ENT Flashcards
(116 cards)
1
Q
What is tonsillitis?
A
Inflammation of the tonsils
2
Q
Most common cause of tonsillitis?
A
Viral tonsillitis most common
If bacterial, most common is group A streptococcus - Streptococcus pyogenes
Most common alternative bacterial cause of tonsillitis Streptococcus pneumoniae
Other bacterial causes:
Haemophilus influenzae
Morazella catarrhalis
Staphylococcus aureus
3
Q
What is Waldeyer’s Tonsillar Ring?
A
Ring of lymphoid tissue in the pharynx, six areas of lymphoid tissue, making up:
Adenoid
Tubal tonsils
Palatine tonsils
Lingual tonsil
4
Q
Peak ages of presentation of tonsilitis?
A
5 to 10
15 to 20
5
Q
Which tonsils are most commonly involved in tonsilitis?
A
The palatine tonsils are the ones typically infected and enlarged in tonsillitis. These are the tonsils at either side at the back of the throat.
6
Q
Clinical presentation of tonsilitis?
A
FEVER
SORE THROAT
PAINFUL SWALLOW
Tonsillitis can present with non-specific symptoms, particularly in younger children. They may present with only a fever, poor oral intake, headache, vomiting or even abdominal pain.
Examination of the throat will reveal red, inflamed and enlarged tonsils, with or without exudates. Exudates are small white patches of pus on the tonsils.
7
Q
What should be examined in suspected tonsilitis asides from the throat?
A
Always examine the ears (otoscopy) to visualising the tympanic membranes and palpate for any cervical lymphadenopathy when assessing a child with suspected tonsillitis.
8
Q
What features score points under the Centor Criteria?
A
Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)
9
Q
What features score points on the FeverPAIN Score?
A
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
10
Q
Significance of FeverPAIN score
A
A score of 2 – 3 gives a 34 – 40% probability and 4 – 5 gives a 62 – 65% probability of bacterial tonsilitis
11
Q
Significance of Centor criteria
A
A score of 3 or more gives a 40 – 60 % probability of bacterial tonsillitis, and it is appropriate to offer antibiotics.
12
Q
Serious pathology to rule out in ?tonsilitis
A
meningitis
epiglottitis
peritonsillar abscess
13
Q
Advice to parents of children with likely viral tonsilitis?
A
Advise simple analgesia with paracetamol and ibuprofen to control pain and fever.
NICE clinical knowledge summaries suggest advising patients to return if the pain has not settled after 3 days or the fever rises above 38.3ºC. If this occurs you can start antibiotics or consider an alternative diagnosis.
14
Q
Considering antibiotics?
A
Consider prescribing antibiotics if the Centor score is ≥ 3 or the FeverPAIN score is ≥ 4.
Also consider antibiotics if they are at risk of more serious infections, for example young infants, immunocompromised patients or those with significant co-morbidity, or there is a history of rheumatic fever.
Delayed prescriptions can be considered. This involves educating patients or parents about the likely viral nature of the sore throat, and providing a prescription that is to be collected only in the event that the symptoms do not improve or worsen in the next 2 – 3 days.
15
Q
When should admission be considered for children with tonsilitis?
A
Consider admission if the patient is immunocompromised, systemically unwell, dehydrated, has stridor, respiratory distress or evidence of a peritonsillar abscess or cellulitis.
16
Q
Antibiotic therapy in bacterial tonsilitis
A
Penicillin V (also called phenoxymethylpenicillin) for a 10 day course is typically first line
Clarithromycin is the first line choice in true penicillin allergy.
17
Q
Potential complications of tonsilitis?
A
Chronic tonsillitis
Peritonsillar abscess, also known as quinsy
Otitis media if the infection spreads to the inner ear
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis
18
Q
How is the treatment of children with OSAS different to that of adults?
A
Surgery can be completely curative
19
Q
Ménière’s disease management
A
Avoidance of stressors
Betahistine
Diuretic therapy
Grommet
Hearing aid
Prochlorperazine (buccal or IM)
Intra-tympanic gentamicin/steroid
20
Q
Quinsy signs
A
The uvula deviated AWAY from the site of infection
A unilaterally enlarged tonsil, with or without exudate
A unilateral peritonsillar swelling with mucosal cellulitis
21
Q
What is quinsy?
A
Quinsy is the common name for a peritonsillar abscess.
Peritonsillar abscess arises when there is a bacterial infection with trapped pus, forming an abscess in the region of the tonsils.
Peritonsillar abscesses are usually a complication of untreated or partially treated tonsillitis, although it can arise without tonsillitis.
22
Q
Peritonsilitis vs tonsilitis occurrence
A
Quinsy can occur just as frequently in teenagers and young adults as it does in children, unlike tonsillitis which is much more common in children.
23
Q
Presentation of quinsy
A
Patients present with similar symptoms to tonsillitis:
Sore throat
Painful swallowing
Fever
Neck pain
Referred ear pain
Swollen tender lymph nodes
Additional symptoms that can indicate a peritonsillar abscess include:
Trismus, which refers to when the patient is unable to open their mouth
Change in voice due to the pharyngeal swelling, described in textbooks as a “hot potato voice”
Swelling and erythema in the area beside the tonsils on examination
24
Q
What organism usually causes quinsy?
A
Quinsy is usually due to a bacterial infection. The most common organism is streptococcus pyogenes (group A strep), but it is also commonly caused by staphylococcus aureus and haemophilus influenzae.
25
Management of quinsy
incision and drainage
A broad spectrum antibiotic such as co-amoxiclav would be an appropriate choice to cover the common causes, but local guidelines will guide antibiotic choice according to local bacterial resistance.
Some ENT surgeons give steroids (i.e. dexamethasone) to settle inflammation and help recovery, although this is not universal.
26
What is a tonsillectomy and why is it performed?
Tonsillectomy is the name for the surgical removal of the tonsils. Removing the tonsils prevents further episodes of tonsillitis, although patients can still get a sore throat.
7 or more in 1 year
5 per year for 2 years
3 per year for 3 years
Other indications are:
Recurrent tonsillar abscesses (2 episodes)
Enlarged tonsils causing difficulty breathing, swallowing or snoring
27
How many episodes of tonsilitis in one year indicated tonsillectomy?
7 or more
28
How many episodes of tonsilitis in two years indicated tonsillectomy?
5 per year
29
How many episodes of tonsilitis across 3 years indicated tonsillectomy?
3 per year
30
When might tonsillectomy be indicated for reasons other than a specified number of episodes of recurrent tonsilitis?
Recurrent tonsillar abscesses (2 episodes)
Enlarged tonsils causing difficulty breathing, swallowing or snoring
31
Potential complications of tonsillectomy
Pain, particularly a sore throat where the tonsillar tissue has been removed. This can last 2 weeks.
Damage to teeth
Infection
Post-tonsillectomy bleeding
Risks of a general anaesthetic
32
Observation following tonsillectomy?
The procedure is usually performed as a day case, and patients go home 6 – 8 hours after the operation, after a period of observation.
33
What is the main significant complication following tonsillectomy, and up to when might it occur? Why is it serious?
Post tonsillectomy bleeding is the main significant complication after a tonsillectomy.
Significant bleeding can occur in up to 5% of patients who have had a tonsillectomy and it requires urgent management.
This can happen up to 2 weeks after the operation.
Bleeding can be severe and in rare cases life threatening, usually due to aspiration of blood.
34
Management of post tonsillectomy bleeding?
Call the ENT registrar and get them involved early
Get IV access and send bloods including a FBC, clotting screen, group and save and crossmatch
Keep the child calm and give adequate analgesia
Sit them up and encourage them to spit the blood rather than swallowing
Make the child nil by mouth incase an anaesthetic and operation is required
IV fluids for maintenance and resuscitation as required
If there is severe bleeding or airway compromise, call an anaesthetist as intubation may be required.
Prior to going back to theatre there are two options for stopping less severe bleeds:
1. Hydrogen peroxide gargle
2. Adrenalin soaked swab applied topically
35
Otitis media is infection of which part of the ear?
Middle ear: space sitting between tympanic membrane (ear drum) and inner ear (chochlea, vestibular apparatus and nerves)
36
How does infection occur in otitis media?
The bacteria enter from the back of the throat through the eustachian tube.
A bacterial infection of the middle ear is often preceded by a viral upper respiratory tract infection.
37
What is the most common bacterial causes of otitis media, as well as other ENT infections such as rhino-sinusitis and tonsillitis?
streptcoccus pneumoniae
38
Bacterial causes of otitis media?
Streptococcus pneumoniae (most common)
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
39
Presentation of otitis media
Ear pain
Conductive hearing loss (affected ear)
URTI symptoms: fever, cough, coryzal symptoms, sore throat, feeling generally unwell
Balance issues and vertigo when infection affecting the vestibular system
Discharge from ear (if TM perforated)
Other non specific symptoms: vomiting, irritability, lethargy, poor feeding
40
In a normal child the tympanic membrane should appear how?
“pearly-grey”, translucent and slightly shiny
You should be able to visualise the malleus through the membrane and a cone of light reflecting the light of the otoscope.
41
Tympanic membrane in otitis media
Buldging, red, inflamed looking membrane
If perforation: discharge in ear canal and hole in TM
42
When should consideration for paediatric assessment or admission be considered in children of otitis media?
Consider referral to paediatrics for assessment or admission if symptoms are severe or there is diagnostic doubt.
Always refer for specialist assessment and to consider admission in infants younger than 3 months with a temperature above 38ºC or 3 – 6 months with a temperature higher than 39ºC.
43
For how long do most cases of otitis media last?
They state that most cases of otitis media will resolve within 3 days without antibiotics, but it can last for up to a week.
44
General management principals
Most cases of otitis media will resolve without antibiotics, and NICE guidelines from 2018 highlight the importance of not providing antibiotics for otitis media.
Complications (mainly mastoiditis) are rare. Give simple analgesia to help with pain and fever.
There are three options regarding prescribing antibiotics to patients with otitis media:
Immediate antibiotics
Delayed prescription
No antibiotics
45
Otitis media - considering immediate antibiotics
Consider prescribing antibiotics at the initial presentation in patients who have significant co-morbidities, are systemically unwell or are immunocompromised.
Children less than 2 years with bilateral otitis media and children with otorrhoea (discharge) are more likely to benefit from antibiotics.
46
Consider delayed prescription of antibiotics -
Consider a delayed prescription that can be collected and used after 3 days if symptoms have not improved or have worsened at any time.
This can be useful with patients that are very keen on antibiotics or where you suspect they might get worse.
47
What antibiotics are used in otitis media
The first line choice of antibiotic is amoxicillin for 5 days. Alternatives are erythromycin and clarithromycin.
48
Complications of otitis media
Otitis medial with effusion
Hearing loss (usually temporary)
Perforated eardrum
Recurrent infection
Mastoiditis (rare)
Abscess (rare)
49
What is seen here
bulging, red, inflamed looking membrane suggestive of otitis media
50
What is seen here
A dull tympanic membrane with air bubbles or a visible fluid level, suggestive of otitis media with effusion
51
What is ''glue ear''
Glue ear is also known as otitis media with effusion. The middle ear becomes full of fluid, causing a loss of hearing in that ear.
52
Why does glue ear/OME occur?
The middle ear becomes full of fluid, causing a loss of hearing in that ear.
The Eustachian tube connects the middle ear to the back of the throat.
It helps drain secretions from the middle ear.
When it becomes blocked, this causes middle ear secretions (fluid) to build up in the middle ear space.
53
What is the main symptom of glue ear?
Conductive hearing loss in the affected ear
54
What is the main complication of glue ear?
Otitis media (infection)
55
What is seen in otoscopy in OME?
Otoscopy can show a dull tympanic membrane with air bubbles or a visible fluid level, although it can look normal.
56
Management of OME
Referral for audiometry to help establish the diagnosis and extent of hearing loss.
Glue ear is usually treated conservatively, and resolves without treatment within 3 months.
Children with co-morbidities affecting the structure of the ear, such as Down’s syndrome or cleft palate may require hearing aids or grommets.
57
Role of grommets in managing OME
Grommets are tiny tubes inserted into the tympanic membrane by an ENT surgeon. This allows fluid from the middle ear to drain through the tympanic membrane to the ear canal.
Usually grommets are inserted under general anaesthetic as a day case procedure. The procedure is relatively safe with few complications.
Grommets usually fall out within a year, and only 1 in 3 patients require further grommets to be inserted for persistent glue ear.
58
Congenital causes of hearing loss in children?
Maternal rubella or cytomegalovirus infection during pregnancy
Genetic deafness can be autosomal recessive or autosomal dominant
Associated syndromes, for example Down’s syndrome
59
Perinatal causes of hearing loss in children?
Prematurity
Hypoxia during or after birth
60
After birth causes of hearing loss in children
Jaundice
Meningitis and encephalitis
Otitis media or glue ear
Chemotherapy
61
How might hearing loss present in children?
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.
Children with hearing difficulties may present with parental concerns about hearing or with behavioural changes associated with not being able to hear:
Ignoring calls or sounds
Frustration or bad behaviour
Poor speech and language development
Poor school performance
62
Testing hearing in children
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.
Younger children (under 3 years) are tested by looking for a basic response to sound (i.e. turning towards a sound).
Older children can be tested properly with headphones and specific tones and volumes.
The results of audiometry testing are recorded on an audiogram, which can help identify and differentiate conductive and sensorineural hearing loss.
63
What is charted on an audiogram?
Audiograms are charts that document the volume at which patients can hear different tones.
The frequency in hertz (Hz) is plotted on the x-axis, from low to high pitched.
The volume in decibels (dB) is plotted on the y-axis, from loud at the bottom to quiet at the top.
It is worth noting that the lower down the chart, the higher the decibels and the louder the volume.
64
In audiometry hearing is tested in both ears separately and both air and bone conduction are tested separately. Which symbols are used to mark each of these separate measurements?
X – Left sided air conduction
] – Left sided bone conduction
O – Right sided air conduction
[ – Right sided bone conduction
65
How is an audiogram made during audiometery?
Hearing is tested to establish the minimum volume required for the patient to hear each frequency, and this level is plotted on the chart. The louder the sound required for the patient to hear, the worse their hearing is and the lower on the chart they will plot. For example, a 1000 Hz sound will be played at various volumes until the patient can just about hear the sound. If this sound is heard at 15 dB, a mark is made on the chart where 1000 Hz meets 15 dB. If this sound can only be heard at 80 dB, a mark is made where 1000 Hz meets 80 dB.
66
Audiogram - sensorineural hearing loss
In patients with sensorineural hearing loss, both air and bone conduction readings will be more than 20 dB, plotted below the 20 dB line on the chart. This may affect only one side, one side more than the other or both sides equally.
67
Audiogram - conductive hearing loss
In patients with conductive hearing loss, bone conduction readings will be normal (between 0 and 20 dB), however air conduction readings will be greater than 20 dB, plotted below the 20 dB line on the chart. In conductive hearing loss, sound can travel through bones but is not conducted through air due to pathology along the route into the ear.
68
Audiogram - mixed hearing loss
In patients with mixed hearing loss, both air and bone conduction readings will be more than 20 dB, however there will be a difference of more than 15 dB between the two (bone conduction > air conduction).
69
Management of childhood hearing loss
Establishing the diagnosis is the first step. After the diagnosis is established, input from the multidisciplinary team is required for support with hearing, speech, language and learning:
Speech and language therapy
Educational psychology
ENT specialist
Hearing aids for children who retain some hearing
Sign language
70
Why/where do nosebleeds (epistaxis) typically occur?
They originate from Kiesselbach’s plexus, which is also known as Little’s area.
This is an area of the nasal mucosa at the front of the nasal cavity that contains a lot of blood vessels.
When the mucosa is disrupted in this area and the blood vessels are exposed, for example due to trauma from a child picking their nose, they are prone to bleeding.
71
Presentation of epistaxis?
Nosebleeds are common in otherwise healthy children.
They can be triggered by nose picking, colds, vigorous nose blowing, trauma and changes in the weather.
If children swallow blood during a nosebleed, they may present with vomiting blood.
Bleeding is usually unilateral.
Bleeding from both nostrils may indicated bleeding posteriorly in the nose.
72
Recurrent and significant nosebleeds
Recurrent and significant nosebleeds might require investigations to look for an underlying cause, such as thrombocytopenia or clotting disorders.
73
What might bilateral epistaxis indicate?
Bleeding from both nostrils may indicated bleeding posteriorly in the nose.
74
How to advise patients/parents on managing nosebleeds?
Sit up and tilt the head forwards. Tilting the head backwards is not advised as blood will flow towards the airway.
Squeeze the soft part of the nostrils together for 10 – 15 minutes
Spit any blood in the mouth out rather than swallowing
75
When might epistaxis need management in hospital?
When bleeding does not stop after 10 – 15 minutes, the nosebleed is severe, from both nostrils or they are unstable, patients may require admission to hospital.
76
Hospital management of epistaxis?
Nasal packing using nasal tampons or inflatable packs
Nasal cautery using a silver nitrate stick
After treating a nosebleed consider prescribing naseptin (chlorhexidine and neomycin) four times daily for 10 days to reduce any crusting, inflammation and infection. This is contraindicated in peanut or soya allergy.
77
What is cleft lip?
Cleft lip is a congenital condition where there is a split or open section of the upper lip. This opening can occur at any point along the top lip, and can extend as high as the nose.
78
What is cleft palate?
Cleft palate is where a defect exists in the hard or soft palate at the roof of the mouth. This leaves an opening between the mouth and the nasal cavity. Cleft lip and cleft palate can occur together or on their own.
79
Cleft lip/palate: associations
Most cases of cleft lip and cleft palate occur randomly.
Having a relative with cleft lip or palate makes it slightly more likely, however it does not follow a traditional inheritance pattern like conditions such as cystic fibrosis.
3 in 10 cases of cleft lip or palate are associated with another underlying syndrome.
80
Cleft lip/palate complications
Cleft lip or cleft palate is not life threatening, although it can lead to significant problems with feeding, swallowing and speech.
It can also have significant psycho-social implications, including affecting bonding between mother and child.
Surgery generally resolves these problems.
Children with cleft palates can be more prone to hearing problems, ear infections and glue ear.
81
Management of cleft lip/pallete
Patients should be referred to the local cleft lip services. This involves the specialist multi-disciplinary team:
Specialist nurses to support and coordinate care
Plastic, maxillofacial and ENT surgeons
Dentists
Speech and language therapists
Psychologists
General practitioners
The first priority is to ensure the baby can eat and drink. This may involve specially shaped bottles and teats. The specialist nurse will follow the child up through surgery and beyond to ensure good development.
The definitive treatment is to surgically correct the cleft lip or palate. This leaves a subtle scar, but is generally very successful, giving full functionality to the child. Cleft lip surgery is usually performed at 3 months, whilst cleft palate surgery done at 6 – 12 months.
82
When is cleft lip surgery typically performed?
3 months
83
When is clef palette surgery typically beformed?
6-12 months
84
What is ankyloglossia more commonly known as?
Tongue tie
85
What is ankyloglossia/tongue tie?
This is when a baby is born with a short and tight lingual frenulum, the attachment of the tongue to the floor of the mouth.
This prevents them properly extending their tongue out of the mouth and makes it difficult for them to latch onto the breast.
It usually presents as poor feeding or when noticed by the mother, midwife or doctor on newborn checks.
86
Management of tongue tie?
Mild tongue tie can be monitored and would not be expected to cause any issues.
When it affect feeding they may benefit from treatment:
Tongue tie can be cured with a frenotomy.
This involves a trained person cutting the tongue tie. This can usually be done on the ward or in the clinic without any anaesthetic. Complications are very rare, and include excessive bleeding, scar formation and infection.
87
What is a cystic hygroma?
A cystic hygroma is a malformation of the lymphatic system that results in a cyst filled with lymphatic fluid. It is most commonly a congenital abnormality and is typically located in the posterior triangle of the neck on the left side.
88
Where is cystic hygroma typically located?
It is most commonly a congenital abnormality and is typically located in the posterior triangle of the neck on the left side.
Cystic hygromas most commonly present in the neck or armpit.
89
When might cystic hygroma present?
It may be seen on antenatal scans, picked up on routine baby checks or discovered later when noticed incidentally.
90
Features of a cystic hygroma
Can be very large
Are soft
Are non-tender
Transilluminate
91
Potential complications of cystic hygroma?
Depending on the location and size, cystic hygromas can interfere with feeding, swallowing or breathing.
It can become infected, in which case it will turn red, hot and tender.
There can be haemorrhage into the cyst.
92
Management of cystic hygroma?
Treatment varies based on the size, location and complications. Watching and waiting can be appropriate as it is a benign condition. They do not resolve spontaneously, but can show some regression.
Aspiration (giving temporary improvement), surgical removal and sclerotherapy are treatment options.
93
What is this congenital abnormality?
A cystic hygroma
Malformation of the lymphatic system that results in a cyst filled with lymphatic fluid
94
How does a thyroglossal cyst form?
During fetal development, the thyroid gland starts at the base of the tongue.
From here it gradually travels down the neck to its final position in front of the trachea, beneath the larynx.
It leaves a track behind called the thyroglossal duct, which then disappears.
When part of the thyroglossal duct persists it can give rise to a fluid filled cyst.
This is called a thyroglossal cyst.
95
What is the key differential for thyroglossal cyst?
Ectopic thyroid tissue - commonly occurs at a similar location
96
What is the main potential complication of a thyroglossal duct cyst?
The main complication is infection of the cyst, causing a hot, tender and painful lump.
97
What abnormality is seen here?
Thyroglossal cyst
98
Features of thyroglossal cyst
Mobile
Non-tender
Soft
Fluctuant
Typically in midline of the neck
Movement upon tongue protusion?
99
How, on examination, can a thyroglossal cyst be easily differentiated from other neck lumps, and why?
Thyroglossal cysts move up and down with movement of the tongue.
This is a key feature that demonstrates a midline neck lump is a thyroglossal cyst.
This occurs due to the connection between the thyroglossal duct and the base of the tongue.
100
Thyroglossal cyst: management and diagnosis?
Ultrasound or CT scan can confirm the diagnosis.
Thyroglossal cysts are usually 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.
101
Why do brachial cysts occur?
A branchial cyst is a congenital abnormality arising when the second branchial cleft fails to properly form during fetal development.
This leaves a space surrounded by epithelial tissue in the lateral aspect of the neck.
This space can fill with fluid.
This fluid filled lump is called a branchial cyst.
Branchial cysts arising from the first, third and fourth branchial clefts are possible, although they are much more rare.
102
What is occuring here as a result of underlying congenital abnormality?
Brachial cyst, forming fue to fluid filling in a space left when the second brachial cleft fails to properly form during fetal development
103
How and where do brachial cysts present?
Branchial cysts present as a round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck.
104
At what age do brachial cysts tend to present?
Branchial cysts tend to present after the age of 10 years, most commonly in young adulthood when the cyst becomes noticeable or infected.
105
How do brachial cysts differ from cystic hygromas?
They are just anterior to the sternocleidomastoid muscle, round, soft and non-tender. If the lump transilluminates, it is more likely to be a cystic hygroma.
106
What is a fistula?
A fistula is an abnormal connection between two epithelial surfaces.
107
What is a sinus?
A sinus is a blind ending pouches.
108
What is a brachial cleft sinus?
A branchial cleft sinus describes when the branchial cyst is connected via a tract to the outer skin surface.
There will be a small hole visible in the skin beside the cyst.
There may be a noticeable discharge from the sinus.
109
What is a brachial pouch sinus describes?
A branchial pouch sinus describes when the branchial cyst is connected via a tract to the oropharynx.
110
What is a brachial fistula?
A branchial fistula describes when there is a tract connecting the oropharynx to the outer skin surface via the branchial cyst.
111
Why do sinuses and fistula increase the risk of complications iwht a brachial cyst?
Sinuses and fistula pose an increased risk of infections in the branchial cyst, as they are a way for pathogens to get in.
112
Management of brachial cyst?
Where the branchial cleft is not causing any functional or cosmetic issues, conservative management may be appropriate.
Where recurrent infections are occurring, there is diagnostic doubt about the cause of the neck lump or it is causing other functional or cosmetic issues, surgical excision may be appropriate.
113
Which drug if taken in pregnancy is associated with increased risk of cleft lip
First trimester exposure to benzodiazepines has been associated with increased risk of cleft lip
114
What psychiatric drug is associated with cleft Lip if taken in pregnancy
First trimester exposure to benzodiazepines has been associated with increased risk of cleft lip
115
What method of testing the child's hearing will be used as part of the school entry health screening program?
Pure tone audiometry
116
What test is used to screen newborns for hearing problems
Otoacoustic emission test is used to screen newborns for hearing problems
