Paediatric - ENT Flashcards by Aureliah K

URTI

Name 3 causes of the common cold

rhinovirus
RSV
Coronavirus

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URTI

What is the presentation of pharyngitis

pharynx and soft palate are inflamed

enlarged and tender local lymph nodes

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URTI

Name 2 viral and 1 bacterial cause of pharyngitis

viral

common cold
adenovirus
EBV

Bacterial
- Group A beta haemolytic strep (common in older children)

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URTI

What age group is tonsillitis common in

5 - 10

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URTI

Name 4 causes of tonsillitis

Viral - most common
- EBV

Bacterial

Group A strep - strep pyogenes
Step pneumonia
H.influenzae
S.aureus

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URTI

What is viral tonsillitis associated with

headache
apathy
abdominal pain

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URTI

what is bacterial tonsillitis associated with

cervical lymphadenopathy

tonsillar exudate

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URTI

What is the presentation of tonsillitis

fever 
sore throat 
painful swallowing 
poor feeding 
headache 
abdominal pain 
vomiting

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URTI

Describe the examination required for suspected tonsillitis

look in mouth
- red / inflamed / enlarged tonsils

Otoscopy

palpate for cervical lymphadenopathy

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URTI

What are the 2 criteria used in suspected tonsillitis and what are they used for

CENTOR

FEVER PAIN

estimate probability tonsillitis is due to bacterial infection and will benefit from Abx

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URTI

Describe the criteria used in CENTOR score

Fever > 38
tonsillar exudate
absence of cough
tender anterior cervical lymph nodes

score > 3 suggests Strep infection that would benefit from Abx

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URTI

Describe the criteria used in FEVER PAIN score

fever > 38 
Purulence - exudate 
Attend rapidly - < 3 days 
Inflamed tonsils 
No cough or coryza

score > 4

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URTI

What is the management of symptomatic tonsillitis

paracetamol +/- Ibuprofen

educate if viral tonsillitis and provide safety net
- Pain not settled in 3 days
- fever > 38.3
consider Ddx and start Abx

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URTI

When should you consider Abx in tonsillitis

centor score > 3
Fever pain > 4
immunocompromised 
significant co-morbidity 
Hx of rheumatic fever

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URTI

What Abx are required in bacterial tonsillitis

1st line - Penicillin
If allergic:
Clarithromycin

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URTI

What is otitis media and when is it common

Infection of middle ear resulting in fluid build up

6 - 12m

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URTI

Why is otitis media common in children

Eustachian tube is short, horizontal and functions poorly

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URTI

what often preceeds an otitis media infection

Viral URTI

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URTI

What bacteria commonly cause otitis media

Strep pneumonia - Most common
H. Influenzae
S. aureus
Strep penumoniae

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URTI

How does otitis media present

Ear pain - tugging 
reduced hearing 
fever 
irritability 
sx or URTI 
- fever 
- cough 
- coryzal sx 
balance issues and vertigo

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URTI

How does a drum perforation in otitis media present

Easing of pain

purulent discharge

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URTI

What examinations are required for suspected otitis media

Hearing
- loss of conductive hearing

Otoscopy

bright red and bulging
loss of light reflex

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URTI

What is the management of otitis media

Pain - Analgesia
- Paracetamol +/- Ibuprofen

most resolve without Abx

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URTI

When should you consider Abx in otitis media

Systemically unwell 
Immunocompromised 
> 4 days with no sx improvement 
< 2 years old and bilateral 
< 3 months old 
Perforated ear drum

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URTI | What Abx are used in otitis media

Amoxicillin

URTI | What are the complications of otitis media

Mastoiditis meningitis Glue ear if recurrent

URTI | How does mastoiditis present and how is it managed

Pain on palpation of mastoid process Laterally and inferiorly displaced pinna - protrudes forwards thick purulent discharge - Urgent ENT referral - IV Abx - Mastoidectomy

URTI | What are the risk factors for otitis media

anatomical abnormalities - clef palate older siblings URTI

URTI | What is glue ear and what age groups is it common in

otitis media with effusion 2 - 7 years old

URTI | What causes glue ear

blockage of eustachian tube eustachian tube connects back of the throat to the ear - usually drains secretions from middle ear

URTI | How does glue ear present

reduction in hearing conductive hearing loss - Rhinne's

URTI | What does examination of the ear show in glue ear

Otoscopy dull and retracted tympanic membrane - with air bubbles - visible fluid level

URTI | What investigations should be performed in suspected glue ear

Audiogram - conductive deficits Tympanometry - flat tympanogram

URTI | What is the management of glue ear

referral for audiometry conservative - resolves in 3m Children with co-morbidities affecting the structure of the ear, such as Down’s syndrome or cleft palate may require hearing aids or grommets.

URTI | What are grommets and how long do they last

tiny tubes inserted in to tympanic membrane allows fluid from middle ear to drain through tympanic membrane into outer ear Fall out in 1 year

URTI | what advice should be given to children with grommets

Avoid diving but can swim

URTI | What should be done if problems reoccur after grommet insertion

reinsertion of grommet with adjuvant adenoidectomy

DEAFNESS | What are the 2 broad categories of deafness

Sensorineural - lesion in cochlea / nerve - present at birth Conductive - abnormalities in ear canal or middle ear - often glue ear

URTI | What is the main complication of glue ear

otitis media

DEAFNESS | Name 5 causes of sensorineural deafness

``` genetic congenital infection - rubella - CMV - Syphilis Hyperbilirubinemia Menilites head injury drugs - aminoglyclasides (gentamicin) - furosemide ```

DEAFNESS | What is the management of sensorineural deafness

hearing aids cochlear implants

DEAFNESS | Name 5 causes of conductive hearing loss

``` Glue ear eustachian tube dysfunction downs syndrome cleft palate wax ```

URT | What is the other name for a floppy larynx and when does it commonly present

laryngomalacia 4 weeks

URT | How does laryngomalacia present

``` congenital stridor - worse on feeding / exertion / crying failure to thrive IWB Normal voice ```

URT | What are the investigations for laryngomalacia

bronchoscopy - omega shaped epiglottis - short aryepiglottic folds - prolapsing arytenoids

URT | What is the management of laryngomalacia

resolves naturally in 18m

CELLULITIS | What causes periorbital cellulitis

local trauma to skin spread from paranasal sinus infection or dental abscess

CELLULITIS | what is the presentation of periorbital cellulitis

fever erythema, tenderness, oedema of eyelid unilateral signs

CELLULITIS | what is a red flag sign in periorbital cellulitis

loss of red colour vision | - sign of optic nerve compromise

CELLULITIS | what is the management of periorbital cellulitis

ENT referral | Iv Abx - ceftriaxone

CELLULITIS | how does orbital cellulitis present

proptosis painful / limited eye movements double vision reduced visual acuity

CELLULITIS | what is the investigation of choice for orbital cellulitis

CT/MRI - Assess posterior spread of infection

CELLULITIS | what is the management of of orbital cellulitis

IV Abx | surgical decompression

CELLULITIS | what are the complications associated with

meningitis abscess formation cavernous sinus thrombosis

CELLULITIS | How do you differentiate between orbital and periorbital cellulitis

NOT PERIORBITAL - Reduced visual acuity - Proptosis - Ophthalmoplegia

SQUINT | what is a squint

occurs due to misalignment of visual axis

SQUINT | What are the causes of a squint

``` refractive error - most common cataracts retinoblastoma visual loss opthamolplegia ```

SQUINT | What are the 2 types of squint

Concomitant - Imbalance in extraocular muscles paralytic squint - paralysis of extraocular muscles

SQUINT | Name 1 causes of a concomitant squint and how is it managed

refractive error correct with glasses

SQUINT | Name 1 cause of a paralytic squint

motor nerve palsy Intracranial palsy

SQUINT | What 2 tests are used in squints

detect - corneal light nature - cover test

SQUINT | What must be checked in an infant with a squint

red reflexes

SQUINT | What is the criteria for ophthalmology review in a child

divergent squint paralytic squint squint persistent beyond 3m

SQUINT | What is the rule of thumb for lenses

long sight - convex Hypermetropia short sight - concave Myopia

SQUINT | What is amblyopia

Reduction of visual acuity in an eye that has not received a clear image Usually unilateral

SQUINT | Name 3 causes of amblyopia

squint refractive errors cataracts

SQUINT | What is the management of amblyopia

patching of good eye early treatment before 7

Paediatric - ENT Flashcards

(67 cards)