Respiratory - ENT

Question 1

What are the clinical features of epiglottits?

Answer 1

• high fever, very ill, toxic looking child - an intensely painful throat that prevents child from speaking or swallowing, saliva drools down the chin- soft inspiratory stridor and rapidly increasing respiratory difficulty over hours - the child is sitting immobile, upright, with an open mouth to optimise the airway

Question 2

What are the causes of upper airway obstruction?

Answer 2

viral laryngotracheobronchitis - croup - COMMON RARE causes:epiglottitis bacterial tracheitis laryngeal or oesophageal foreign body allergic laryngeal angioedema etc.

Question 3

How can you differentiate between the other causes of airway obstruction and epiglottitis?

Answer 3

Croup Epiglottitis Onset over days over hoursPreceding coryza yes no Cough severe, barking absent or slight Able to drink yes noDrooling saliva no yesAppearance unwell toxic, very ill Fever <38.5 >38.5Stridor harsh rasping soft whisperingVoice, cry hoarse muffled, reluctant to speak

Question 4

How does acute otitis media present?

Answer 4

ear pain and fever

Question 5

How does acute otitis media appear on examination?

Answer 5

examine tympanic membrane - acute OM = bright red and buldging - pus in external canal if perforated

Question 6

How is acute otitis media treated?

Answer 6

• simple analgesia - most resolve spontaneously - Abx shorten pain duration but don’t reduce risk of hearing loss - amoxicillin

Question 7

What organism commonly causes otitis media?

Answer 7

virus - RSV, rhinovirusbacteria - pneumococcus, H.influenza common at 6-12 months

Question 8

How does otitis media with effusion present? (glue ear)

Answer 8

possible decreased hearing asymptomatic

Question 9

What is seen on examination in patients with otitis media with effusion?

Answer 9

ear drum is dull and retracted may see a visible fluid level flat trace on tympanometry

Question 10

How is otitis media with effusion treated?

Answer 10

Grommets no effective medical treatment adenoidectomy may be helpful if recurrent OME with hearing loss, obstructive sleep apnoea

Question 11

When is otitis media common?How does it effect these children?

Answer 11

2-7 year olds most common cause of conductive hearing loss in children this can lead to speech and learning difficulties if recurrent with hearing loss

Question 12

How does tonsillitis present?

Answer 12

inflammation of tonsils purulent exudate if bacterial may see headache, apathy, abdo pain, cervical lymphadenopathy and white exudate

Question 13

What investigations can be done if you suspect tonsillitis?

Answer 13

Culture

Question 14

How is tonsillitis managed?

Answer 14

ABx - penicillin, erythromycin avoid amoxicillin in glandular fever as causes rash

Question 15

What are the common pathogens causing tonsillitis?

Answer 15

group A B-haemolytic streptococcus, EBV (infective mononucleosis)

Question 16

When is a tonsillectomy considered?

Answer 16

quinsy (abscess) recurrent severe tonsillitis sleep apnoea

Question 17

What is pharyngitis?

Answer 17

Sore throat Pharynx and soft palate are inflamed usually viral could be group A B-haemolytic strep in older children

Question 18

How does sinusitis present?

Answer 18

Most commonly maxillary - may get secondary bacterial infection –> pain and swelling

Question 19

How is sinusitis treated?

Answer 19

ABx, analegesia topical decongestants

Question 20

What conditions are URTIs?

Answer 20

common cold (coryza) sore throat (pharyngitis, including tonsillitis) acute otitis media sinusitis (relatively uncommon) children often present with a combination

Question 21

How does the common cold (coryza) present?

Answer 21

clear or mucopurulent nasal discharge nasal blockage

Question 22

How is the common cold managed?

Answer 22

self limiting

Question 23

What organism commonly causes coryza?

Answer 23

rhinoviruscoronavirus RSV

Question 24

When is a child considered to have a fever?

Answer 24

> 38 degrees C

Question 25

How should a fever be treated?

Answer 25

should be assessed for an underlying cause paracetamol/ibuprofen should be used

Question 26

When is hospital admission required with an URTI?

Answer 26

rarely required but may be necessary if feeding and fluid intake is inadequate

Question 27

How does viral croup present?

Answer 27

barking cough stridor hoarseness may see fever and coryza before difficulty breathing symptoms are often worse at night

Question 28

How is viral croup investigated and treated?

Answer 28

look for oedema of subglottic area oral dexamethasone NEB steroids helpIf severe NEW epinephrine with oxygen

Question 29

What commonly causes viral croup? In what age group is it common?

Answer 29

95% of all laryngotracheal infections most likely parainfluenza peaks in 2 year olds admission threshold lowest in <12 months due to narrow airway

Question 30

How is epiglottitis managed?

Answer 30

urgent admission intubate cultures IV ABx - cefuroxime Prophylactic rifampicin for household contacts

Question 31

What organisms commonly causes epiglottitis?

Answer 31

H. influenza B Reduced by Hib vaccine - now rare NB if child cries will lose airway

Question 32

What are the clinical features of bacterial tracheitis?

Answer 32

high fever rapid airway obstruction thick airway secretions caused by staph aureus

Question 33

How is bacterial trracheitis managed?

Answer 33

IV ABx Intubation and ventilation if required

Question 34

Outline the basic management of acute upper airway obstruction?

Answer 34

- reduce anxiety - be calm and confident - observe for signs of hypoxia or deterioration - agitiation, fatigue, drowsiness - provide oxygen if required and tolerated- do not examine the throat with a spatula - oral, NEB or IV steroids are beneficial in croup - if severe administer NEB epinephrine and contact anaesthetist- tracheal intubation if respiratory failure develops

Question 35

What is the immediate danger with burns and smoke inhalation?How should this be managed?

Answer 35

check for airway burns - soot in nasal and oral cavities - cough, hoarseness, stridor - coughing up black sputum - difficulty breathing - scorched eyebrowns or hair early intubation important if evolving airway is swelling as may become impossible with progressive obstruction of the airway