Paediatrics + ENT Flashcards
1 month milestones
- lift head
- track with eyes
- coo
- recognise parents
6 month milestones
- sit up
- raking grasp
- babbles
- stranger anxiety
12 month milestones
- walk
- 2 finger pincer grasp
- mama/dada
- imitate parent
9 month milestones
- walk with assistance
- 3 finger grasp
- wave bye-bye/patacake
2 year milestones
- climb 2 steps
- 2 word phrases
- 2 step commands
- stack 6 blocks
3 year milestones
- tricycle
- 2 word sentences
- brush teeth
- draw circle
4 year milestones
- hop
- copy cross
- play with kids
Management of child with non-serious fever
Keep cool
Give fluids - continue breast feeding
Paracetamol or ibuprofen - whichever is effective
Keep away from school/nursery
Give parents clear advice about deterioration
Indications for referral of febrile child
<3 months - temp > 38
> 3 months - temp > 39.9
Early signs of meningococcal disease
Infants - non-specific signs such as drowsiness, lethargy or poor feeding
Cold hands and feet
Skin changes
Leg pains
Features of meningococcal disease
Purpuric rash Neck stiffness Lethargy Postitive Kernig's sing Vomiting Headache Photophobia Altered consciousness
Features of UTI
Non-specific symptoms
- unexplained fever
- recurrent fevers
Risk factors for UTI
Congenital - vesicoureteric reflux - posterior urethral valve Spinal lesions Constipation Poor hygiene
Differential diagnosis of UTI
Vulval irritation
Balanitis
Threadworms
Sexual abuse
Management of UTI
Urine dipstick
Refer if less than 3 months or any red flag symptoms
Antibiotics - nitrofurantoin
Red flags for a febrile child
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
Other red flag symptoms for a febrile child
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
Causes of cough
Acute - URTI - croup - pneumonia - pertussis Chronic - post-bronchiolitis or pertussis - aspiration of feed - GORD Recurrent - asthma - cystic fibrosis - bronchiectasis
Causes of stridor
Acute - croup - 6mnths to 6 yr - epiglottitis - 1-6yrs - acute allergic reaction Chronic - congenital
Causes of wheeze
RTI Atopic asthma Croup GORD Inhaled foreign body Heart failure
Define stidor
Noise that occurs on inspiration due to parital upper airway obstruction
Define croup
Laryngo-tracheal infection usually caused by parainfluenza virus
More common in winter
Starts with URTI then barking cough and stridor develop later
Management of croup
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
When should a child with croup be refereed to hospital
Refer to hospital if
- ill child with cyanotic spells
- respiratory distress, feeding difficulties or dehydration
- suspect epiglottis
Features of epiglottis
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
Define bronchiolitis
Caused by respiratory syncytial virus (RSV)
Occurs mainly in winter in babies under 12 months
Features of bronchiolitis
Cough and URTI
Later respiratory symptoms develop and breathing difficulties
Chest hyper-inflation with widespread wheeze and fine crackles
Describe asthma
Inflammatory disease of the airways with reversible outflow obstruction
Associated with bronchial hyperresponsiveness
Clinical features of asthma
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
Symptoms of acute severe asthma
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
Treatment of acute severe asthma
Beta-agonists - salbuatoml
- up to 10 puffs
Refer to hospital urgently if no improvement
Features of life-threatening asthma
Hypotension Confusion Exhaustion Poor respiratory effort/silent chest PF < 35%
Treatment of life-threatening asthma
Refer urgently to hospital
Give salbutamol and oxygen via facemask
Differential diagnosis of asthma
Cystic fibrosis
Bronchopulmonary dysplasia
Bronchiectasis
Management of chronic asthma
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
Inhalers used for each age group
Dry powder inhaler = > 5 years
Metered dose inhaler with facemask = infants
Metered dose inhaler with spacer = < 5 years
Stepwise management of asthma in children
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
Treatment for asthma exacerbations
Rescue course of prednisolone for 3-14 days
Features of constipation in an infant
< 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
Serious underlying causes of constipation in a child
Hirschsprung's disease Coeliac disease Hypothyroidism Anorectal abnormalities Neurological conditions Abdominal tumours
Reasons to refer for specialist assessment in a child with constipation
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
Treatment of idiopathic constipation
Macrogol - adjust dose according to response
Stimulant laxative
Continue for several weeks once normal bowel habit achieved
Advise balance diet and adequate fluid intake
Causes of acute diarrhoea in children
Infective gastrenteritis
Food poisoning
Diarrhoea associated with febrile illness
- URTI, TUI
Causes of vomiting in infants
Overfeeding, posseting GORD Gasteroenteritis Pyloric stenosis Malrotation Intussusception Extra-abdominal causes of infection
Causes of vomiting in older children
Gasteroenteritis Viral illness Systemic infection Migraine Bulimia Raised intracranial pressure Pregnancy Drugs
Causes of chronic diarrhoea in children
Toddler diarrhoea Post-infective gasteroenteritis Parasites Overflow from constipation Malabsorption - UC, Crohn's, cystic fibrosis
Causes of acute abdominal pain
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
Causes of recurrent abdominal pain
- 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
Refer to specialist for malabsorption if
Chronic diarrhoea
Failure to thrive or weight loss
Steatorrhoea
Iron/other nutrient deficiency
Causes of malabsorption in children
Cow's milk intolerance - protein allergy or lactose intolerance Coeliac disease Cystic fibrosis Chronic infection - giardiasis IBD
Presentation of cow’s milk allergy
GI symptoms - diarrhoea - occasionally with blood - constipation Skin - urticaria - eczema Other - wheeze - rhinitis - conjunctivitis
Treatment of cow’s milk allergy
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
Diagnosis of cow’s milk allergy
Withdraw cow’s milk
Skin prick/RAST tests - high false negatives and positive results
Presentation of lactose intolerance
Infancy - abdominal distension - diarrhoea - explosive and watery - vomiting - failure to thrive Childhood - milder abdo pain and distension - diarrhoea and vomiting
Features of anorectal atresia
Baby fails to pass meconium and no visible anus
- often fistula to urethra or vagina
Surgical treatment
Features of non-acute inguinal hernia
History of intermittent groin +/- scrotal swelling
- spermatic cord may be thickened on affected side
- refer for herniotomy
Features of acute inguinal hernia
Sudden appearance of an irreducible groin or scrotal swelling
- emergency admission for reduction and repair
Features of diaphragmatic hernia
Bowel herniates into chest cavity - defect in one hemidiaphragm
-> pulmonary hypoplasia in utero or lung compression postnatally
Features of febrile convulsions
Epileptic seizures provoked by fever in otherwise normal children
- FH
- brief and generalised
Causes of febrile convulsions
Viral infection Otitis media Tonsillitis UTI Gastroenteritis LRTI Meningitis Post-immunisation
Presentation of nappy rash
Glazed erythema in napkin area
- sparing skinfolds
Secondary bacterial or fungal infection is common
Differential diagnosis of nappy rash
Seborrhhoeic eczema
Candidiasis
Napkin psoriasis
Management of nappy rash
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
Clinical features of acne vulgaris
Comedones - high density on face, chest and back Inflammatory lesions - papules and pustules - nodules or cysts Scaring Pigmentation Seborrhoea
Differential diagnosis for acne vulgaris
Rosacea Perioral dermatitis Folliculitis and boils Drug-induced acne Keratosis pilaris
Management of acne vulgaris
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
Red flags for serious pathology in acute childhood limp
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
Detection of headlice
Detection combing with fine toothed comb
- live louse must be found
Management of headlice
Physical, chemical or traditional insecticide
Postnatal visit includes
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
Postpartum contraception
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
Mother’s 6wk postnatal check
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
Causes of postnatal breast soreness
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
Treatment of postnatal haemorrhoids
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
Features of baby blues
Very common Women become tearful and low - within 1st 10d of delivery Be supportive - usually resolves
Features of postnatal depression
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
Risk factors for post natal depression
Depression during pregnancy Bad birth experience Social problems PMH or FMH Alcohol or drug abuse
Management of post-natal depression
Talk through problems - refer to health visitor
Give information
Check TFTs
Referral for psychological therapies - CBT
Antidepressant medication - Setraline
Monitor progress
Features of infant 6wk check
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
Define sudden infant death syndrome (SIDS)
Sudden and unexpected death of an infant under 1 year
- apparently occurring during sleep
Risk factors for SIDS
Maternal smoking Putting baby sleeping on back Falling asleep in the same bed as baby Overheating Bulking or loose items of bedding During breastfeeding
Signs and symptoms of otitis externa
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
Signs and symptoms of chronic otitis externa
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
Signs and symptoms of malignant otitis
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
Differential diagnosis of otitis externa
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
Treatment of localised otitis externa
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
Causes of acute diffuse otitis externa
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
When should a swab be taken from someone with otitis externa
Treatment fails
Recurrent or chronic
Topical treatment cannot be delivered effectively
Infection spread beyond external auditory canal
Condition severe enough to require oral antibiotics
Management of chronic otitis externa
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
Symptoms of acute otitis media
Sudden onset earache In younger children - holding, tugging or rubbing ear - fever - crying - poor feeding, behavioural change
Otoscopic features of acute otitis media
Red, yellow or cloudy tympanic membrane
Moderate to severe bulge of tympanic membrane
Perforation of tympanic membrane
Differential diagnosis of acute otitis media
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
Who should be admitted with acute otitis media
Severe systemic infection Suspected complications - meningitis - mastoiditis - intracranial abscess - sinus thrombosis - facial nerve palsy Children under 3 months
Management of acute otitis media
Analgesia - regular paracetamol and ibuprofen
No evidence of decongestants or antihistamines
Antibiotic prescription - delayed
- 5-7 day course amoxicillin / clarithromycin
Management of persistent acue otitis media
5-7 day course of co-amoxiclav
Refer if recurrent
Features of chronic suppurative otitis media
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
Management of chronic suppurative otitis media
Do not swab ear
Refer for ENT assessment
Define chronic suppurative otitis media
Chronic inflammation of the middle ear and mastoid cavity
-> perforation of tympanic membrane
Define otitis media with effusion
Glue ear
Collection of fluid within the middle ear space without signs of acute inflammation
Features of otitis media with effusion
Hearing loss
Mild intermittent ear pain with fullness or popping
Aural discharge
Recurrent ear infections, UTRI or frequent nasal obstruction
Otoscopic features of otitis media with effusion
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
Management of otitis media with effusion
Active observation for 6-12 weeks as spontaneous resolution common
Refer to ENT
Define benign paroxysmal positional vertigo
Disorder of the inner ear characterised by repeated episodes of positional vertigo
- symptoms occur with changes in position of the head
Causes of benign paroxysmal positional vertigo
Loose calcium carbonate debris in semi-circular canals of the ear
Complications of benign paroxysmal positional vertigo
Falls - particularly in older people
Difficulty performing daily activities
Adverse effects on quality of life
Increased likelihood of depression
Management of benign paroxysmal positional vertigo
Most recover over several weeks
Repositioning manoeuvre - Epley
Get out of bed slowly
Do not drive whilst feeling dizzy
Define Meniere’s disease
Clinical syndrome characterised by episodes of vertigo, fluctuating hearing loss, tinnitus and feeling of fullness in ear
Risk factors for Meniere’s disease
Autoimmunity Genetic susceptibility Metabolic disturbances Vascular factors Viral infection Head trauma
Complications of Meniere’s disease
Falls
Psychological effects
Social activities
Features of benign paroxysmal positional vertigo
Symptoms brought on by specifics movements
- N+V
Hearing loss and tinnitus not associated
Features of Meniere’s disease
Vertigo - spontaneous episodes 20mins-12hrs
Fluctuating hearing, tinnitus and perception of aural fullness
Hearing loss - sensioneural
Differential diagnosis of Meniere’s disease
Tumours - acoustic neuroma MS Perilymph fistula Vascular events - TIA Migrane Benign paroxysmal positional vertigo Vestibular neuronitis Acute labyrinthitis
Management of Meniere’s disease
Admit those with severe symptoms
Refer to ENT to confirm diagnosis
Define tinnitus
Perception of sound in absence of sound from external environment
Diseases associated with tinnitus
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
Complications of tinnitus
Impaired concentration Interference with daily activities Loneliness, withdrawal and social isolation Sleep disturbance Anxiety Depression Suicide
Management of tinnitus
May resolve by herself Treat underlying cause Review medication Discuss sound therapy Psychological therapy
Refer those with tinnitus urgently if
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
Define vertigo
Symptom
False sensation of movement of person or their surroundings in absence of physical movement
Causes of vertigo
Peripheral - benign paroxysmal positional vertigo - vestibular neuronitis - labyrinthitis - Meniere's disease - vestibular ototoxicity Central - migraine - stroke or TIA
Management of central vertigo
Admit urgently or refer to balance specialist
Consider symptomatic drug treatment
- N+V = cyclizine
Management of peripheral vertigo
Admit urgently if - severe N+V - sudden onset - in seconds - central neurological symptoms - acute deafness Refer to balance specialist
Define vestibular neuronitis (acute labrynthitis)
Disorder characterised by acute, isolated, spontaneous and prolonged vertigo of peripheral origin
Inflammation of vestibular nerve - post viral infection
Define labyrinthitis
Inflammation of the labyrinths
- hearing loss
Complications of vestibular neuronitis
Benign paroxysmal positional vertigo
Phobic postural vertigo
Adverse effects of QoL
Increased fall risk
Features of vestibular neuronitis
Rotational vertigo Nausea Balance affected Hearing loss and tinnitus not features No focal neurology
Management of vestibular neuronitis
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
Define sinusitis
Symptomatic inflammation of paranasal sinuses
Acute - resolves within 12 wks
Recurrent acute - four or more annual episodes without persistent symptoms
Chronic sinusitis
Causes of acute sinusitis
URTI - viral -> bacterial Associated with - asthma - allergic rhinitis - smoking - anatomical variation or mechanical obstruction - seasonal variation - impaired ciliary motility - cystic fibrosis
Causes of chronic sinusitis
Atopy Asthma Ciliary impairment Aspirin sensitivity Immunocompromise Genetic factors Cigarette smoking Iatrogenic factors
Complications of acute sinusitis
Orbital complications - orbital cellulitis - orbital abscess - cavernous sinus thrombosis Intracranial - meningitis - encephalitis - abscess - venous thrombosis Bony - osteomyelitis Progression to chronic sinusitis
Complications of chronic sinusitis
Extra-sinus symptoms - sleep problems - fatigue - depression Impact on employment Reduction in social functioning High healthcare usage
Features of acute sinusitis
Usually follows common cold
Increase in symptoms after 5 days
- nasal blockage or nasal discharge
Less than 12 wks
Refer those with acute sinusitis if
Severe systemic infection
Intraorbital or periorbital complications
Intracranial complications
Management of acute sinusitis
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
Management of chronic sinusitis
Inform may last several months Advise to - avoid allergic triggers - stop smoking - practise good dental hygiene Nasal irrigation with saline solution Intranasal corticosteriods
Categories of hearing loss
Conductive
- due to abnormalities of outer and middle ear
Sensorineural
- abnormalities of the cochlea, auditory nerve or other structures in neural pathway
Mixed
Causes of conductive hearing loss
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
Causes of sensorineural hearing loss
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
Investigations for BPPV
Dix-Hallpike manoeuvre
Supine lateral head turns
Management of BPPV
Patient education + reassurance
3 position particle repositioning manoeuvre
Vestibular suppressant medication
Define allergic rhinitis
Inflammatory condition of the upper respiratory tract
Characterised by nasal pruritis, sneezing, rhinorrhoea and nasal congestion
Risk factors for allergic rhinitis
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
Investigations of allergic rhinitis
Therapeutic trial of antihistamine or intranasal corticosteriod
Management of allergic rhinitis
Oral antihistamine plus allergen avoidance
Risk factors for otitis externa
External auditory canal obstruction High environmental humidity Warmer environmental temperatures Swimming Local trauma Allergy Skin disease Diabetes Immunocompromised
Risk factors for acute otitis media
Day care attendance Older siblings Younger age FH Absence of breastfeeding Supe feedings Lower socioeconomic status Craniofacial anomaly Male sex Dummy use
What is cholesteatoma
Accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid
- may enlarge and invade adjacent bone
Diagnostic factors of cholesteatoma
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
Risk factors for cholesteatoma
Middle ear disease Eustachian tube dysfunction Otological surgery Traumatic blast injury to ear FH Congential anomalies
Investigations for cholesteatoma
Otoscopy
Pure tone audiogram
CT scan of petrous temporal bone
Management of cholesteatoma
Surgery
Preoperative topical antibiotics + aural care
Second-look surgery or MRI
History of noise-related hearing loss
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
Investigations for noise-related hearing loss
Audiometry - bilateral sensorineural hearing loss in high frequencies
History of age-related hearing impairment
Slow, gradual hearing loss - usually bilateral
Investigations for age-related hearing impairment
Audiometry - bilateral sensoineural hearing loss - usually high frequency
Define mastoiditis
Inflammation of mastoid air cells
- bacterial otitis media can spread
Responds well to parental antibiotics
History of congenital hearing loss
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
Define nasal polyp
Benign swellings of mucosal lining of paranasal sinuses
Diagnositc features of nasal polyps
Nasal obstruction Nasal discharge Facial pain/pressure Direct visualisation Reduced sense of smell Cough
Risk factors for nasal polyps
Asthma
Aspirin sensitivity
Genetic predisposition
Investigations for nasal polyps
Anterior rhinoscopy
Nasal endoscopy
Management of nasal polyps
Intranasal corticosteriods
Nasal saline irrigation
Doxycycline
Surgical polypectomy
Define Mongolian Spots
Grey-blue patches on back, bottom or legs
- bruise like
Harmless
Define Erythema Toxicum
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
Treatment of headlice
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
Define colic
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
Management of colic
Hold/cuddle baby Sit baby upright when feeding to stop swallowing air Wind after feeds Rock baby over shoulder Bath baby in warm water
Presentation of measles
Erythamatous partially confluent rash
Begins behind ears
Coplic spots - white lesions in mouth
Presentation of Scarlet Fever
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
Presentation of rubella
Non confluent, pink, maculopapular rash
Begins behind ears
Presentation of erythema infectiosum
Fifth disease Do no necessarily develop rash - red papules on extremities and trunk - develop to lace-like reticular appearance - blotchy red rash on cheek
Presentation of Roseola infantum
Patchy, rose pink
Usually most pronounced on torsum
3 days high fever
Presentation of chicken pox
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
Normal gait variations in children
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
