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Yr3 - GP > Paediatrics + ENT > Flashcards

Paediatrics + ENT Flashcards

1
Q

1 month milestones

A
  • lift head
  • track with eyes
  • coo
  • recognise parents
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2
Q

6 month milestones

A
  • sit up
  • raking grasp
  • babbles
  • stranger anxiety
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3
Q

12 month milestones

A
  • walk
  • 2 finger pincer grasp
  • mama/dada
  • imitate parent
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4
Q

9 month milestones

A
  • walk with assistance
  • 3 finger grasp
  • wave bye-bye/patacake
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5
Q

2 year milestones

A
  • climb 2 steps
  • 2 word phrases
  • 2 step commands
  • stack 6 blocks
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6
Q

3 year milestones

A
  • tricycle
  • 2 word sentences
  • brush teeth
  • draw circle
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7
Q

4 year milestones

A
  • hop
  • copy cross
  • play with kids
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8
Q

Management of child with non-serious fever

A

Keep cool
Give fluids - continue breast feeding
Paracetamol or ibuprofen - whichever is effective
Keep away from school/nursery
Give parents clear advice about deterioration

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9
Q

Indications for referral of febrile child

A

<3 months - temp > 38

> 3 months - temp > 39.9

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10
Q

Early signs of meningococcal disease

A

Infants - non-specific signs such as drowsiness, lethargy or poor feeding
Cold hands and feet
Skin changes
Leg pains

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11
Q

Features of meningococcal disease

A 
Purpuric rash
Neck stiffness
Lethargy
Postitive Kernig's sing
Vomiting
Headache
Photophobia
Altered consciousness
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12
Q

Features of UTI

A

Non-specific symptoms

  • unexplained fever
  • recurrent fevers
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13
Q

Risk factors for UTI

A 
Congenital
- vesicoureteric reflux
- posterior urethral valve
Spinal lesions
Constipation
Poor hygiene
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14
Q

Differential diagnosis of UTI

A

Vulval irritation
Balanitis
Threadworms
Sexual abuse

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15
Q

Management of UTI

A

Urine dipstick
Refer if less than 3 months or any red flag symptoms
Antibiotics - nitrofurantoin

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16
Q

Red flags for a febrile child

A 
Colour
- pale/ashen/mottled/blue
Activity
- no response to social cues
- appears ill
- weak high-pitched or continuous cry
- unable to rouse
Resp
- grunting
- tachypnoea
- RR > 60
- chest indrawing
Hydration
- reduced skin tugor
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17
Q

Other red flag symptoms for a febrile child

A 
Fever > 38 if 0-3 mnths
Fever > 39.9 if 3-6 mnths
Non-blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Focal seizures
Bile stained vomiting
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18
Q

Causes of cough

A 
Acute
- URTI
- croup
- pneumonia
- pertussis
Chronic
- post-bronchiolitis or pertussis
- aspiration of feed
- GORD
Recurrent
- asthma
- cystic fibrosis
- bronchiectasis
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19
Q

Causes of stridor

A 
Acute
- croup - 6mnths to 6 yr
- epiglottitis - 1-6yrs
- acute allergic reaction
Chronic
- congenital
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20
Q

Causes of wheeze

A 
RTI
Atopic asthma
Croup
GORD
Inhaled foreign body
Heart failure
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21
Q

Define stidor

A

Noise that occurs on inspiration due to parital upper airway obstruction

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22
Q

Define croup

A

Laryngo-tracheal infection usually caused by parainfluenza virus
More common in winter
Starts with URTI then barking cough and stridor develop later

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23
Q

Management of croup

A

Most managed at home

  • keep calm and reassure
  • sit child upright
  • dexamethasone and nebulised steriods reduce severity
  • inhaling steam not shown any benefit
  • do not give cough mixtures - cause drowsiness
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24
Q

When should a child with croup be refereed to hospital

A

Refer to hospital if

  • ill child with cyanotic spells
  • respiratory distress, feeding difficulties or dehydration
  • suspect epiglottis
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25
Q

Features of epiglottis

A

Rare since haemophilus influenzae type B immunisation
Medical emergency
Rapid onset - over few hours
Child ill with soft stridor, lean foward, drooling because of extreme difficulty swallowing

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26
Q

Define bronchiolitis

A

Caused by respiratory syncytial virus (RSV)

Occurs mainly in winter in babies under 12 months

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27
Q

Features of bronchiolitis

A

Cough and URTI
Later respiratory symptoms develop and breathing difficulties
Chest hyper-inflation with widespread wheeze and fine crackles

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28
Q

Describe asthma

A

Inflammatory disease of the airways with reversible outflow obstruction
Associated with bronchial hyperresponsiveness

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29
Q

Clinical features of asthma

A 
Recurrent wheeze
- worse at night/early morning
- expiratory
- high pitched
Tightness of chest and breathlessness
Recurrent cough
- dry
Trigger factors
- URTI
- pets
- dust
- cold
- exercise
Family history of atopy
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30
Q

Symptoms of acute severe asthma

A

Unable to complete sentences, altered consciousness
PR > 120 if >5, > 140 if 2-5
RR > 30 if >5, >40 if 2-5
SpO2 < 92%
Peak flow < 33-55% of best/predicted PEFR

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31
Q

Treatment of acute severe asthma

A

Beta-agonists - salbuatoml
- up to 10 puffs
Refer to hospital urgently if no improvement

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32
Q

Features of life-threatening asthma

A 
Hypotension
Confusion
Exhaustion
Poor respiratory effort/silent chest
PF < 35%
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33
Q

Treatment of life-threatening asthma

A

Refer urgently to hospital

Give salbutamol and oxygen via facemask

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34
Q

Differential diagnosis of asthma

A

Cystic fibrosis
Bronchopulmonary dysplasia
Bronchiectasis

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35
Q

Management of chronic asthma

A 
Monitor growth
Peak flow and/or symptom diary
Check inhaler technique and compliance
Ask about attacks, use of inhaler and exercise-induced episodes
Ask about sleep disturbances
Choose inhaler suitable for child's age
Consider allergen avoidance
Advise about active/passive smoking and flu vaccination
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36
Q

Inhalers used for each age group

A

Dry powder inhaler = > 5 years
Metered dose inhaler with facemask = infants
Metered dose inhaler with spacer = < 5 years

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37
Q

Stepwise management of asthma in children

A

Step 1 - mild intermittent asthma
- inhaled short-acting beta-agonist as needed
Step 2 - regular preventer therapy
- add inhaled corticosteriod
- or leukotriene receptor antagonist if inhaled steroid cannot be used
Step 3 - add on therapy
- aged 2-5 = leukotriene receptor antagonist
- aged < 2 = continue to step 4
Step 4 - persistent poor control
- refer to respiratory paediatrician

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38
Q

Treatment for asthma exacerbations

A

Rescue course of prednisolone for 3-14 days

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39
Q

Features of constipation in an infant

A 
< 3 stools per week
Hard, large or rabbit-dropping stools
Overflow soiling
Distress on stooling or anal pain
Bleeding associated with hard stool
Straining
Poor appetite or abdo pain that improves after stool has passed
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40
Q

Serious underlying causes of constipation in a child

A 
Hirschsprung's disease
Coeliac disease
Hypothyroidism
Anorectal abnormalities
Neurological conditions
Abdominal tumours
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41
Q

Reasons to refer for specialist assessment in a child with constipation

A

Delay in passing meconium or constipation since birth
Abnormal appearance, postition or patency of anus
Ribbon-like stool
New leg weakness, deformity or neuromuscular signs
Asymmetrical gluteal muscles, sacral naevus, sinus or pit
Abdominal distension with vomiting or gross distension

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42
Q

Treatment of idiopathic constipation

A

Macrogol - adjust dose according to response
Stimulant laxative
Continue for several weeks once normal bowel habit achieved
Advise balance diet and adequate fluid intake

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43
Q

Causes of acute diarrhoea in children

A

Infective gastrenteritis
Food poisoning
Diarrhoea associated with febrile illness
- URTI, TUI

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44
Q

Causes of vomiting in infants

A 
Overfeeding, posseting
GORD
Gasteroenteritis
Pyloric stenosis
Malrotation
Intussusception
Extra-abdominal causes of infection
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45
Q

Causes of vomiting in older children

A 
Gasteroenteritis
Viral illness
Systemic infection
Migraine
Bulimia
Raised intracranial pressure
Pregnancy
Drugs
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46
Q

Causes of chronic diarrhoea in children

A 
Toddler diarrhoea
Post-infective gasteroenteritis
Parasites
Overflow from constipation
Malabsorption - UC, Crohn's, cystic fibrosis
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47
Q

Causes of acute abdominal pain

A 
Surgical
- appendicitis
- Meckel's
- intestinal obstruction
- intussusception
- strangulated hernias
Medical
- gasteroenteritis
- UTI/pyelonephritis
- tonsilitis
- mesenteric adenitis
- DKA
- IBD
Extra-abdominal
- torsion of testis
- ovarian cyst
- ectopic pregnancy
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48
Q

Causes of recurrent abdominal pain

A
  • functional
  • abdominal migraine
  • IBS
  • non-ulcer dyspepsia
  • IBD
  • coeliac disease
  • giardia
    Extra-abdominal
  • gynaecological - dysmenorrhoea, ovarian cyst, PID
  • psychosocial
  • referred pain from hip/spine
  • UTI
  • sickle cell disease
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49
Q

Refer to specialist for malabsorption if

A

Chronic diarrhoea
Failure to thrive or weight loss
Steatorrhoea
Iron/other nutrient deficiency

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50
Q

Causes of malabsorption in children

A 
Cow's milk intolerance - protein allergy or lactose intolerance
Coeliac disease
Cystic fibrosis
Chronic infection - giardiasis
IBD
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51
Q

Presentation of cow’s milk allergy

A 
GI symptoms
- diarrhoea - occasionally with blood
- constipation
Skin
- urticaria
- eczema
Other
- wheeze
- rhinitis
- conjunctivitis
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52
Q

Treatment of cow’s milk allergy

A

Elimination cows milk - replace with hydrolysed protein milk formula
Amino acid formula
Advise solids should be diary free
Most grow out - challenged with foods containing milk from 12 months

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53
Q

Diagnosis of cow’s milk allergy

A

Withdraw cow’s milk

Skin prick/RAST tests - high false negatives and positive results

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54
Q

Presentation of lactose intolerance

A 
Infancy
- abdominal distension
- diarrhoea - explosive and watery
- vomiting
- failure to thrive
Childhood
- milder abdo pain and distension
- diarrhoea and vomiting
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55
Q

Features of anorectal atresia

A

Baby fails to pass meconium and no visible anus
- often fistula to urethra or vagina
Surgical treatment

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56
Q

Features of non-acute inguinal hernia

A

History of intermittent groin +/- scrotal swelling

  • spermatic cord may be thickened on affected side
  • refer for herniotomy
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57
Q

Features of acute inguinal hernia

A

Sudden appearance of an irreducible groin or scrotal swelling
- emergency admission for reduction and repair

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58
Q

Features of diaphragmatic hernia

A

Bowel herniates into chest cavity - defect in one hemidiaphragm
-> pulmonary hypoplasia in utero or lung compression postnatally

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59
Q

Features of febrile convulsions

A

Epileptic seizures provoked by fever in otherwise normal children

  • FH
  • brief and generalised
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60
Q

Causes of febrile convulsions

A 
Viral infection
Otitis media
Tonsillitis
UTI
Gastroenteritis
LRTI
Meningitis
Post-immunisation
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61
Q

Presentation of nappy rash

A

Glazed erythema in napkin area
- sparing skinfolds
Secondary bacterial or fungal infection is common

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62
Q

Differential diagnosis of nappy rash

A

Seborrhhoeic eczema
Candidiasis
Napkin psoriasis

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63
Q

Management of nappy rash

A

Advise parents to keep nappy area dry
Give baby as much time as possible without nappy
Apply moisturiser as soap substitute
Apply barrier cream between nappy changes
Topical treatment with antifungal combined with hydrocortisone if not clearing

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64
Q

Clinical features of acne vulgaris

A 
Comedones - high density on face, chest and back
Inflammatory lesions
- papules and pustules
- nodules or cysts
Scaring
Pigmentation 
Seborrhoea
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65
Q

Differential diagnosis for acne vulgaris

A 
Rosacea
Perioral dermatitis
Folliculitis and boils
Drug-induced acne
Keratosis pilaris
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66
Q

Management of acne vulgaris

A 
Advise
- avoid overwashing skin
- avoid picking/squeezing
Topical retinoid - adapalene
- contraindicated in pregnancy
- with benzoyl peroxide
Topical antibiotic - clindamycin
Azeliac acid
Macrolide antibiotics
COOP in women
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67
Q

Red flags for serious pathology in acute childhood limp

A

Pain waking the child at night - malignancy
Signs of redness, swelling or stiffness at joint/limb - infection or inflammatory joint disease
Weight loss, anorexia, fever, night sweats or fatigue - malignancy, infection or inflammation
Unexplained rash or bruising - haematological or inflammatory joint disease
Limp and stiffness in morning - inflammatory joint disease
Severe pain, anxiety and agitation after traumatic injury - compartment syndrome

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68
Q

Detection of headlice

A

Detection combing with fine toothed comb

- live louse must be found

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69
Q

Management of headlice

A

Physical, chemical or traditional insecticide

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70
Q

Postnatal visit includes

A

Rhesus status
Hb on day 5 - if < 10g/dl iron supplements for 3 months
Rubella status
Temperature, pulse and bp - high BP associated with pre-eclampsia
Fundus
Pain
Vaginal loss - red, brown then yellow - fresh bleeding is abnormal
Mobilising
Feeding
Mental state

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71
Q

Postpartum contraception

A

Not needed till 21 days postpartum
COC contraindicated if breastfeeding - inhibit lactation and enters breast milk
POP - > 3 weeks to avoid risk of heavy bleeding
Implants - > 6 wks to avoid heavy/irregular bleeding
IUD/IUS - < 48hr post delivery
Cap - 5-6wks
Condoms
Sterilization - best delayed for a few months

72
Q

Mother’s 6wk postnatal check

A

BP and weight - discuss control if overweight
Abdominal examination - uterus not palpable
Vaginal examination - only if problems with tears/episiotomy, persistent vaginal bleeding, pain or perform cervical smear
Screen for depression
Check Hb if anaemic postnataly
Check rubella

73
Q

Causes of postnatal breast soreness

A 
Sore/cracked nipples
- nipple shields
Skin infection
- usually due to candidia infeciton - treat mother and baby with miconazole oral gel 
Blocked duct
- hard tender lump
- express milk or massage
Mastitis
- tender, hot reddened area of breast +/- fever
- flucloxacillin 500mg qds and NSAIDs
- continue breastfeeding/express milk
Breast abscess
- admit for incision and drainage
74
Q

Treatment of postnatal haemorrhoids

A

Local ice packs
Topical preparations
Resting lying on one side
Keeping stools soft using a stool softener
Wash haemorrhoids with cool water after opening bowels

75
Q

Features of baby blues

A 
Very common
Women become tearful and low 
- within 1st 10d of delivery
Be supportive
- usually resolves
76
Q

Features of postnatal depression

A 
Common
Peak 12wks after delivery
Screen and 6-4wks and 3-4months
During the past month have you
- felt down, depressed or hopeless
- little interest or pleasure in doing things
77
Q

Risk factors for post natal depression

A 
Depression during pregnancy
Bad birth experience
Social problems
PMH or FMH
Alcohol or drug abuse
78
Q

Management of post-natal depression

A

Talk through problems - refer to health visitor
Give information
Check TFTs
Referral for psychological therapies - CBT
Antidepressant medication - Setraline
Monitor progress

79
Q

Features of infant 6wk check

A 
Physical exam
- congenital heart disease
- developmental dysplasia of the hip
- congenital cataract
- undescended testes
Review of development
- feeding and weight gain
- growth chart
- vision and hearing screen
- social development - smiling, coos, glugs and cries
Health promotion
- immunisations
- breastfeeding
- reduce risk of sudden infant death syndrome
- dangers of passive smoking
- car safety
- dental heath
80
Q

Define sudden infant death syndrome (SIDS)

A

Sudden and unexpected death of an infant under 1 year

- apparently occurring during sleep

81
Q

Risk factors for SIDS

A 
Maternal smoking
Putting baby sleeping on back
Falling asleep in the same bed as baby
Overheating
Bulking or loose items of bedding
During breastfeeding
82
Q

Signs and symptoms of otitis externa

A 
Signs
- ear canal/external ear red, swollen or eczematous
- swelling in ear canal
- discharge
- inflammed eardrum
Symptoms
- itch
- severe ear pain
- pain worse when tragus or pinna moved
- tenderness moving jaw
- tender regional lymphadenitis
83
Q

Signs and symptoms of chronic otitis externa

A 
Signs
- lack of earwax in external ear canal
- dry hypertrophic skin
- pain on manipulation of external ear canal/auricle
Symptoms
- constant itch in ear
- mild discomfort
- mild pain
84
Q

Signs and symptoms of malignant otitis

A 
Signs
- granulation tissue at bone-cartilage junction of ear canal/ exposed bone in ear canal
- facial nerve palsy - dropping of face on side of lesion
- temp over 39 degrees
Symptoms
- pain and headache
- vertigo
- profound hearing loss
85
Q

Differential diagnosis of otitis externa

A

Acute otitis media - otitis externa can be secondary to otorrhoea from otitis media
Foreign body
Impacted earwax - pain and deafness
Cholesteatoma - eroding epithelial tissue in middle ear and mastoid with discharge in the ear canal
Mastoiditis - very unwell, high temp, marked hearing loss
Malignant otitis
Neoplasm - swelling that bleeds easily
Referred pain - spehnoidal sinus, teeth, neck
Ramsay Hunt syndrome - herpes zoster affecting facial nerve, a/w facial paralysis and loss of taste
Barotrauma - divers, air travel or blow to ear
Skin conditions

86
Q

Treatment of localised otitis externa

A

Pain
- analgesic - paracetamol or ibuprofen
- application of local heat - warm flannel
Infection
- antibacterial otic drops
- only consider oral antibiotics for sever infection or high risk
- cellulitis spread beyoud ear canal
- systemic signs of infection
- 7 day oral flucloxacillin or clarithromycin
Drain pus if causing severe pain and swelling

87
Q

Causes of acute diffuse otitis externa

A

Radiotherapy to ear, neck or head
Previous ear surgery
Previous topical treatments for otitis externa
Atopic, allergic or irritant dermatitis
Dermatoses
Trauma to ear canal from cleaning, scratching or instrumentation
Use of hearing aids or ear plugs
Exposure to water or humid clinate
Diabetes, immunosuppression and older age

88
Q

When should a swab be taken from someone with otitis externa

A

Treatment fails
Recurrent or chronic
Topical treatment cannot be delivered effectively
Infection spread beyond external auditory canal
Condition severe enough to require oral antibiotics

89
Q

Management of chronic otitis externa

A 
Fungal infection suspected
- topical antifungal - clotrimazole 1%
Irritant cause or allergic dermatitis
- avoid contact with irritant
- topical corticosteriod
Seborrhoeic dermatitis
- topical antifungal and cortiosteriod combination
90
Q

Symptoms of acute otitis media

A 
Sudden onset earache
In younger children
- holding, tugging or rubbing ear
- fever
- crying
- poor feeding, behavioural change
91
Q

Otoscopic features of acute otitis media

A

Red, yellow or cloudy tympanic membrane
Moderate to severe bulge of tympanic membrane
Perforation of tympanic membrane

92
Q

Differential diagnosis of acute otitis media

A

Otitis media with effusion - fluid in middle ear without symptoms/signs of infection
- conductive hearing loss
- effusion and bubbles visible with normal tympanic membrane
Chronic suppurative otitis media - persistent inflammation and perforation of tympanic membrane with draining discharge for more than 2 weeks
Myringitis - erythema and injection of tympanic membrane visible
Eustachian tube dysfunction
Mastoiditis
Malignancy
Referred pain

93
Q

Who should be admitted with acute otitis media

A 
Severe systemic infection
Suspected complications
- meningitis
- mastoiditis
- intracranial abscess
- sinus thrombosis
- facial nerve palsy
Children under 3 months
94
Q

Management of acute otitis media

A

Analgesia - regular paracetamol and ibuprofen
No evidence of decongestants or antihistamines
Antibiotic prescription - delayed
- 5-7 day course amoxicillin / clarithromycin

95
Q

Management of persistent acue otitis media

A

5-7 day course of co-amoxiclav

Refer if recurrent

96
Q

Features of chronic suppurative otitis media

A 
Ear discharge persisting for more than 2 weeks without ear pain or fever
Hearing loss in affected ear
History of
- acute otitis media
- ear trauma
- grommet insert
- allergy, atopy or URTI
Tinnitus
97
Q

Management of chronic suppurative otitis media

A

Do not swab ear

Refer for ENT assessment

98
Q

Define chronic suppurative otitis media

A

Chronic inflammation of the middle ear and mastoid cavity

-> perforation of tympanic membrane

99
Q

Define otitis media with effusion

A

Glue ear

Collection of fluid within the middle ear space without signs of acute inflammation

100
Q

Features of otitis media with effusion

A

Hearing loss
Mild intermittent ear pain with fullness or popping
Aural discharge
Recurrent ear infections, UTRI or frequent nasal obstruction

101
Q

Otoscopic features of otitis media with effusion

A 
No signs of inflammation or discharge
Serous, mucoid or purulent effusion
- abnormal colour of drum
- loss of light reflex
- opacification of drum
- air bubbles or air/fluid level
- retracted, concave or indrawn drum
102
Q

Management of otitis media with effusion

A

Active observation for 6-12 weeks as spontaneous resolution common
Refer to ENT

103
Q

Define benign paroxysmal positional vertigo

A

Disorder of the inner ear characterised by repeated episodes of positional vertigo
- symptoms occur with changes in position of the head

104
Q

Causes of benign paroxysmal positional vertigo

A

Loose calcium carbonate debris in semi-circular canals of the ear

105
Q

Complications of benign paroxysmal positional vertigo

A

Falls - particularly in older people
Difficulty performing daily activities
Adverse effects on quality of life
Increased likelihood of depression

106
Q

Management of benign paroxysmal positional vertigo

A

Most recover over several weeks
Repositioning manoeuvre - Epley
Get out of bed slowly
Do not drive whilst feeling dizzy

107
Q

Define Meniere’s disease

A

Clinical syndrome characterised by episodes of vertigo, fluctuating hearing loss, tinnitus and feeling of fullness in ear

108
Q

Risk factors for Meniere’s disease

A 
Autoimmunity
Genetic susceptibility
Metabolic disturbances 
Vascular factors
Viral infection
Head trauma
109
Q

Complications of Meniere’s disease

A

Falls
Psychological effects
Social activities

110
Q

Features of benign paroxysmal positional vertigo

A

Symptoms brought on by specifics movements
- N+V
Hearing loss and tinnitus not associated

111
Q

Features of Meniere’s disease

A

Vertigo - spontaneous episodes 20mins-12hrs
Fluctuating hearing, tinnitus and perception of aural fullness
Hearing loss - sensioneural

112
Q

Differential diagnosis of Meniere’s disease

A 
Tumours - acoustic neuroma
MS
Perilymph fistula
Vascular events - TIA
Migrane
Benign paroxysmal positional vertigo
Vestibular neuronitis
Acute labyrinthitis
113
Q

Management of Meniere’s disease

A

Admit those with severe symptoms

Refer to ENT to confirm diagnosis

114
Q

Define tinnitus

A

Perception of sound in absence of sound from external environment

115
Q

Diseases associated with tinnitus

A 
Age-related hearing loss
Noise-induced hearing loss
Meniere's disease
Impacted wax
Ototoxic drugs
- loop diuretics
- aspirin and NSAIDs
- antimalarials
- tetracyclines
- macrolide antibiotics
- aminoglycoside antibiotics
Ear infections
- otitis media
- otitis externa
Neurological disorders
- acoustic neuroma
- MS
Metabolic disorders
- thyroid disorders
- DM
Psychological disorders
- anxiety 
- depression
Mechanical disorders
- head trauma
- TMJ disorders
116
Q

Complications of tinnitus

A 
Impaired concentration
Interference with daily activities
Loneliness, withdrawal and social isolation
Sleep disturbance
Anxiety
Depression
Suicide
117
Q

Management of tinnitus

A 
May resolve by herself
Treat underlying cause
Review medication
Discuss sound therapy
Psychological therapy
118
Q

Refer those with tinnitus urgently if

A

Refer immediately if

  • high risk of suicide - crisis mental health management
  • significant neurological symptoms
  • acute uncontrolled vestibular symptoms
  • suspected stroke
  • sudden onset pulsatile tinnitus
  • tinnitus secondary to head trauma
119
Q

Define vertigo

A

Symptom

False sensation of movement of person or their surroundings in absence of physical movement

120
Q

Causes of vertigo

A 
Peripheral
- benign paroxysmal positional vertigo
- vestibular neuronitis
- labyrinthitis
- Meniere's disease
- vestibular ototoxicity
Central
- migraine
- stroke or TIA
121
Q

Management of central vertigo

A

Admit urgently or refer to balance specialist
Consider symptomatic drug treatment
- N+V = cyclizine

122
Q

Management of peripheral vertigo

A 
Admit urgently if
- severe N+V
- sudden onset - in seconds
- central neurological symptoms
- acute deafness
Refer to balance specialist
123
Q

Define vestibular neuronitis (acute labrynthitis)

A

Disorder characterised by acute, isolated, spontaneous and prolonged vertigo of peripheral origin
Inflammation of vestibular nerve - post viral infection

124
Q

Define labyrinthitis

A

Inflammation of the labyrinths

- hearing loss

125
Q

Complications of vestibular neuronitis

A

Benign paroxysmal positional vertigo
Phobic postural vertigo
Adverse effects of QoL
Increased fall risk

126
Q

Features of vestibular neuronitis

A 
Rotational vertigo
Nausea
Balance affected
Hearing loss and tinnitus not features
No focal neurology
127
Q

Management of vestibular neuronitis

A 
Reassure will settle over several weeks
Best rest maybe necessary
Do not drive whilst dizzy
If symptoms severe offer short term symptomatic drug treatment
- N+V = cyclizine
128
Q

Define sinusitis

A

Symptomatic inflammation of paranasal sinuses
Acute - resolves within 12 wks
Recurrent acute - four or more annual episodes without persistent symptoms
Chronic sinusitis

129
Q

Causes of acute sinusitis

A 
URTI
- viral -> bacterial
Associated with
- asthma
- allergic rhinitis
- smoking
- anatomical variation or mechanical obstruction
- seasonal variation
- impaired ciliary motility - cystic fibrosis
130
Q

Causes of chronic sinusitis

A 
Atopy
Asthma
Ciliary impairment
Aspirin sensitivity
Immunocompromise
Genetic factors
Cigarette smoking
Iatrogenic factors
131
Q

Complications of acute sinusitis

A 
Orbital complications
- orbital cellulitis
- orbital abscess
- cavernous sinus thrombosis
Intracranial
- meningitis
- encephalitis
- abscess
- venous thrombosis
Bony
- osteomyelitis
Progression to chronic sinusitis
132
Q

Complications of chronic sinusitis

A 
Extra-sinus symptoms
- sleep problems
- fatigue
- depression
Impact on employment
Reduction in social functioning
High healthcare usage
133
Q

Features of acute sinusitis

A

Usually follows common cold
Increase in symptoms after 5 days
- nasal blockage or nasal discharge
Less than 12 wks

134
Q

Refer those with acute sinusitis if

A

Severe systemic infection
Intraorbital or periorbital complications
Intracranial complications

135
Q

Management of acute sinusitis

A 
Symptoms less than 10 days
- do not offer antibiotic prescription
- advise usually causes by virus
- takes 2-3 wks to resolve
Symptoms more than 10 days
- high-dose nasal corticosteroid
Antibiotics unlikely to improve symptoms
136
Q

Management of chronic sinusitis

A 
Inform may last several months
Advise to
- avoid allergic triggers
- stop smoking
- practise good dental hygiene
Nasal irrigation with saline solution
Intranasal corticosteriods
137
Q

Categories of hearing loss

A

Conductive
- due to abnormalities of outer and middle ear
Sensorineural
- abnormalities of the cochlea, auditory nerve or other structures in neural pathway
Mixed

138
Q

Causes of conductive hearing loss

A 
Impacted ear wax
Foreign bodies
Tympanic membrane perforation
Infection - otitis externa, otitis media
Cholesteatoma 
Middle ear effusion
Otosclerosis - abnormal bone growth affecting small bones of ear
Neoplasm
Exostoses - hard bony growths in ear canal
139
Q

Causes of sensorineural hearing loss

A 
Age related
Noise exposure - temporary or permanent
Sudden sensorineural hearing loss
Meniere's disease
Exposure to ototoxic substances
Labyrinthitis
Vestibular schwannoma
Neurological conditions
Malignancy
Trauma to head
Systemic infections
Autoimmune conditions
Hereditary conditions
140
Q

Investigations for BPPV

A

Dix-Hallpike manoeuvre

Supine lateral head turns

141
Q

Management of BPPV

A

Patient education + reassurance
3 position particle repositioning manoeuvre
Vestibular suppressant medication

142
Q

Define allergic rhinitis

A

Inflammatory condition of the upper respiratory tract

Characterised by nasal pruritis, sneezing, rhinorrhoea and nasal congestion

143
Q

Risk factors for allergic rhinitis

A 
Family history of atophy
Age < 20
Positive allergen skin-prick tests
Inadequate exposure to animals or other micro-organism-rich environments in early life
Western lifestyle
Ethnicity
Environmental pollen
Heavy maternal smoking
Breastfeeding
144
Q

Investigations of allergic rhinitis

A

Therapeutic trial of antihistamine or intranasal corticosteriod

145
Q

Management of allergic rhinitis

A

Oral antihistamine plus allergen avoidance

146
Q

Risk factors for otitis externa

A 
External auditory canal obstruction
High environmental humidity
Warmer environmental temperatures
Swimming
Local trauma
Allergy
Skin disease
Diabetes
Immunocompromised
147
Q

Risk factors for acute otitis media

A 
Day care attendance
Older siblings
Younger age
FH
Absence of breastfeeding
Supe feedings
Lower socioeconomic status
Craniofacial anomaly
Male sex
Dummy use
148
Q

What is cholesteatoma

A

Accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid
- may enlarge and invade adjacent bone

149
Q

Diagnostic factors of cholesteatoma

A 
Hearing loss
Ear discharge resistant to antibiotic therapy
Attic crust in retraction pocket
White mass behind intact tympanic membrane
Tinnitus
Otalgia
Altered taste
Dizziness
Facial nerve weakness
150
Q

Risk factors for cholesteatoma

A 
Middle ear disease
Eustachian tube dysfunction
Otological surgery 
Traumatic blast injury to ear
FH
Congential anomalies
151
Q

Investigations for cholesteatoma

A

Otoscopy
Pure tone audiogram
CT scan of petrous temporal bone

152
Q

Management of cholesteatoma

A

Surgery
Preoperative topical antibiotics + aural care
Second-look surgery or MRI

153
Q

History of noise-related hearing loss

A 
Gradual hearing loss
Working in noisy environment
Use of power tools
Use of motorcycles
Shooting hobby
Difficulty hearing speech in loud environments
Occasional ringing in ears
154
Q

Investigations for noise-related hearing loss

A

Audiometry - bilateral sensorineural hearing loss in high frequencies

155
Q

History of age-related hearing impairment

A

Slow, gradual hearing loss - usually bilateral

156
Q

Investigations for age-related hearing impairment

A

Audiometry - bilateral sensoineural hearing loss - usually high frequency

157
Q

Define mastoiditis

A

Inflammation of mastoid air cells
- bacterial otitis media can spread
Responds well to parental antibiotics

158
Q

History of congenital hearing loss

A

Parents have normal hearing (autosomal-recessive disorder)
Present at birth or develops later in childhood - may fluctuate in severity
Normal otoscopy and and auditory brainstem response testing

159
Q

Define nasal polyp

A

Benign swellings of mucosal lining of paranasal sinuses

160
Q

Diagnositc features of nasal polyps

A 
Nasal obstruction
Nasal discharge
Facial pain/pressure
Direct visualisation
Reduced sense of smell
Cough
161
Q

Risk factors for nasal polyps

A

Asthma
Aspirin sensitivity
Genetic predisposition

162
Q

Investigations for nasal polyps

A

Anterior rhinoscopy

Nasal endoscopy

163
Q

Management of nasal polyps

A

Intranasal corticosteriods
Nasal saline irrigation
Doxycycline
Surgical polypectomy

164
Q

Define Mongolian Spots

A

Grey-blue patches on back, bottom or legs
- bruise like
Harmless

165
Q

Define Erythema Toxicum

A

Common within 2-3 days after birth
Red and raised rash on face, arms and legs
Not warm to touch
Will self-resolve in a few days

166
Q

Treatment of headlice

A 
Wet combing cold standard
- wash hair
- apply lots of condition
- comb from roots to end
- days 1, 5, 9 and 13
Medicated lotions and sprays
167
Q

Define colic

A

Baby cries a lot but with no obvious cause

Cry more than 3 hours a day, 3 days a week for at least a week

168
Q

Management of colic

A 
Hold/cuddle baby
Sit baby upright when feeding to stop swallowing air
Wind after feeds
Rock baby over shoulder
Bath baby in warm water
169
Q

Presentation of measles

A

Erythamatous partially confluent rash
Begins behind ears
Coplic spots - white lesions in mouth

170
Q

Presentation of Scarlet Fever

A

Fine partially confluent maculopapular rash
Begins on neck
Most prounced in underarm and groin areas
Non-blanching petechiae
Red face with perioral pallor
Bright red toungue colour with enlarged papillae

171
Q

Presentation of rubella

A

Non confluent, pink, maculopapular rash

Begins behind ears

172
Q

Presentation of erythema infectiosum

A 
Fifth disease
Do no necessarily develop rash
- red papules on extremities and trunk
- develop to lace-like reticular appearance
- blotchy red rash on cheek
173
Q

Presentation of Roseola infantum

A

Patchy, rose pink
Usually most pronounced on torsum
3 days high fever

174
Q

Presentation of chicken pox

A

Widespread rash affecting entire body - including scalp and oral mucosa
Begins as small red bumps that develop into fluid-filled blisters/pustules
- eventually forms scabs

175
Q

Normal gait variations in children

A

Toe walking - up to 3 years
In-toe walking due to persisting femoral antevresion - 3-8 years
Internal tibial torsion - knees point forward but feed point in
Metatarsus adductus = flexible C-shaped lateral border of foot - up to 6 years
Bow legs - birth to early toddler-hood
Knock-knees - up to 7 years
Flat feet common
Crooked toes - resolve with weight bearing

Yr3 - GP (8 decks)

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