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Yr3 - GP > Paediatrics + ENT > Flashcards

Paediatrics + ENT Flashcards

(175 cards)

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1
Q

1 month milestones

A
  • lift head
  • track with eyes
  • coo
  • recognise parents
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2
Q

6 month milestones

A
  • sit up
  • raking grasp
  • babbles
  • stranger anxiety
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3
Q

12 month milestones

A
  • walk
  • 2 finger pincer grasp
  • mama/dada
  • imitate parent
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4
Q

9 month milestones

A
  • walk with assistance
  • 3 finger grasp
  • wave bye-bye/patacake
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5
Q

2 year milestones

A
  • climb 2 steps
  • 2 word phrases
  • 2 step commands
  • stack 6 blocks
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6
Q

3 year milestones

A
  • tricycle
  • 2 word sentences
  • brush teeth
  • draw circle
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7
Q

4 year milestones

A
  • hop
  • copy cross
  • play with kids
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8
Q

Management of child with non-serious fever

A

Keep cool
Give fluids - continue breast feeding
Paracetamol or ibuprofen - whichever is effective
Keep away from school/nursery
Give parents clear advice about deterioration

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9
Q

Indications for referral of febrile child

A

<3 months - temp > 38

> 3 months - temp > 39.9

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10
Q

Early signs of meningococcal disease

A

Infants - non-specific signs such as drowsiness, lethargy or poor feeding
Cold hands and feet
Skin changes
Leg pains

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11
Q

Features of meningococcal disease

A 
Purpuric rash
Neck stiffness
Lethargy
Postitive Kernig's sing
Vomiting
Headache
Photophobia
Altered consciousness
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12
Q

Features of UTI

A

Non-specific symptoms

  • unexplained fever
  • recurrent fevers
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13
Q

Risk factors for UTI

A 
Congenital
- vesicoureteric reflux
- posterior urethral valve
Spinal lesions
Constipation
Poor hygiene
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14
Q

Differential diagnosis of UTI

A

Vulval irritation
Balanitis
Threadworms
Sexual abuse

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15
Q

Management of UTI

A

Urine dipstick
Refer if less than 3 months or any red flag symptoms
Antibiotics - nitrofurantoin

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16
Q

Red flags for a febrile child

A 
Colour
- pale/ashen/mottled/blue
Activity
- no response to social cues
- appears ill
- weak high-pitched or continuous cry
- unable to rouse
Resp
- grunting
- tachypnoea
- RR > 60
- chest indrawing
Hydration
- reduced skin tugor
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17
Q

Other red flag symptoms for a febrile child

A 
Fever > 38 if 0-3 mnths
Fever > 39.9 if 3-6 mnths
Non-blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Focal seizures
Bile stained vomiting
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18
Q

Causes of cough

A 
Acute
- URTI
- croup
- pneumonia
- pertussis
Chronic
- post-bronchiolitis or pertussis
- aspiration of feed
- GORD
Recurrent
- asthma
- cystic fibrosis
- bronchiectasis
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19
Q

Causes of stridor

A 
Acute
- croup - 6mnths to 6 yr
- epiglottitis - 1-6yrs
- acute allergic reaction
Chronic
- congenital
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20
Q

Causes of wheeze

A 
RTI
Atopic asthma
Croup
GORD
Inhaled foreign body
Heart failure
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21
Q

Define stidor

A

Noise that occurs on inspiration due to parital upper airway obstruction

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22
Q

Define croup

A

Laryngo-tracheal infection usually caused by parainfluenza virus
More common in winter
Starts with URTI then barking cough and stridor develop later

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23
Q

Management of croup

A

Most managed at home

  • keep calm and reassure
  • sit child upright
  • dexamethasone and nebulised steriods reduce severity
  • inhaling steam not shown any benefit
  • do not give cough mixtures - cause drowsiness
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24
Q

When should a child with croup be refereed to hospital

A

Refer to hospital if

  • ill child with cyanotic spells
  • respiratory distress, feeding difficulties or dehydration
  • suspect epiglottis
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25
Features of epiglottis
Rare since haemophilus influenzae type B immunisation Medical emergency Rapid onset - over few hours Child ill with soft stridor, lean foward, drooling because of extreme difficulty swallowing
26
Define bronchiolitis
Caused by respiratory syncytial virus (RSV) | Occurs mainly in winter in babies under 12 months
27
Features of bronchiolitis
Cough and URTI Later respiratory symptoms develop and breathing difficulties Chest hyper-inflation with widespread wheeze and fine crackles
28
Describe asthma
Inflammatory disease of the airways with reversible outflow obstruction Associated with bronchial hyperresponsiveness
29
Clinical features of asthma
``` Recurrent wheeze - worse at night/early morning - expiratory - high pitched Tightness of chest and breathlessness Recurrent cough - dry Trigger factors - URTI - pets - dust - cold - exercise Family history of atopy ```
30
Symptoms of acute severe asthma
Unable to complete sentences, altered consciousness PR > 120 if >5, > 140 if 2-5 RR > 30 if >5, >40 if 2-5 SpO2 < 92% Peak flow < 33-55% of best/predicted PEFR
31
Treatment of acute severe asthma
Beta-agonists - salbuatoml - up to 10 puffs Refer to hospital urgently if no improvement
32
Features of life-threatening asthma
``` Hypotension Confusion Exhaustion Poor respiratory effort/silent chest PF < 35% ```
33
Treatment of life-threatening asthma
Refer urgently to hospital | Give salbutamol and oxygen via facemask
34
Differential diagnosis of asthma
Cystic fibrosis Bronchopulmonary dysplasia Bronchiectasis
35
Management of chronic asthma
``` Monitor growth Peak flow and/or symptom diary Check inhaler technique and compliance Ask about attacks, use of inhaler and exercise-induced episodes Ask about sleep disturbances Choose inhaler suitable for child's age Consider allergen avoidance Advise about active/passive smoking and flu vaccination ```
36
Inhalers used for each age group
Dry powder inhaler = > 5 years Metered dose inhaler with facemask = infants Metered dose inhaler with spacer = < 5 years
37
Stepwise management of asthma in children
Step 1 - mild intermittent asthma - inhaled short-acting beta-agonist as needed Step 2 - regular preventer therapy - add inhaled corticosteriod - or leukotriene receptor antagonist if inhaled steroid cannot be used Step 3 - add on therapy - aged 2-5 = leukotriene receptor antagonist - aged < 2 = continue to step 4 Step 4 - persistent poor control - refer to respiratory paediatrician
38
Treatment for asthma exacerbations
Rescue course of prednisolone for 3-14 days
39
Features of constipation in an infant
``` < 3 stools per week Hard, large or rabbit-dropping stools Overflow soiling Distress on stooling or anal pain Bleeding associated with hard stool Straining Poor appetite or abdo pain that improves after stool has passed ```
40
Serious underlying causes of constipation in a child
``` Hirschsprung's disease Coeliac disease Hypothyroidism Anorectal abnormalities Neurological conditions Abdominal tumours ```
41
Reasons to refer for specialist assessment in a child with constipation
Delay in passing meconium or constipation since birth Abnormal appearance, postition or patency of anus Ribbon-like stool New leg weakness, deformity or neuromuscular signs Asymmetrical gluteal muscles, sacral naevus, sinus or pit Abdominal distension with vomiting or gross distension
42
Treatment of idiopathic constipation
Macrogol - adjust dose according to response Stimulant laxative Continue for several weeks once normal bowel habit achieved Advise balance diet and adequate fluid intake
43
Causes of acute diarrhoea in children
Infective gastrenteritis Food poisoning Diarrhoea associated with febrile illness - URTI, TUI
44
Causes of vomiting in infants
``` Overfeeding, posseting GORD Gasteroenteritis Pyloric stenosis Malrotation Intussusception Extra-abdominal causes of infection ```
45
Causes of vomiting in older children
``` Gasteroenteritis Viral illness Systemic infection Migraine Bulimia Raised intracranial pressure Pregnancy Drugs ```
46
Causes of chronic diarrhoea in children
``` Toddler diarrhoea Post-infective gasteroenteritis Parasites Overflow from constipation Malabsorption - UC, Crohn's, cystic fibrosis ```
47
Causes of acute abdominal pain
``` Surgical - appendicitis - Meckel's - intestinal obstruction - intussusception - strangulated hernias Medical - gasteroenteritis - UTI/pyelonephritis - tonsilitis - mesenteric adenitis - DKA - IBD Extra-abdominal - torsion of testis - ovarian cyst - ectopic pregnancy ```
48
Causes of recurrent abdominal pain
- functional - abdominal migraine - IBS - non-ulcer dyspepsia - IBD - coeliac disease - giardia Extra-abdominal - gynaecological - dysmenorrhoea, ovarian cyst, PID - psychosocial - referred pain from hip/spine - UTI - sickle cell disease
49
Refer to specialist for malabsorption if
Chronic diarrhoea Failure to thrive or weight loss Steatorrhoea Iron/other nutrient deficiency
50
Causes of malabsorption in children
``` Cow's milk intolerance - protein allergy or lactose intolerance Coeliac disease Cystic fibrosis Chronic infection - giardiasis IBD ```
51
Presentation of cow's milk allergy
``` GI symptoms - diarrhoea - occasionally with blood - constipation Skin - urticaria - eczema Other - wheeze - rhinitis - conjunctivitis ```
52
Treatment of cow's milk allergy
Elimination cows milk - replace with hydrolysed protein milk formula Amino acid formula Advise solids should be diary free Most grow out - challenged with foods containing milk from 12 months
53
Diagnosis of cow's milk allergy
Withdraw cow's milk | Skin prick/RAST tests - high false negatives and positive results
54
Presentation of lactose intolerance
``` Infancy - abdominal distension - diarrhoea - explosive and watery - vomiting - failure to thrive Childhood - milder abdo pain and distension - diarrhoea and vomiting ```
55
Features of anorectal atresia
Baby fails to pass meconium and no visible anus - often fistula to urethra or vagina Surgical treatment
56
Features of non-acute inguinal hernia
History of intermittent groin +/- scrotal swelling - spermatic cord may be thickened on affected side - refer for herniotomy
57
Features of acute inguinal hernia
Sudden appearance of an irreducible groin or scrotal swelling - emergency admission for reduction and repair
58
Features of diaphragmatic hernia
Bowel herniates into chest cavity - defect in one hemidiaphragm -> pulmonary hypoplasia in utero or lung compression postnatally
59
Features of febrile convulsions
Epileptic seizures provoked by fever in otherwise normal children - FH - brief and generalised
60
Causes of febrile convulsions
``` Viral infection Otitis media Tonsillitis UTI Gastroenteritis LRTI Meningitis Post-immunisation ```
61
Presentation of nappy rash
Glazed erythema in napkin area - sparing skinfolds Secondary bacterial or fungal infection is common
62
Differential diagnosis of nappy rash
Seborrhhoeic eczema Candidiasis Napkin psoriasis
63
Management of nappy rash
Advise parents to keep nappy area dry Give baby as much time as possible without nappy Apply moisturiser as soap substitute Apply barrier cream between nappy changes Topical treatment with antifungal combined with hydrocortisone if not clearing
64
Clinical features of acne vulgaris
``` Comedones - high density on face, chest and back Inflammatory lesions - papules and pustules - nodules or cysts Scaring Pigmentation Seborrhoea ```
65
Differential diagnosis for acne vulgaris
``` Rosacea Perioral dermatitis Folliculitis and boils Drug-induced acne Keratosis pilaris ```
66
Management of acne vulgaris
``` Advise - avoid overwashing skin - avoid picking/squeezing Topical retinoid - adapalene - contraindicated in pregnancy - with benzoyl peroxide Topical antibiotic - clindamycin Azeliac acid Macrolide antibiotics COOP in women ```
67
Red flags for serious pathology in acute childhood limp
Pain waking the child at night - malignancy Signs of redness, swelling or stiffness at joint/limb - infection or inflammatory joint disease Weight loss, anorexia, fever, night sweats or fatigue - malignancy, infection or inflammation Unexplained rash or bruising - haematological or inflammatory joint disease Limp and stiffness in morning - inflammatory joint disease Severe pain, anxiety and agitation after traumatic injury - compartment syndrome
68
Detection of headlice
Detection combing with fine toothed comb | - live louse must be found
69
Management of headlice
Physical, chemical or traditional insecticide
70
Postnatal visit includes
Rhesus status Hb on day 5 - if < 10g/dl iron supplements for 3 months Rubella status Temperature, pulse and bp - high BP associated with pre-eclampsia Fundus Pain Vaginal loss - red, brown then yellow - fresh bleeding is abnormal Mobilising Feeding Mental state
71
Postpartum contraception
Not needed till 21 days postpartum COC contraindicated if breastfeeding - inhibit lactation and enters breast milk POP - > 3 weeks to avoid risk of heavy bleeding Implants - > 6 wks to avoid heavy/irregular bleeding IUD/IUS - < 48hr post delivery Cap - 5-6wks Condoms Sterilization - best delayed for a few months
72
Mother's 6wk postnatal check
BP and weight - discuss control if overweight Abdominal examination - uterus not palpable Vaginal examination - only if problems with tears/episiotomy, persistent vaginal bleeding, pain or perform cervical smear Screen for depression Check Hb if anaemic postnataly Check rubella
73
Causes of postnatal breast soreness
``` Sore/cracked nipples - nipple shields Skin infection - usually due to candidia infeciton - treat mother and baby with miconazole oral gel Blocked duct - hard tender lump - express milk or massage Mastitis - tender, hot reddened area of breast +/- fever - flucloxacillin 500mg qds and NSAIDs - continue breastfeeding/express milk Breast abscess - admit for incision and drainage ```
74
Treatment of postnatal haemorrhoids
Local ice packs Topical preparations Resting lying on one side Keeping stools soft using a stool softener Wash haemorrhoids with cool water after opening bowels
75
Features of baby blues
``` Very common Women become tearful and low - within 1st 10d of delivery Be supportive - usually resolves ```
76
Features of postnatal depression
``` Common Peak 12wks after delivery Screen and 6-4wks and 3-4months During the past month have you - felt down, depressed or hopeless - little interest or pleasure in doing things ```
77
Risk factors for post natal depression
``` Depression during pregnancy Bad birth experience Social problems PMH or FMH Alcohol or drug abuse ```
78
Management of post-natal depression
Talk through problems - refer to health visitor Give information Check TFTs Referral for psychological therapies - CBT Antidepressant medication - Setraline Monitor progress
79
Features of infant 6wk check
``` Physical exam - congenital heart disease - developmental dysplasia of the hip - congenital cataract - undescended testes Review of development - feeding and weight gain - growth chart - vision and hearing screen - social development - smiling, coos, glugs and cries Health promotion - immunisations - breastfeeding - reduce risk of sudden infant death syndrome - dangers of passive smoking - car safety - dental heath ```
80
Define sudden infant death syndrome (SIDS)
Sudden and unexpected death of an infant under 1 year | - apparently occurring during sleep
81
Risk factors for SIDS
``` Maternal smoking Putting baby sleeping on back Falling asleep in the same bed as baby Overheating Bulking or loose items of bedding During breastfeeding ```
82
Signs and symptoms of otitis externa
``` Signs - ear canal/external ear red, swollen or eczematous - swelling in ear canal - discharge - inflammed eardrum Symptoms - itch - severe ear pain - pain worse when tragus or pinna moved - tenderness moving jaw - tender regional lymphadenitis ```
83
Signs and symptoms of chronic otitis externa
``` Signs - lack of earwax in external ear canal - dry hypertrophic skin - pain on manipulation of external ear canal/auricle Symptoms - constant itch in ear - mild discomfort - mild pain ```
84
Signs and symptoms of malignant otitis
``` Signs - granulation tissue at bone-cartilage junction of ear canal/ exposed bone in ear canal - facial nerve palsy - dropping of face on side of lesion - temp over 39 degrees Symptoms - pain and headache - vertigo - profound hearing loss ```
85
Differential diagnosis of otitis externa
Acute otitis media - otitis externa can be secondary to otorrhoea from otitis media Foreign body Impacted earwax - pain and deafness Cholesteatoma - eroding epithelial tissue in middle ear and mastoid with discharge in the ear canal Mastoiditis - very unwell, high temp, marked hearing loss Malignant otitis Neoplasm - swelling that bleeds easily Referred pain - spehnoidal sinus, teeth, neck Ramsay Hunt syndrome - herpes zoster affecting facial nerve, a/w facial paralysis and loss of taste Barotrauma - divers, air travel or blow to ear Skin conditions
86
Treatment of localised otitis externa
Pain - analgesic - paracetamol or ibuprofen - application of local heat - warm flannel Infection - antibacterial otic drops - only consider oral antibiotics for sever infection or high risk - cellulitis spread beyoud ear canal - systemic signs of infection - 7 day oral flucloxacillin or clarithromycin Drain pus if causing severe pain and swelling
87
Causes of acute diffuse otitis externa
Radiotherapy to ear, neck or head Previous ear surgery Previous topical treatments for otitis externa Atopic, allergic or irritant dermatitis Dermatoses Trauma to ear canal from cleaning, scratching or instrumentation Use of hearing aids or ear plugs Exposure to water or humid clinate Diabetes, immunosuppression and older age
88
When should a swab be taken from someone with otitis externa
Treatment fails Recurrent or chronic Topical treatment cannot be delivered effectively Infection spread beyond external auditory canal Condition severe enough to require oral antibiotics
89
Management of chronic otitis externa
``` Fungal infection suspected - topical antifungal - clotrimazole 1% Irritant cause or allergic dermatitis - avoid contact with irritant - topical corticosteriod Seborrhoeic dermatitis - topical antifungal and cortiosteriod combination ```
90
Symptoms of acute otitis media
``` Sudden onset earache In younger children - holding, tugging or rubbing ear - fever - crying - poor feeding, behavioural change ```
91
Otoscopic features of acute otitis media
Red, yellow or cloudy tympanic membrane Moderate to severe bulge of tympanic membrane Perforation of tympanic membrane
92
Differential diagnosis of acute otitis media
Otitis media with effusion - fluid in middle ear without symptoms/signs of infection - conductive hearing loss - effusion and bubbles visible with normal tympanic membrane Chronic suppurative otitis media - persistent inflammation and perforation of tympanic membrane with draining discharge for more than 2 weeks Myringitis - erythema and injection of tympanic membrane visible Eustachian tube dysfunction Mastoiditis Malignancy Referred pain
93
Who should be admitted with acute otitis media
``` Severe systemic infection Suspected complications - meningitis - mastoiditis - intracranial abscess - sinus thrombosis - facial nerve palsy Children under 3 months ```
94
Management of acute otitis media
Analgesia - regular paracetamol and ibuprofen No evidence of decongestants or antihistamines Antibiotic prescription - delayed - 5-7 day course amoxicillin / clarithromycin
95
Management of persistent acue otitis media
5-7 day course of co-amoxiclav | Refer if recurrent
96
Features of chronic suppurative otitis media
``` Ear discharge persisting for more than 2 weeks without ear pain or fever Hearing loss in affected ear History of - acute otitis media - ear trauma - grommet insert - allergy, atopy or URTI Tinnitus ```
97
Management of chronic suppurative otitis media
Do not swab ear | Refer for ENT assessment
98
Define chronic suppurative otitis media
Chronic inflammation of the middle ear and mastoid cavity | -> perforation of tympanic membrane
99
Define otitis media with effusion
Glue ear | Collection of fluid within the middle ear space without signs of acute inflammation
100
Features of otitis media with effusion
Hearing loss Mild intermittent ear pain with fullness or popping Aural discharge Recurrent ear infections, UTRI or frequent nasal obstruction
101
Otoscopic features of otitis media with effusion
``` No signs of inflammation or discharge Serous, mucoid or purulent effusion - abnormal colour of drum - loss of light reflex - opacification of drum - air bubbles or air/fluid level - retracted, concave or indrawn drum ```
102
Management of otitis media with effusion
Active observation for 6-12 weeks as spontaneous resolution common Refer to ENT
103
Define benign paroxysmal positional vertigo
Disorder of the inner ear characterised by repeated episodes of positional vertigo - symptoms occur with changes in position of the head
104
Causes of benign paroxysmal positional vertigo
Loose calcium carbonate debris in semi-circular canals of the ear
105
Complications of benign paroxysmal positional vertigo
Falls - particularly in older people Difficulty performing daily activities Adverse effects on quality of life Increased likelihood of depression
106
Management of benign paroxysmal positional vertigo
Most recover over several weeks Repositioning manoeuvre - Epley Get out of bed slowly Do not drive whilst feeling dizzy
107
Define Meniere's disease
Clinical syndrome characterised by episodes of vertigo, fluctuating hearing loss, tinnitus and feeling of fullness in ear
108
Risk factors for Meniere's disease
``` Autoimmunity Genetic susceptibility Metabolic disturbances Vascular factors Viral infection Head trauma ```
109
Complications of Meniere's disease
Falls Psychological effects Social activities
110
Features of benign paroxysmal positional vertigo
Symptoms brought on by specifics movements - N+V Hearing loss and tinnitus not associated
111
Features of Meniere's disease
Vertigo - spontaneous episodes 20mins-12hrs Fluctuating hearing, tinnitus and perception of aural fullness Hearing loss - sensioneural
112
Differential diagnosis of Meniere's disease
``` Tumours - acoustic neuroma MS Perilymph fistula Vascular events - TIA Migrane Benign paroxysmal positional vertigo Vestibular neuronitis Acute labyrinthitis ```
113
Management of Meniere's disease
Admit those with severe symptoms | Refer to ENT to confirm diagnosis
114
Define tinnitus
Perception of sound in absence of sound from external environment
115
Diseases associated with tinnitus
``` Age-related hearing loss Noise-induced hearing loss Meniere's disease Impacted wax Ototoxic drugs - loop diuretics - aspirin and NSAIDs - antimalarials - tetracyclines - macrolide antibiotics - aminoglycoside antibiotics Ear infections - otitis media - otitis externa Neurological disorders - acoustic neuroma - MS Metabolic disorders - thyroid disorders - DM Psychological disorders - anxiety - depression Mechanical disorders - head trauma - TMJ disorders ```
116
Complications of tinnitus
``` Impaired concentration Interference with daily activities Loneliness, withdrawal and social isolation Sleep disturbance Anxiety Depression Suicide ```
117
Management of tinnitus
``` May resolve by herself Treat underlying cause Review medication Discuss sound therapy Psychological therapy ```
118
Refer those with tinnitus urgently if
Refer immediately if - high risk of suicide - crisis mental health management - significant neurological symptoms - acute uncontrolled vestibular symptoms - suspected stroke - sudden onset pulsatile tinnitus - tinnitus secondary to head trauma
119
Define vertigo
Symptom | False sensation of movement of person or their surroundings in absence of physical movement
120
Causes of vertigo
``` Peripheral - benign paroxysmal positional vertigo - vestibular neuronitis - labyrinthitis - Meniere's disease - vestibular ototoxicity Central - migraine - stroke or TIA ```
121
Management of central vertigo
Admit urgently or refer to balance specialist Consider symptomatic drug treatment - N+V = cyclizine
122
Management of peripheral vertigo
``` Admit urgently if - severe N+V - sudden onset - in seconds - central neurological symptoms - acute deafness Refer to balance specialist ```
123
Define vestibular neuronitis (acute labrynthitis)
Disorder characterised by acute, isolated, spontaneous and prolonged vertigo of peripheral origin Inflammation of vestibular nerve - post viral infection
124
Define labyrinthitis
Inflammation of the labyrinths | - hearing loss
125
Complications of vestibular neuronitis
Benign paroxysmal positional vertigo Phobic postural vertigo Adverse effects of QoL Increased fall risk
126
Features of vestibular neuronitis
``` Rotational vertigo Nausea Balance affected Hearing loss and tinnitus not features No focal neurology ```
127
Management of vestibular neuronitis
``` Reassure will settle over several weeks Best rest maybe necessary Do not drive whilst dizzy If symptoms severe offer short term symptomatic drug treatment - N+V = cyclizine ```
128
Define sinusitis
Symptomatic inflammation of paranasal sinuses Acute - resolves within 12 wks Recurrent acute - four or more annual episodes without persistent symptoms Chronic sinusitis
129
Causes of acute sinusitis
``` URTI - viral -> bacterial Associated with - asthma - allergic rhinitis - smoking - anatomical variation or mechanical obstruction - seasonal variation - impaired ciliary motility - cystic fibrosis ```
130
Causes of chronic sinusitis
``` Atopy Asthma Ciliary impairment Aspirin sensitivity Immunocompromise Genetic factors Cigarette smoking Iatrogenic factors ```
131
Complications of acute sinusitis
``` Orbital complications - orbital cellulitis - orbital abscess - cavernous sinus thrombosis Intracranial - meningitis - encephalitis - abscess - venous thrombosis Bony - osteomyelitis Progression to chronic sinusitis ```
132
Complications of chronic sinusitis
``` Extra-sinus symptoms - sleep problems - fatigue - depression Impact on employment Reduction in social functioning High healthcare usage ```
133
Features of acute sinusitis
Usually follows common cold Increase in symptoms after 5 days - nasal blockage or nasal discharge Less than 12 wks
134
Refer those with acute sinusitis if
Severe systemic infection Intraorbital or periorbital complications Intracranial complications
135
Management of acute sinusitis
``` Symptoms less than 10 days - do not offer antibiotic prescription - advise usually causes by virus - takes 2-3 wks to resolve Symptoms more than 10 days - high-dose nasal corticosteroid Antibiotics unlikely to improve symptoms ```
136
Management of chronic sinusitis
``` Inform may last several months Advise to - avoid allergic triggers - stop smoking - practise good dental hygiene Nasal irrigation with saline solution Intranasal corticosteriods ```
137
Categories of hearing loss
Conductive - due to abnormalities of outer and middle ear Sensorineural - abnormalities of the cochlea, auditory nerve or other structures in neural pathway Mixed
138
Causes of conductive hearing loss
``` Impacted ear wax Foreign bodies Tympanic membrane perforation Infection - otitis externa, otitis media Cholesteatoma Middle ear effusion Otosclerosis - abnormal bone growth affecting small bones of ear Neoplasm Exostoses - hard bony growths in ear canal ```
139
Causes of sensorineural hearing loss
``` Age related Noise exposure - temporary or permanent Sudden sensorineural hearing loss Meniere's disease Exposure to ototoxic substances Labyrinthitis Vestibular schwannoma Neurological conditions Malignancy Trauma to head Systemic infections Autoimmune conditions Hereditary conditions ```
140
Investigations for BPPV
Dix-Hallpike manoeuvre | Supine lateral head turns
141
Management of BPPV
Patient education + reassurance 3 position particle repositioning manoeuvre Vestibular suppressant medication
142
Define allergic rhinitis
Inflammatory condition of the upper respiratory tract | Characterised by nasal pruritis, sneezing, rhinorrhoea and nasal congestion
143
Risk factors for allergic rhinitis
``` Family history of atophy Age < 20 Positive allergen skin-prick tests Inadequate exposure to animals or other micro-organism-rich environments in early life Western lifestyle Ethnicity Environmental pollen Heavy maternal smoking Breastfeeding ```
144
Investigations of allergic rhinitis
Therapeutic trial of antihistamine or intranasal corticosteriod
145
Management of allergic rhinitis
Oral antihistamine plus allergen avoidance
146
Risk factors for otitis externa
``` External auditory canal obstruction High environmental humidity Warmer environmental temperatures Swimming Local trauma Allergy Skin disease Diabetes Immunocompromised ```
147
Risk factors for acute otitis media
``` Day care attendance Older siblings Younger age FH Absence of breastfeeding Supe feedings Lower socioeconomic status Craniofacial anomaly Male sex Dummy use ```
148
What is cholesteatoma
Accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid - may enlarge and invade adjacent bone
149
Diagnostic factors of cholesteatoma
``` Hearing loss Ear discharge resistant to antibiotic therapy Attic crust in retraction pocket White mass behind intact tympanic membrane Tinnitus Otalgia Altered taste Dizziness Facial nerve weakness ```
150
Risk factors for cholesteatoma
``` Middle ear disease Eustachian tube dysfunction Otological surgery Traumatic blast injury to ear FH Congential anomalies ```
151
Investigations for cholesteatoma
Otoscopy Pure tone audiogram CT scan of petrous temporal bone
152
Management of cholesteatoma
Surgery Preoperative topical antibiotics + aural care Second-look surgery or MRI
153
History of noise-related hearing loss
``` Gradual hearing loss Working in noisy environment Use of power tools Use of motorcycles Shooting hobby Difficulty hearing speech in loud environments Occasional ringing in ears ```
154
Investigations for noise-related hearing loss
Audiometry - bilateral sensorineural hearing loss in high frequencies
155
History of age-related hearing impairment
Slow, gradual hearing loss - usually bilateral
156
Investigations for age-related hearing impairment
Audiometry - bilateral sensoineural hearing loss - usually high frequency
157
Define mastoiditis
Inflammation of mastoid air cells - bacterial otitis media can spread Responds well to parental antibiotics
158
History of congenital hearing loss
Parents have normal hearing (autosomal-recessive disorder) Present at birth or develops later in childhood - may fluctuate in severity Normal otoscopy and and auditory brainstem response testing
159
Define nasal polyp
Benign swellings of mucosal lining of paranasal sinuses
160
Diagnositc features of nasal polyps
``` Nasal obstruction Nasal discharge Facial pain/pressure Direct visualisation Reduced sense of smell Cough ```
161
Risk factors for nasal polyps
Asthma Aspirin sensitivity Genetic predisposition
162
Investigations for nasal polyps
Anterior rhinoscopy | Nasal endoscopy
163
Management of nasal polyps
Intranasal corticosteriods Nasal saline irrigation Doxycycline Surgical polypectomy
164
Define Mongolian Spots
Grey-blue patches on back, bottom or legs - bruise like Harmless
165
Define Erythema Toxicum
Common within 2-3 days after birth Red and raised rash on face, arms and legs Not warm to touch Will self-resolve in a few days
166
Treatment of headlice
``` Wet combing cold standard - wash hair - apply lots of condition - comb from roots to end - days 1, 5, 9 and 13 Medicated lotions and sprays ```
167
Define colic
Baby cries a lot but with no obvious cause | Cry more than 3 hours a day, 3 days a week for at least a week
168
Management of colic
``` Hold/cuddle baby Sit baby upright when feeding to stop swallowing air Wind after feeds Rock baby over shoulder Bath baby in warm water ```
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Presentation of measles
Erythamatous partially confluent rash Begins behind ears Coplic spots - white lesions in mouth
170
Presentation of Scarlet Fever
Fine partially confluent maculopapular rash Begins on neck Most prounced in underarm and groin areas Non-blanching petechiae Red face with perioral pallor Bright red toungue colour with enlarged papillae
171
Presentation of rubella
Non confluent, pink, maculopapular rash | Begins behind ears
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Presentation of erythema infectiosum
``` Fifth disease Do no necessarily develop rash - red papules on extremities and trunk - develop to lace-like reticular appearance - blotchy red rash on cheek ```
173
Presentation of Roseola infantum
Patchy, rose pink Usually most pronounced on torsum 3 days high fever
174
Presentation of chicken pox
Widespread rash affecting entire body - including scalp and oral mucosa Begins as small red bumps that develop into fluid-filled blisters/pustules - eventually forms scabs
175
Normal gait variations in children
Toe walking - up to 3 years In-toe walking due to persisting femoral antevresion - 3-8 years Internal tibial torsion - knees point forward but feed point in Metatarsus adductus = flexible C-shaped lateral border of foot - up to 6 years Bow legs - birth to early toddler-hood Knock-knees - up to 7 years Flat feet common Crooked toes - resolve with weight bearing

Yr3 - GP (8 decks)

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