Respiratory - ENT Flashcards

1
Q

What are the clinical features of epiglottits?

A
  • high fever, very ill, toxic looking child - an intensely painful throat that prevents child from speaking or swallowing, saliva drools down the chin- soft inspiratory stridor and rapidly increasing respiratory difficulty over hours - the child is sitting immobile, upright, with an open mouth to optimise the airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes of upper airway obstruction?

A

viral laryngotracheobronchitis - croup - COMMON RARE causes:epiglottitis bacterial tracheitis laryngeal or oesophageal foreign body allergic laryngeal angioedema etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can you differentiate between the other causes of airway obstruction and epiglottitis?

A

Croup Epiglottitis Onset over days over hoursPreceding coryza yes no Cough severe, barking absent or slight Able to drink yes noDrooling saliva no yesAppearance unwell toxic, very ill Fever <38.5 >38.5Stridor harsh rasping soft whisperingVoice, cry hoarse muffled, reluctant to speak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does acute otitis media present?

A

ear pain and fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does acute otitis media appear on examination?

A

examine tympanic membrane - acute OM = bright red and buldging - pus in external canal if perforated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is acute otitis media treated?

A
  • simple analgesia - most resolve spontaneously - Abx shorten pain duration but don’t reduce risk of hearing loss - amoxicillin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What organism commonly causes otitis media?

A

virus - RSV, rhinovirusbacteria - pneumococcus, H.influenza common at 6-12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does otitis media with effusion present? (glue ear)

A

possible decreased hearing asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is seen on examination in patients with otitis media with effusion?

A

ear drum is dull and retracted may see a visible fluid level flat trace on tympanometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is otitis media with effusion treated?

A

Grommets no effective medical treatment adenoidectomy may be helpful if recurrent OME with hearing loss, obstructive sleep apnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is otitis media common?How does it effect these children?

A

2-7 year olds most common cause of conductive hearing loss in children this can lead to speech and learning difficulties if recurrent with hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does tonsillitis present?

A

inflammation of tonsils purulent exudate if bacterial may see headache, apathy, abdo pain, cervical lymphadenopathy and white exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What investigations can be done if you suspect tonsillitis?

A

Culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is tonsillitis managed?

A

ABx - penicillin, erythromycin avoid amoxicillin in glandular fever as causes rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the common pathogens causing tonsillitis?

A

group A B-haemolytic streptococcus, EBV (infective mononucleosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is a tonsillectomy considered?

A

quinsy (abscess) recurrent severe tonsillitis sleep apnoea

17
Q

What is pharyngitis?

A

Sore throat Pharynx and soft palate are inflamed usually viral could be group A B-haemolytic strep in older children

18
Q

How does sinusitis present?

A

Most commonly maxillary - may get secondary bacterial infection –> pain and swelling

19
Q

How is sinusitis treated?

A

ABx, analegesia topical decongestants

20
Q

What conditions are URTIs?

A

common cold (coryza) sore throat (pharyngitis, including tonsillitis) acute otitis media sinusitis (relatively uncommon) children often present with a combination

21
Q

How does the common cold (coryza) present?

A

clear or mucopurulent nasal discharge nasal blockage

22
Q

How is the common cold managed?

A

self limiting

23
Q

What organism commonly causes coryza?

A

rhinoviruscoronavirus RSV

24
Q

When is a child considered to have a fever?

A

> 38 degrees C

25
Q

How should a fever be treated?

A

should be assessed for an underlying cause paracetamol/ibuprofen should be used

26
Q

When is hospital admission required with an URTI?

A

rarely required but may be necessary if feeding and fluid intake is inadequate

27
Q

How does viral croup present?

A

barking cough stridor hoarseness may see fever and coryza before difficulty breathing symptoms are often worse at night

28
Q

How is viral croup investigated and treated?

A

look for oedema of subglottic area oral dexamethasone NEB steroids helpIf severe NEW epinephrine with oxygen

29
Q

What commonly causes viral croup? In what age group is it common?

A

95% of all laryngotracheal infections most likely parainfluenza peaks in 2 year olds admission threshold lowest in <12 months due to narrow airway

30
Q

How is epiglottitis managed?

A

urgent admission intubate cultures IV ABx - cefuroxime Prophylactic rifampicin for household contacts

31
Q

What organisms commonly causes epiglottitis?

A

H. influenza B Reduced by Hib vaccine - now rare NB if child cries will lose airway

32
Q

What are the clinical features of bacterial tracheitis?

A

high fever rapid airway obstruction thick airway secretions caused by staph aureus

33
Q

How is bacterial trracheitis managed?

A

IV ABx Intubation and ventilation if required

34
Q

Outline the basic management of acute upper airway obstruction?

A
  • reduce anxiety - be calm and confident - observe for signs of hypoxia or deterioration - agitiation, fatigue, drowsiness - provide oxygen if required and tolerated- do not examine the throat with a spatula - oral, NEB or IV steroids are beneficial in croup - if severe administer NEB epinephrine and contact anaesthetist- tracheal intubation if respiratory failure develops
35
Q

What is the immediate danger with burns and smoke inhalation?How should this be managed?

A

check for airway burns - soot in nasal and oral cavities - cough, hoarseness, stridor - coughing up black sputum - difficulty breathing - scorched eyebrowns or hair early intubation important if evolving airway is swelling as may become impossible with progressive obstruction of the airway