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ENT Flashcards

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1
Q

how long does otitis externa have to last to be chronic?

A

3 months

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2
Q

where does localised otitis externa affect?

A

infection of a hair follicle in the ear which can develop into a boil

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3
Q

where does diffuse otitis externa affect?

A

widespread inflammation of the skin and subdermis

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4
Q

what causes malignant otitis externa ?

A

arises when the infection spreads to the mastoid and temporal bones causing osteomyelitis

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5
Q

what bacteria can cause otitis externa ?

A

Pseudomonas Aeruginosa or Staphylococcus Aureus

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6
Q

what are some risk factors of otitis externa ?

A 
hot and humid climates 
swimming 
older age 
DM
eczema 
wax build up 
trauma
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7
Q

what are DD for otitis externa ?

A 
acute otitis media with perforation 
furunculosis 
viral infections 
tumours 
cholesteatoma 
impacted wax
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8
Q

what is the management of otitis externa ?

A

avoid getting ear wet
analgesia
antibiotic or anti fungal ear drops

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9
Q

what complications can occur with otitis externa ?

A 
abscesses
ear canal stenosis
perforated ear drum 
celllulitis 
malignant otitis externa
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10
Q

what age is most affected by acute mastoiditis ?

A

<2yrs

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11
Q

how does the mastoid air cells communicate with the middle ear?

A

via a small canal known as the aditus to mastoid antrum.

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12
Q

what are the 3 locations that an abscess from acute mastoiditis ?

A

Behind the pinna in an area known as Macewen’s triangle, or higher

Superior to the pinna towards the zygomatic process

Over the squamous temporal bone

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13
Q

where is MacEwen’s triangle?

A

area behind the pinna

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14
Q

what are DD for acute mastoiditis ?

A

Infected pre-auricular sinus (located near the front of the ear)
Infected/inflamed post-aural lymph node
Langerhans cell histiocytosis
Rhabdomyosarcoma

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15
Q

what antibiotics are used for acute mastoiditis?

A

high-dose co-amoxiclav or ceftriaxone

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16
Q

what are intracranial complications of acute mastoiditis ?

A

Intracranial infections including meningitis; epidural, temporal lobe or cerebral abscess; subdural empyema
Dural sinus thrombosis

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17
Q

what age is most affected by peri orbital cellulitis?

A

10yrs

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18
Q

what sex is more affected by peri orbital cellulitis ?

A

males

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19
Q

what sinus is most affected during periorbital cellulitis ?

A

ethmoidal sinusitis

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20
Q

what organisms cause periorbital cellulitis

A

Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, group A streptococcus

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21
Q

what vaccine has reduced the numbers of periorbital cellulitis cases?

A

HiB vaccine

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22
Q

what will orbital cellulitis present with?

A 
Proptosis
Ophthalmoplegia
Decreased visual acuity
Loss of red colour vision – first sign of optic neuropathy
Chemosis
Painful diplopia
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23
Q

what classification is used for periorbital cellulitis ?

A

Chandler classification

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24
Q

what blood test is used to measure response to treatment ?

A

CRP and WBC count

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25
what imaging can be done for periorbital cellulitis ?
CT scan
26
what is DD for periorbital cellulitis ?
``` Vesicles of herpes zoster ophthalmicus Erythematous irritation of contact dermatitis Raised, dry plaques of atopic dermatitis Hordeolum or stye Chalazion Dacrocystitis Blepharitits ```
27
what is Chalazion?
blocked meibomian gland
28
what is dacrocystitis ?
infection of the lacrimal sac,
29
when is urgent drainage recommended during peri orbital cellulitis ?
when there are intracranial complications at time of presentation and frontal sinusitis
30
what is chandler classification used for?
classifying peri orbital cellulitis
31
how many stages of chandler classification is there?
5
32
what are the 5 stages of the chandler classification?
``` 1 = confined to eyelid 2 = extends into orbital tissue, no abscess 3 = abscess forms deep to the periosteum of the orbit 4 = collection of pus inside or outside muscle cone, intra orbital abscess 5 = infection into cavernous sinus ```
33
what cranial nerves could be damaged when the cavernous sinus is involved in periorbital cellulitis ?
3rd, 5th, 6th
34
what % of children with sinus related problems with develop peri orbital cellulitis ?
35%
35
what % of people with orbital cellulitis will loss their vision?
11%
36
infection of which sinus carries the highest risk of intracranial spread?
frontal sinus
37
what tonsils are inflamed in tonsillitis ?
palatine tonsils
38
what is the commonest bacterial cause of tonsillitis ?
streptococcus | - group A strep (strep pyogenes)
39
what viruses commonly cause tonsillitis ?
adenovirus and EBV
40
what is a risk factor for tonsillitis in children?
smoking
41
how long does tonsillitis usually last for?
5-7days
42
if tonsillitis lasts for more than 7 days what might this suggest?
glandular fever
43
on examination what might be seen during tonsillitis ?
red inflamed tonsils white exudate spots cervical lymphadenopathy
44
what two criteria are used to assess what patients require antibiotics for tonsillitis ?
centor criteria | feverPAIN criteria
45
what are the four features of Centor criteria ?
tonsillar exudate tender anterior cervical lymphadenopathy fever absence of a cough
46
what are the four features of feverPAIN criteria ?
``` Fever (during previous 24 hours) Purulence Attend rapidly (within 3 days after onset of symptoms) Severely Inflamed tonsils No cough or coryza ```
47
what 6 criteria are used to predict the likeliness of a group A strep infection ?
``` Age 5-15 Season (between late autumn and early spring) Fever (>38.3°C) Cervical lymphadenopathy Pharyngeal erythema, oedema, or exudate No viral URTI symptoms ```
48
for what ENT condition should the child not be examined ?
epiglottitis
49
what are some DD for tonsillitis ?
``` peritonsillar abscess pharyngitis glandular fever tonsillar malignancy epiglottitis ```
50
is tonsillar malignancy usually bilateral or unilateral
unilateral
51
what investigations can be done for tonsillitis ?
if child is admitted | - FBC, LFTs (glandular fever will have deranged LFTs), U&Es (dehydration may lead to AKI)
52
what signs may indicate a child needs to be admitted?
respiratory compromise - tachypnoea, low sats, use of accessory muscles patients unable to eat or drink patients who are not getting better on antibiotics in the community
53
what score of the centor criteria is highly suggestive of bacterial infection?
3 or more out of 4
54
what antibiotic can be given for tonsillitis ?
Benzylpenicillin for 7-10days | - dose according to age
55
when can a pt be offered tonsillectomy ? | number of infections in 1,2 and 3 years ?
in 1 year = 7 or more in 2 years = 5 or more per year in 3 years = 3 or more per year
56
state 2 post strep conditions ?
post streptococcal glomerulonephritis (PSGM) acute rheumatic fever
57
what is the classic triad of symptoms with post strep glomerulonephritis ?
HTN, haematuria, oedema
58
what causes acute rheumatic fever?
is an autoimmune response to group A strep that cause prolonged fever, anaemia, arthritis and pancarditis
59
what ages are most affected by peritonsillar abscess?
20-40yrs
60
what is another name for peritonsillar abscess?
quinsy
61
are complications of tonsillitis common?
no
62
what muscle forms the anterior tonsillar pillar?
glossopalatine muscle
63
what muscle forms the posterior tonsillar pillar?
pharyngopalatine muscle
64
what bacterial infection in peritonsillar abscesses is common in 15-24yrs ?
fusobacterium necrophorum
65
what antibiotics are used for peritonsillar abscesses?
co-amoxiclav | clindamycin (if penicillin allergic)
66
what clinical features suggest peritonsillar abscess?
trismus (muscle spasm preventing jaw opening fully) deviation of uvula away from affected side unilateral throat pain fever fatigue drooling
67
what blood tests can be done for peritonsillar abscess?
FBC, LFT, U&Es, CRP | ebstein barr virus antibodies
68
can co-amoxiclav be prescribed for tonsillitis ?
no | - there is a small risk of permanent skin rash if the tonsillitis is due to glandular fever
69
after IV benpen antibiotics for peritonsillar abscess, what oral antibiotics should be prescribed on discharge?
oral penicillin V (Phenoxymethylpenicillin)
70
how can epstein barre virus be transmitted ?
exchange of saliva blood transfusion organ transplant
71
what clinical signs on examination may be present during infectious mononucleosis ?
inflamed tonsils significant cervical lymphadenopathy HSM palatal petechiae
72
what WBC will be raised in infectious mononucleosis ?
lymphocytes
73
what specific tests can be done for glandular fever ?
monospot test (relies on generation of non specific heterophiles IgM autoantibodies) ELISA based immunoassays
74
state some complications of infectious mononucleosis ?
``` post viral fatigue malignancy guillain barre syndrome encephalitis splenic rupture ```
75
what malignancies are associated with Epstein barre virus ?
burkitts, Hodgkins, T cell lymphomas and nasopharyngeal carcinoma
76
due to the risk of splenic rupture what advice should be given to infectious mononucleosis patients?
avoiding contact sports for 4-6 weeks post treatment
77
a quinsy is a collection of pus in which space?
peritonsilllar

Y4 Paeds (15 decks)

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