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3A > paeds ENT and ophthalmology > Flashcards

paeds ENT and ophthalmology Flashcards

1
Q

Who is most commonly affected by acute otitis media

A

young children- commonly between the ages of 6-12 months

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2
Q

why are young children at increased risk of otitis media

A

they have short, horizontal, poorly functioning eustachian tubes

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3
Q

what is otitis media

A

inflammation of the middle ear from infection

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4
Q

how does otitis media usually present

A

rapid onset ear pain
fever
irritability
poor feeding
vomiting
sleep disturbance

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5
Q

What are the most common causes of otitis media?

A

bacterial infection most common in children - strep pneumonia, haemophilus influenzae, moraxella catarrhalis
Viral infection- RSV, adenovirus, enterovirus

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6
Q

RF for otitis media

A

male
parental smokng
immunodeficiency
formula feeding
attendance of daycare
structural abnormalities associated with Down’s syndrome
Dummies

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7
Q

How does otitis media present on otoscopy

A

erythema of the tympanic membrane
presence of effusion in the middle ear - air fluid level, bulging tympanic membrane
Perforation of tympanic membrane

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8
Q

How is otitis media diagnosed?

A

physical examination
Usually no further investigations- may culture, may CT if concern for mastoiditis, audiometry

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9
Q

How is otitis media treated ?

A

If systemically unwell or immunocompromised antibiotics - amoxicillin 5-7 days
If generally well can use delayed antibiotics- give analgesia for 2-3 days and if still symptomatic give Abx

Other treatment:
- warm compress
- paracetamol or ibuprofen
- eardrops with anaesthetic and analgesia - not decongestant drops

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10
Q

Complications of otitis media

A

facial nerve palsy
mastoiditis
labyrinthitis
meningitis
brain abscess
hearing loss
otitis media with effusions

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11
Q

What is classified as recurrent otitis media

A

more than 3 episodes in 6 months or more than 4 episodes in one year

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12
Q

what is glue ear

A

otitis media with effusion

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13
Q

epidemiology of glue ear

A

peaks at age 2
more than 50% of children have an episode in the first year of life

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14
Q

RF for glue ear

A

winter
male
sibling with glue ear
bottle feeding
daycare attendance
parental smoking
Downs syndrome and GORD

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15
Q

presentation of glue ear

A

hearing loss
communcation difficulties
impaired language and speech development
lack of concentration,
balance problems

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16
Q

how does glue ear present on examination?

A

opacification of the ear drum due to scarring
no current signs of inflammation
loss of the light reflex
presence of bubbles or a fluid level

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17
Q

Treatment of glue ear

A

active observation for the first 3 months
gromet insertion- allows air to pass into the middle ear
apeniodectomy

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18
Q

What investigation needs to be done urgently in children presenting with eyelid swelling, redness and tenderness with no improvement after initial treatment

A

contrast enhanced CT scan of the orbit to assess for orbital cellulitis

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19
Q

What is periorbital cellulitis?

A

inflammation of the superficial eyelid (anterior to the orbital septum) usually from a superficial source such as an insect bite.

It includes inflammation of the eyelids, skin and subcutaneous tissues of the face but not the soft tissues behind the orbital septum

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20
Q

Who is most commonly affected by periorbital cellulitis

A

children much more than adults
more common in boys
more common in winter.

21
Q

Causes of periorbital cellulitis

A

in adults it is usually from a superficial site such as an insect bite
In children it might be secondary to a bacterial cellulitis

22
Q

What bacteria are commonly associated with periorbital cellulitis

A

staph aureus,
staph epidermis
strep species

23
Q

How might sinusitis spread to cause periorbital cellulitis

A

from the ethmoid sinus across the thin lamina papracea
from the floor of the frontal sinus
from the roof of the maxillary sinus

24
Q

How does periorbital cellulitis present ?

A

red swollen eye
painful
acute onset
fever
NO OCULAR SYMPTOMS

25
Q

investigations of periorbital cellulitis

A

CT sinus and orbits with contrast to rule out orbital cellulitis
swabs
blood cultures

26
Q

management of periorbital cellulitis

A

antibiotics- IV for 2-5 days or oral if can have daily follow up.
May include co-amoxiclav or cefotaxime

27
Q

RF for orbital cellulitis

A

childhood
previous sinus infection
lack of the Hib vaccine
recent periorbital cellulitis
ear or facial infetion

28
Q

most common causes of orbital cellulitis

A

staph. aureus
streptoccus
HiB

29
Q

How does orbital cellulitis present ?

A

redness and swelling around the eye
severe ocular pain
visual disturbance
proptosis
ophthalmoplegia
eyelid oedema

30
Q

how can you differentiate orbital and periorbital cellulitis

A

orbital cellulitis has ocular symptoms:
- reduced visual acuity
- ophthalmoplegia
- pain of moving eyes
- proptosis

31
Q

investigations of orbital cellulitis

A

CT contrast
swabs

32
Q

What is another name for squint

A

strabismus

33
Q

what is strabismus

A

any form of misalignment of the eyes where the images projected on the retina do not match and the patient experiences double vision

34
Q

What is a concomitant squit?

A

one which occurs due to differences in the control of the extraocular muscles

35
Q

what is a paralytic squint

A

one that occurs due to paralysis of one or more of the extraocular muscles (rare)

36
Q

Causes of strabismus

A

-idiopathic

-reduced vision in one eye- refractive errors, retinoblastomas, cataracts, ocular malformation

-neurodevelopmental abnormalities (cerebral palsy, downs sydrome)

-abnormal extra-ocular muscles- congenital abnormalities, head injury, hydrocephalus

37
Q

Rf for strabismums

A

low birth weight
prematurity
maternal smoking in pregnancy
hypermetropia
family history
pseudosquint

38
Q

what are the 4 types of squints

A

esotropia
exotropia
hypertropia
hypotropia

39
Q

describe an esotropia squint

A

there is an inward position of the affected eye (it moves towards the nose)

40
Q

describe an exotropia squint

A

there is outward movement of the affected eye- it deviates towards the ear

41
Q

How does a hypertropia squint present?

A

upwards movement of the affected eye

42
Q

how does a hypotropia squint present?

A

downwards movement of the affected eye

43
Q

How can strabismus be diagnosed?

A
  • inspection of eye movements
  • fundoscopy to rule out differentials
  • Hirschberg’s test
  • cover test
44
Q

How does hirschberg’s test work?

A

corneal light reflex test
- a light is shone into the patients eyes from one metre away
- the reflection of the light on their cornea should be symmetrical but in strabismus will be asymmetrical

45
Q

How does the cover test work in the diagnosis of strabismus?

A

The child is asked to look forward and fix on an object in from of the them

One eye is covered - this is then moved to the other eye and the movement of the eye is observed
- if it moves inwards it means it was looking out when covered (exotropia)
- if it moves outwards it means it had drifted in when covered (esotropia)

46
Q

How can strabismus be treated?

A

occlusive patch - covers the good eye to make the weaker eye develop

atoprine drops - cause blurry vision in the good eye

47
Q

What is a complication of untreated stabismus and why does it occur?

A

amblyopia (lazy eye)
- occurs as the visual cortex suppresses the image from the misaligned eye to prevent double vision
- this reduces the development of the visual pathways of that eye and reduces its visual acuity

48
Q
A

3A (33 decks)

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