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3a Notes AC > Paeds ENT & Opthal > Flashcards

Paeds ENT & Opthal Flashcards

1
Q

Pathophysiology Otitis Media

Children have short horizontal eustaschian tubes which function poorly

A
  • Infection between tympanic membrane and inner ear
  • Bacteria enter via Eustachian tubes
  • Pathogens: RSV, Rhinovirus, Step Pneumonia, Staph Auerus, Influenza

most children will have one episode in lifetime

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2
Q

Signs and Symptoms Otitis Media

A
  • Ear pain
  • Reduced hearing in affected ear
  • URTI incl. coryza
  • Balance issues
  • Ear discharge if perforation
  • Some children tug their ear
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3
Q

Investigations & Management Otitis Media

A
  • Tympanic membrane: red bulging, inflamed.
  • If perforation Discharge and hotle seen using otoscope
  • Self limiting but admit infants under 3mths if high fever
  • Abx (amoxicillin) given for 5 days if not resolved by day 4, there is bilateral pain or there’s perforation.

in patients with penicillin allergy, erythromycin or clarithromycin should be given.

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4
Q

Complications Otitis Media

A
  • Perforation of the tympanic membrane → otorrhoea.
  • Hearing loss
  • Labyrinthitis
  • mastoiditis
  • meningitis
  • brain abscess
  • facial nerve paralysis

unresolved with acute otitis media with perforation may develop into chronic suppurative otitis media (CSOM)

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5
Q

What is Glue Ear

Otitis media

RF: Male, Sibling with glue ear, bottle feeding, parental smoking

A

Otitis media with effusion (glue ear). Middle ear becomes full of fluid, causing a loss of hearing in that ear. This condition predisposes to further infections and therefore a cycle with otitis media.
Otoscopy can show a dull tympanic membrane with air bubbles or a visible fluid level

Peaks at 2Y

(glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)

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6
Q

Treatment Glue ear

A

Grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months
Adenoidectomy

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7
Q

Common causes of hearing loss?

Congenital, Perinatal, After birth

A

Congenital
* Maternal Rubella or CMV infection
* Genetic Deafness can be Autosomal dominant or recessive
* Down Syndrome

Perinatal
* Prematurity
* Hypoxia During or after birth

After Birth
* Jaundice
* Meningitis/Encephalitis
* Otitis Media

Audiometry and Audiogram also used

The UK newborn hearing screening programme (NHSP) tests hearing in all neonates. This involves special equipment that delivers sound to each eardrum individually and checks for a response. This can identify congenital hearing problems early.

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8
Q

Causes of Tonsilitis

Palatine tonsils usually infected

Tonsils are a part of the lymphatic system

A
  • Group A strep (pyogenes)
    Can also be caused by Strep Pneumonaie, Influenza, staph aureus
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9
Q

Signs and Symptoms of Tonsilitis

A
  • Fever
  • sore throat (with tonsillar exudate)
  • painful swallowing
  • lymphadenopathy
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10
Q

Centor Criteria for Tonsilitis

Score or 3 or more suggests Abx will be appropriate

A
  1. Fever >38
  2. Tonsillar exudate
  3. absence of cough
  4. tender anterior cervical nodes
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11
Q

Complications of Tonsilitis

A
  • Quinsey (peritonsillar abscess) - urgent ENT referral for drainage
  • Post strep Glomerulonephritis - nephritic syndrome
  • Can cause Scarlet fever
  • Obstructive sleep apnea
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12
Q

Management of Tonsilitis

5x episodes a year -> Tonsilectomy
Also obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils, unresponsive to treatment quinsey -> Tonsillectomy

A
  • Self limiting unless bacterial
  • Penicillin - 10days

Clarithromycin if penicillin allergy

Amoxicillin best avoided as it may cause widespread maculopapular rash if tonsillitis due to infectious mononucleosis.

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13
Q

Glandular Fever

Infectious Mononucleiosis
Pathophysiology

Risk factors relate to transmission – kissing, sharing cups, toothbrushes, and other equipment that transmits saliva.

A
  • Caused by the Epstein-Barr virus (EBV, also known as human herpesvirus 4, HHV-4) in 90% of cases.
  • Secreted in the saliva of infected individuals and they can be infectious several weeks before the illness begins, and intermittently for remainder of patients life.

Can also be caused by CMV

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14
Q

Signs and Symptoms of Infectious Mononucleosis

A

Triad of
1. Pyrexia
2. Lymphadenopathy
3. Sore throat
Others
- Petechiae on palate
- Malaise, anorexia, headache
- splenomegaly
- Haemolytic anaemia

Symptoms resolve 2-4wks

Differentiated from tonsilitis as inflammation in anterior and posterior triangles of the neck whereas for tonsilitis it is uppper anterior

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15
Q

Diagnosing Infectious Mononucleoisis

A

Heterophil antibody test (Monospot test) - NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.

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16
Q

Complications Infectious Mononucleosis

A

Notably associated with Burkitt’s lymphoma and nasopharyngeal carcinoma.
Other complications that are possible include:
- Splenic rupture
- Glomerulonephritis
- Haemolytic anaemia
- Thrombocytopenia
- Chronic fatigue

17
Q

Management Infectious Mononucleoisis

A
  • Usually self-limiting; treatment is symptomatic.
  • In 5% there is Tonsillar exudate then treat with Penicillin

a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

18
Q

Orbital Cellulitis V Periorbital cellulitis

Periorbital much more common affects younger children more.

Both occur commonly in winter months

A
  • Periorbital less serious but can develop into Orbital
  • Reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with periorbital cellulitis
18
Q

Causes of Orbital Cellulitis & Periorbital cellulitis

A
  • Spreading of URTI from the sinuses (mainly for orbital)
  • Streptococcus pneumoniae
  • Staphylococcus aureus
  • Streptococcus pyogenes (group A strep)
  • Haemophilus influenzae may be isolated in children
19
Q

Pathophysiology Periorbital cellulitis

is a less serious superficial infection anterior to the orbital septum, resulting from a superficial tissue injury (chalazion, insect bite etc…)

A

Eyelid and skin infection in front of the orbital septum (front of the eye). Usually comes from spread of local infection such as local skin trauma i.e. bites, spread from local infection i.e. paranasal sinuses, spread from distant infection from the face or upper respiratory tract.

20
Q

Pathophysiology Orbital Cellulitis

an infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe

A

Infection of the soft tissues behind the orbital septum that is sight and life-threatening. Most common route is extension of infection from the periorbital structures i.e. paranasal sinuses or lacrimal sac. Less commonly can be extension of periorbital cellulitis, particularly in young children with immature orbital septum. Other routes include trauma, post-surgery and haematogenous spread from distant bacteraemia.

21
Q

Signs and Symptoms Periorbital cellulitis

is a less serious superficial infection anterior to the orbital septum, resulting from a superficial tissue injury (chalazion, insect bite etc…)

A
  • Acute onset swelling
  • Redness
  • eyelid oedema
  • Fever
  • Malaise
22
Q

Signs and Symptoms Orbital cellulitis

an infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe

A
  • Pain on eye movement
  • Reduced eye movement
  • Changes in vision
  • Abnormal pupil reactions
  • Redness, swelling, fever, malaise
23
Q

Complications of Orbital cellulitis

an infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe

A
  • Raised intraocular pressure
  • optic neuropaty
  • Artery/vein occlusion
  • Orbital abscess
  • Intracranaial complications.
24
Q

Investigation & management for Periorbiral and orbital cellulitis

A
  • CT/MRI
  • Throat and nasal swabs
  • Clinical Diagnosis
  • Orbital: Emergency referrel IV Abx
  • PeriOrbital: Systemic Abx sometimes IV
25
Q

Define Squint/Strabsimus & Epidemiology

A
  • Characterised by misalignment of the visual axes
  • Usually develop within first 3 years of life.
26
Q

Pathophysiology of Strabismus/Squint

Commonly divided into 2

Misalignment of visual axes

A
  1. Concomitant - Non paralytic (most common) due to refractive error and imbalance in extraoccular muscles. Most common is convergent (eye inwards) rarely divergent (eye lateral)
  2. Paralytic (Rare) paralysis of orbital muscle nerves (III, IV, VI) can be serious due to it being from a tumour
27
Q

Signs and Symptoms Strabismus

A
  • Amblyopia: affected eye becomes passive and has reduced function compared to other dominant eye
  • Esotropia: inward squint
  • Exotropia: outward squint
  • Hypertropia: upward squint
  • Hypotropia: downward squint
28
Q

Complications Squint

A

Failure to correct lazy eye can lead to amblyopia: one eye becoming more dominant than other with the lazy eye becoming more disconnected

29
Q

Investigations & Management Strabismus

Treatment needs to start before age of 8 as this is when the visual fields develop till

A

Hirschberg’s Test Pen torch 1m away, observe reflection on cornea, deviation from central Symmetrical indicates squint
Cover Test cover 1 eye then focus on other, then swap over. Watch movement of initially covered eye and see if there is any movement either inwards or outwards.
Occlusive Patch used to cover good eye and force weaker eye to develop.

Using atropine drops in the good eye, causing vision in that eye to be blurred.

3a Notes AC (20 decks)

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