- exudate
• also inspect ears + cervical lymph nodes

Question 5

What criteria can be used to determine whether to give Abx for tonsillitis ? (2)

Answer 5

• Cenotr criteria
• Fever pain score

Question 6

Describe centor criteria. what for ? how many needed ?

Answer 6

probability that tonsillitis is due to bacteria (>3 => indicate Abx use)
- Fever (>38)
- tonsillar exudates
- absence of cough
- lymphadenopathy

Question 7

Describe fever pain criteria. what for ? how many needed ?

Answer 7

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

Question 8

Tonsillitis Mx ?

Answer 8

exclude meningitis, epiglottis
- Fever pain/epiglottis
- Abx: Penecillin V (GAStrep)

Question 9

Tonsillitis complications ? (2)

Answer 9

• peritonsilar abscess
• post strep glomerulonephritis

Question 10

What is quinsy ?

Answer 10

aka peritonsilar abscess (tonsillitis complication)
- bacterial infection with trapped pus => abscess in tonsil region

Question 11

Quinsy mangment ?

Answer 11

pertonsillar abscess
incision + drainage, Abx (broad spec: co-amoxiclav)

Question 12

What is a tonsillectomy ?

Answer 12

surgical removal of tonsils (prevent further eps of tonsillitis)

Question 13

indications for tonsillectomy ? frequency ? (3)

Answer 13

> 7 in 1 yr
5 per yr for 2 yrs
3 per yr for 3 yrs

Question 14

tonsillectomy main complication ?

Answer 14

post tonsillectomy bleeding
- can be life threatening due to blood aspiration

Question 15

What is otitis Media ? where is it ?

Answer 15

infection of the middle ear (space between the tympanic memebrae + inner ear)

Question 16

What structures are in the middle ear ? (3)

Answer 16

• cochlear
• vestibular apparatus
• Nerves

Question 17

Where might bacteria enter to cause otitis media ?

Answer 17

bacteria enter form back of throat through eustachian tube
(associated with viral URTI)

Question 18

what is the most common cause of otitis media ?

Answer 18

strep pneumonia
(common cause of tonsillitis and rhino sinusitis too)

Question 19

Otitis media presentation ? (3)

Answer 19

• ear pain
• reduced hearing
• general symptoms of URTI (fever, cough, coryza, malaise)

Question 20

otitis media OE ?

Answer 20

otoscope to visualise tympanic membrane
- bulging red, inflamed

Question 21

otitis media Mx ?

Answer 21

most cases resolve without Abx
(usually viral cause)

Question 22

otitis media complications ?

Answer 22

• otitis media with effusion (glue ear)
  (this can also cause otitis media)
• hearing loss

Question 23

what is glue ear ?

Answer 23

otitis media with effusion: middle ear become full of fluid => loss of hearing in that ear

Question 24

glue ear Mx ?

Answer 24

• audiometry
• usually resolves within 3 months
• grommets (inserted into tympanic membrane)

Question 25

What two categories can hearing loss be split into ? (2)

Answer 25

- congential - acquired (as result of illness in childhood)

Question 26

causes of congenital hearing loss ? (4)

Answer 26

- maternal rubella - maternal cytomegalovirus - genetic deafness - Downs syndrome

Question 27

perinatal causes of hearing loss ? (2)

Answer 27

- prematurity - hypoxia during/after birth

Question 28

causes of hearing loss after birth ? (4)

Answer 28

- jaundice - meningitis/encephalitis - otitis media/glue ear - chemotherapy

Question 29

hearing loss presentation ?

Answer 29

Newborn hearing screening programme (NHSP) - parental concern

Question 30

hearing loss Mx

Answer 30

audiometry - MDT approach

Question 31

What is the blood source of most nose bleeds ?

Answer 31

littles area (after by little fingers) (kiesselbach's plexus)

Question 32

what can epistaxis be triggered by ? (5)

Answer 32

- nose picking - colds - vigorous nose blowing - trauma - change in weather

Question 33

epistaxis Mx ?

Answer 33

usually resolve without medical assitance - sit up + tilt forwards - Squeeze soft part of nostrils - spit out excess blood

Question 34

What is cleft lip

Answer 34

congenital condition here there is split or opening of upper lip

Question 35

what is cleft palate ?

Answer 35

defect exits in hard of soft palate => opening between mouth + nasal cavity (cleft lip or palate can present together or separately)

Question 36

cleft lip and palate cause ?

Answer 36

most cases are just random

Question 37

cleft lip and palate complication ?

Answer 37

- feedin, swallowing, speech, psychosocial

Question 38

cleft lip + palate Mx ?

Answer 38

MDT - definitive: surgical correction (leaves subtle scar)

Question 39

What is tongue tie ? aka ?

Answer 39

ankaloglossia: baby born with short + tight inguinal frenulum => difficult to latch to breast

Question 40

tongue tie Mx ?

Answer 40

if affecting feeding : frenotomy

Question 41

What is squint ? aka ?

Answer 41

malalignment of the eyes - strabismus

Question 42

what happens when eyes maligned ? how eyes develop from this ?

Answer 42

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)

Question 43

causes of a squint ? most common ?

Answer 43

usually idiopathic - hydopcephalus - CP - space occupying lesion - trauma

Question 44

squint Ix ?

Answer 44

Hirschbergs test

Question 45

squint Mx ? by when ?

Answer 45

treatment needs to be started before 8 yrs (visual fields still developing) - occlusive patch to cover good eye + force weak eye to develop

Question 46

What is hydrocephalus ? due to ? (2)

Answer 46

CSF building up abnormally (excessively) within brain + spinal cord - due to CSF over production or issue with draining + absorbing CSF

Question 47

congenital causes of hydrocephalus ? (3) most common

Answer 47

- aqueduct stenosis (most common) - arachnoid cysts - chromosomal abnormailites

Question 48

hydrocephalus presentation ? in babes

Answer 48

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

Question 49

hydrocephalus Mx ?

Answer 49

VP shunt

Question 50

Was is peri orbital cellulitis ? where affected ?

Answer 50

eyelid + skin infection in front of orbital septum (in front of eye)

Question 51

peri orbital cellulitis presentaiton ?

Answer 51

swollen, red, hot skin around eye lid + eye

Question 52

periorbital cellulitis Ix ?

Answer 52

must be differentiated from orbital cellulitis - urent opthal assessment - CT scan to distinguish

Question 53

periorbital cellulitis Mx ?

Answer 53

- abx - can dev to orbital cellulitis so soldier admission

Question 54

what is orbital cellulitis ? sx ?

Answer 54

sign and life threatening emergency - infection around eyeball involving tissue behind orbital septum - pain with eye movement, reduce eye movement , vision changes, proptosis

Question 55

orbital cellulitis Mx ? (3)

Answer 55

emergency admission + IV Abx + surgical draining (if abscess)