Paediatrics Respiratory

Question 1

Side effects of antibiotics

Answer 1

Diarrhoea
Oral thrush
Nappy rash
Allergic reaction

Question 2

Which age group does Rhinitis most commonly present in children?

Answer 2

5-10 years

In winter months

Question 3

Management of rhinitis in children

Answer 3

Self-limiting

Review if unsure

Question 4

Rhinitis is a prodrome to which conditions in children

Answer 4

Pneumonia
Bronchiolitis
Meningitis
Septicaemia

Question 5

Presentation of otitis media

Answer 5

Erythema
Bulging ear drum
Fever
Pain

Question 6

Management of otitis media

Answer 6

Self limiting

Analgesia for pain

Question 7

Two ways otitis media can occur

Answer 7

Primary viral infection

Secondary to Pneumococcal or haemophilus influenza

Question 8

What is otitis externa?

Answer 8

Inflammation of the external ear canal

Question 9

Three types of otitis externa

Answer 9

Localised
Diffuse
Malignant

Question 10

Difference between acute and chronic otitis externa

Answer 10

Acute - lasts around 3 weeks

Chronic- can last more than 3 months

Question 11

Site of localised otitis externa

Answer 11

Infection of hair follicle - can evolve to boil

Question 12

Where does diffuse otitis externa occur?

Answer 12

Widespread inflammation of skin and subdermis

Question 13

Define malignant otitis externa

Answer 13

Infection spreads to mastoid and temporal bones resulting in osteomyelitis

Question 14

Why is malignant otitis externa described ‘malignant’?

Answer 14

Poor prognosis - not a neoplastic condition

Question 15

Causes of otitis externa

Answer 15

Bacterial infection

Fungal infection

Question 16

4 ways bacterial infection giving rise to otitis externa can occur

Answer 16

Blockage of the canal
Absence of cerumen due to excess cleaning
Trauma
Alteration of pH in canal

Question 17

Risk factors for otitis externa

Answer 17

Hot and humid climates
Swimming
Older age
Diabetes mellitus
Narowing/obstruction of canal
Over-cleaning
Wax build-up
Eczema
Trauma
Radiotherapy to the ear

Question 18

Symptoms of otitis externa

Answer 18

Pain
itching
Discharge
Hearing loss

Question 19

Signs of otitis externa on examination

Answer 19

Oedema
Erythema
Exudate
Mobile tympanic membrane
Pain on movement of tragus or auricle
Pre auricular lymphadenopathy

Question 20

Differential diagnosis to otitis externa

Answer 20

Acute otitis media with perforation of the TM
Furunculosis (infection of a hair follicle in the cartilaginous part of the ear canal)
Viral infections
Tumours of external auditory canal
Cholesteatoma
Foreign body
Impacted wax
Skin conditions eg. acne, psoriasis, contact dermatitis, seborrhoeic dermatitis

Question 21

Investigations for otitis externa - failed treatment

Answer 21

Swabs for microscopy and culture

Question 22

Management of otitis externa

Answer 22

Avoid getting the ear wet use a cap for showering and swimming
Remove any discharge by gently using cotton wool, DO NOT put cotton buds into the ear
Remove any hearing aids and earrings
Use painkillers – paracetamol and ibuprofen

Antibiotic or antifungal ear drops are generally the mainstay of treatment (6). A pope wick can be used to get the drops into the ear if the canal is closed.
If there is cellulitis or lymphadenopathy then oral antibiotics are indicated (4).
In cases of chronic otitis externa, acetic acid and corticosteroid ear drops are used (4).

Question 23

Complications of otitis externa

Answer 23

Stenosis
Abscesses
Perforated ear drum
Cellulitis
Malignant otitis externa