Paeds ENT and ophthalmology Flashcards
Fever pain score
Fever during previous 24 hours
P – Purulence (pus on tonsils)
A – Attended within 3 days of the onset of symptoms
I – Inflamed tonsils (severely inflamed)
N – No cough or coryza
A score of 2 – 3 gives a 34 – 40% probability (consider abx) and 4 – 5 gives a 62 – 65% probability of bacterial tonsillitis (give abx)
Management tonsilitis
- Oral phenoxymethylpenicillin (penicillin V?) for 5 or 10 days
- Clarithomycin or erythromycin(if penicillin allergic)5 days
Chronic tonsilitis referral criteria
> 3 episodes per year for 3 years
5 episodes per year for two years
7 episodes in a single year
Refer to ENT for tonsillectomy
Pathogen bacterial tonsilitis
GABS Group A Beta-haemolytic streptococcus
Two most common bacterial causes of otitis externa?
- pseudomonas aerginosa
- staphlococcus aureus
management of otitis externa
mild
1. acetic acid drops 2%
moderate:
1. Topical abtibiotic and steroid eg:
Otomize spray (Neomycin, dexamethasone and acetic acid)
Fungal:
1. Clotrimazole ear drops
Most common pathogen and others : otitis media
Streptococcus pneumoniae
Other common causes include:
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
If giving abx for otitis media, what is first line? what are alterantives?
- amoxicillin for 5 days
alternatives: erythromycin or clarythromycin
Management fungal otitis externa
clotrimazole ear drops
What should be avoided if perforated ear drum
Aminoglycosides (e.g., gentamicin and neomycin) are potentially ototoxic, rarely causing hearing loss if they get past the tympanic membrane.
Complication of otitis externa?
malignant otitis externa
Admission to hospital under the ENT team
IV antibiotics
Imaging (e.g., CT or MRI head) to assess the extent of the infection
pathophysiology otitis media
whilst viral upper respiratory tract infections (URTIs) typically precede otitis media, most infections are secondary to bacteria, particularly Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
viral URTIs are thought to disturb the normal nasopharyngeal microbiome, allowing bacteria to infect the middle ear via the Eustachian tube
Presentation otitis media
otalgia
+ some children may tug or rub their ear
fever occurs in around 50% of cases
hearing loss
recent viral URTI symptoms are common (e.g. coryza)
ear discharge may occur if the tympanic membrane perforates
Examination otitis media
bulging tympanic membrane → loss of light reflex
opacification or erythema of the tympanic membrane
perforation with purulent otorrhoea
decreased mobility if using a pneumatic otoscope
Who should get antibiotics for otitis media
Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromised or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal
main symptom of glue ear
The main symptom of glue ear is a reduction in hearing in that ear
what may otoscopy show glue ear
dull tympanic membrane with air bubbles or a visible fluid level, although it can look normal.
Management glue ear
- referral to audiometry
- will likley resolve within 3 months conservative
- grommets
Key feature of thyroglossal cyst
Move up and down with movement of the tongue
Mobile
Non-tender
Soft
Fluctuant
Invetsigation and management thyroglossal cyst
Ultrasound or CT scan
surgically removed to provide confirmation of the diagnosis on histology and prevent infections. The cyst can reoccur after surgery unless the full thyroglossal duct is removed
Types of strabismus
Manifest
Esotropia - inwards towards nose
Exotropia - outwards
Hypertropia - upwards
Hypotropia - downwards
Latent picked up with cover test - may be symptomatic
Esophoria
Exophoria
Hyperphoria
Hypophoria
Paralytic
What test shows manifest strabismus
cover/uncover
What test shows latent strabismus
alternate cover test
What is Amblyopia
Defective visual acuity which persists after correction of the refractive error and removal of any pathology
Management ambylopia
Wear appropriate glasses for 16-18 weeks
Occlusion of better seeing eye (patching/atropine)
Up to what age are visual fields developing
up to 8 years
What is atropine?
dilates pupil –> blurry vision - use in good eye to get the other eye better
Management strabismus
- corrective glasses
- occlusion for ambylopia
- Penalization therapy (atropine drops)
Prisms
Orthoptic exercise
Surgery:
Resection of muscles to shorten
Botulinum toxin
Injecting into muscle to temporarily paralyse muscle
Causes of congenital deafness
Maternal rubella or cytomegalovirus infection during pregnancy
Genetic deafness can be autosomal recessive or autosomal dominant
Associated syndromes, for example Down’s syndrome
Hearing screening
otoacoustic - after birth
brain stem - if otoacoustic is abnormal
pure tone - school age
audiometry - older
Most common type of squint?
convergent squint
Commonest cause of convergent squint
hypermetropia (long sightedness)
What is myopia
short sightedness
what is retinoblastoma
Retinoblastoma is the most common ocular malignancy found in children. The average age of diagnosis is 18 months.
Pathophysiology
autosomal dominant
caused by a loss of function of the retinoblastoma tumour suppressor gene on chromosome 13
around 10% of cases are hereditary
features retinoblastoma
absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
strabismus
visual problems
management retinoblastoma
enucleation is not the only option
depending on how advanced the tumour is other options include external beam radiation therapy, chemotherapy and photocoagulation
prognosis retinoblastoma
> 90% surviving into adulthood
cause oribital cellulitis
It is usually a complication of the sinus
disease, most commonly ethmoid sinusitis
