Kidneys And ENT

Question 0

What bacterial pathogens often cause otitis media?

Answer 0

Strep pneumoniae
HiB
If under 6 weeks old - E. coli, pseudomonas

Question 1

Why are kids at increased risk of otitis media?

Answer 1

Developmental Eustachian tube alterations
Immature immune system
Frequent URTIs

Question 2

Presenting symptoms of otitis media?

Answer 2

Otalgia, worse when supine
Otorrhoea, through perf TM or pre existent tympanostomy tube
Headache
Coryzal symptoms suggestive of concurrent URTI
Febrile (convulsions)
Irritability and lethargy
Anorexia, n and v, diarrhoea

Question 3

Features suggestive of OME?

Answer 3

Hearing loss
Tinnitus
Vertigo or unsteadiness

Question 4

What GI condition common in kids is a risk factor for OM?

Answer 4

Reflux

Question 5

4 key things to look for when undertaking otoscopy to diagnose OM?

Answer 5

Colour of TM
Position of TM (bulging in OM, normal or retracted with effusion)
Mobility of TM (pneumatic otoscopy only)
Perforation?

Question 6

Other diagnostic methods for OM?

Answer 6

Tympanometry
Acoustic reflectometry
Tympanocentesis and culture

Question 7

What is it particularly about the ET in kids that makes them susceptible to OM?

Answer 7

Short, horizontal and functions improperly

Question 8

Serious complications of OM?

Answer 8

Mastoiditis and meningitis depending on pathogen

Question 9

What is glue ear otherwise known as?

Answer 9

Otitis media with effusion OME

Question 10

Which antibiotic is widely used for OM and what is it effective/not effective for?

Answer 10

Amoxicillin

Good for reducing duration of symptoms, poor at reducing hearing loss

Question 11

What hearing loss signs does OME precipitate in kids?

Answer 11

Conductive hearing loss (PTA)

Flat line on tympanometry

Question 12

What are the prerequisites for grommet insertion and what is an alternative?

Answer 12

Recurrent URTIs
Chronic glue ear

Alternative = adenoidectomy

Question 13

What urinary factors contribute to UTI susceptibility?

Answer 13

Renal calculi
Congenital malformation - obstructive uropathy
Vesico-ureteric reflux (VUR)
Phimosis

Question 14

What are the classic symptoms of UTI that are more common with age?

Answer 14

Dysuria, frequency and loin pain

Question 15

What is the current recommended method for urine collection in kids?

Answer 15

Clean catch method

Question 16

What 3 imaging studies are recommended for post proven UTI, particularly for younger (<3yrs) kids?

Answer 16

US
MCUG or VCUG
DMSA scan

Question 17

Long term complications of pyelonephritis?

Answer 17

Chronic renal failure

Hypertension

Question 18

4 criteria for severe UTI disease?

Answer 18

Fever >39
Persistent vomiting
Serious dehydration
Poor treatment compliance

Question 19

What neurological congenital defect can be a risk factor for UTIs?

Answer 19

Spina bifida

Question 20

Alternative methods to clean catch for collecting urine?

Answer 20

Plastic bag
Nappy pad
Catheter or SPA for really sick kids

Question 21

What investigation is gold standard for VUR?

Answer 21

MCUG

Question 22

What investigation is gold standard for renal parenchymal defects?

Answer 22

DMSA

Question 23

What antibiotics are commonly used in management of UTI?

Answer 23

Trimethoprim
Cefalexin
Amoxicillin, co amoxyclav

Question 24

What antibiotics are used for acute pyelonephritis?

Answer 24

Oral cephalosporins

Question 25

What kids are most at risk of HSP?

Answer 25

Boys 3-10 yrs old

Question 26

What is HSP commonly preceded by?

Answer 26

URTI

Question 27

What is the pathophysiology behind HSP?

Answer 27

Infection causing high IgA and low IgG Complement activation and deposition in organs (autoimmune) Widespread inflammatory response and vasculitis

Question 28

Describe the rash that is characteristic of HSP

Answer 28

Initially macpap/urticarial, quickly becomes purpuric. Palpable Buttocks down, legs ankles and extensor surfaces (arm)

Question 29

Other features of HSP?

Answer 29

Fever Joint pain/swelling (knees, ankles) Colicky abdominal pain, haematemesis, malaena, intussusception Micro/macroscopic haematuria, mild proteinuria

Question 30

Presenting features of tonsillitis other than sore throat?

Answer 30

Ear pain, abdominal pain Headache Vocal changes High temperature

Question 31

Which lymph nodes are characteristically swollen and tender in tonsillitis?

Answer 31

Anterior cervical nodes

Question 32

What is 'classic strep tonsillitis'?

Answer 32

Acute onset headache, abdo pain and dysphagia

Question 33

Differentials for tonsillitis?

Answer 33

Cold/viral URTI Glandular fever Coxsackievirus infection - blisters in mouth Epiglotitis

Question 34

Centor criteria for Group A B-hemolytic Strep infection likelihood?

Answer 34

``` Hx of fever Absence of cough Anterior cervical lymphadenopathy Tonsillar exudate 3 or more = consider bacterial infection ```

Question 35

NICE specific indications for antibiotics in tonsillitis? (5)

Answer 35

``` Marked systemic upset Unilateral peritonsillitis (?quinsy) Hx of rheumatic fever Increased risk from acute infection e.g. DM, immunocompromised 3 or more centor criteria ```

Question 36

Typical antibiotic for tonsillitis?

Answer 36

10 days of phenoxymethylpenicillin | Alternatively clarithromycin if allergic to penicillin

Question 37

SIGN criteria for surgical referral - tonsillectomy

Answer 37

7 or more episodes in 1 year 5 or more in each of preceding 2 years 3 or more in each of preceding 3 years

Question 38

4 complications of tonsillitis?

Answer 38

Otitis media Quinsy - peritonsillar abscess Sleep interference Exacerbation of guttate psoriasis

Question 39

What can peritonsillar abscess arise as a complication of?

Answer 39

Tonsillitis | Glandular fever

Question 40

What bacteria typically causes a peritonsillar abscess?

Answer 40

Strep pyogenes, although typically a combination

Question 41

Signs of peritonsillar abscess?

Answer 41

``` Severe throat and ear pain Fever, headache, general malaise Drooling, foul smelling breath, dysphagia Trismus Altered voice Neck stiffness/torticollis ```

Question 42

IV antibiotics used for peritonsillar abscess?

Answer 42

Penicillin, amoxicillin Clindamycin Cephalosporins