Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

ENT > 2: Pharyngitis, Tonsillitis, Head and Neck Cancers > Flashcards

2: Pharyngitis, Tonsillitis, Head and Neck Cancers Flashcards

1
Q

What is pharyngitis

A

Inflammation of the pharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the viral causes of pharyngitis

A

EBV
Adenovirus
Influenza vira
Parainfluenza virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the bacterial causes of pharyngitis

A

Group A Streptococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In low income countries, what may cause pharyngitis

A

Diptheria

Measles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can cause pharyngitis in immunocompromised patients or those undergoing irradiation for cancer

A

Candida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What type of pharyngitis is more common in winter - spring

A

Bacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the bacterial causes of pharyngitis

A

Group A streptococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of pharyngitis is more common in summer-autumn

A

Viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the viral causes of pharyngitis

A

EBV

Adenovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How will pharyngitis present

A 
Sore throat 
Fever 
Pharyngeal exudate 
Cervical lymphadenopathy 
Rhinorrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is first-line for all cases of pharyngitis

A

Paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What criteria is used in pharyngitis

A

CENTOR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the centor criteria used for

A

To determine if pharyngitis is due to bacterial infection and hence individual should have antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outline the centor criteria

A

Individual needs >3/4 to be prescribed antibiotics:

(CENTor):
Cough absent

Exudate on tonsils

Nodes enlarged

Tender cervical lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is an alternative scoring system for pharyngitis/tonsillitis

A

Fever PAIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Explain fever pain criteria

A

(F-PAIN)

Fever in past 24h 
Pus on tonsils
Anterior lymphadenopathy 
Inflamed tonsils
No coryzal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does individual need on fever pain criteria to obtain antibiotics

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the indications for sending someone with pharyngitis to hospital

A
  • Systemic infections

- Local complications: quinsy, parapharyngeal abscess, cellulitis, lemierre syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What antibiotics are given first-line for pharyngitis

A

Phenoxymethylpenicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are 3 complications of group A streptococcus pharyngitis

A
  1. Post-streptococcal
    glomerulonephritis
  2. Rheumatic fever
  3. Scarlet fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define tonsillitis

A

Inflammation of palatine tonsils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When are viruses a more common cause of tonsillitis

A

<5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When are bacteria a more common cause of tonsillitis

A

5-15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are 2/3 tonsillitis caused by

A

Viruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the viral causes of tonsillitis
Adenovirus EBV Influenza Parainfluenza
26
What is the most common cause of bacterial tonsillitis
S. Pyogenes
27
What are 3 symptoms of tonsillitis
1. Odynophagia 2. Halitosis 3. Fever
28
What are 3 signs of tonsillitis
Erythematous Exudate Cervical lymphadenopathy
29
What criteria is used in tonsillitis to determine probability it is bacterial and hence needs antibiotics
Centor
30
What is first-line management for tonsillitis for all individuals
Analgesia
31
What scoring systems are used to determine if someone needs antibiotics in tonsillitis
Fever Pain | Centor
32
What does the centor criteria state
Cough absent Exudate Nodes tender T >38
33
What score is needed on centor criteria for antibiotics
>3
34
What is the fever pain criteria
``` Fever Pus Acute presentation - 3d Inflammation No coryzal symptoms ```
35
What score is needed on fever pain for antibiotics
>4
36
If an individual scores fever 2-3 what is recommended
Provide 'back-up' antibiotic prescription. Recommend they use it if symptoms do not resolve in 2-3d
37
What antibiotic is given in tonsillitis
Phenoxymethylpenicillin
38
What are the 6 indications for tonsillectomy
1. 7 episodes in 1y 2. 5 episodes in 2y 3. 3 episodes in 3y 4. Quinsy 5. Sleep apnea 6. Malignancy
39
What is a complication of bacterial tonsillitis
Quinsy
40
What is quinsy
Peri-tonsillar abscess
41
How can quinsy be identified
Deviation of the uvula
42
How is quinsy managed
I+D, metronidazole, amoxicillin
43
What is pharyngeal abscess
Infection spreads from tonsil to fascial planes
44
What is a retropharyngeal abscess
Abscess formation in paravertebral space
45
What is a parapharyngeal abscess
Abscess spreads posterolateral to nasopharynx
46
How will a pharyngeal abscess present
Reduced neck movement and pain
47
What is used to investigate a pharyngeal abscess
CT w/IV contrast
48
What are the indications for tonsillectomy
1. 7 episodes in 1-year (8) 2. 5 episodes in 2-years (7) 3. 3 episodes in 3-years (6) 4. Quinsy 5. Sleep apnea 6. Suspected malignancy
49
what is the time frame for immediate complications of tonsillectomy
<24h
50
what are 3 immediate complications
- Primary haemorrhage - Aspiration - Laryngospasm
51
what are 2 early complications.
- Secondary haemorrhage | - Airway obstruction due to oedema
52
when does secondary haemorrhage occur
Usually 5-10d
53
what causes secondary haemorrhage
Infection of the tonsillar fossa
54
what are the two delayed complications of tonsillectomy
Abscess | Nasopharyngeal stenosis
55
what is the term head and neck cancer used to refer to
Cancers of: - Nasophargyneal - Orophargyneal - Pharynx - Larynx - Salivary glands
56
where type of cancer are 90% of head and neck cancers
Squamous Cell Carcinoma
57
what are head and neck cancers collectively referred to as
Head and Neck Squamous Cell Carcinoma (HNSCC)
58
what are three pre-malignant conditions for HNSCC
Leucoplakia = white patches Erythroplakia = red patches Erythroleucoplakia = red and white patches
59
what is leukoplakia
White patches
60
what is erythroplakia
Red patches
61
what is erythroleukoplakia
Red and White Patches
62
what are pre-malignant conditions associated with
Smoking and alcohol consumption
63
what is the risk of pre-malignant condition transforming to malignancy
20%
64
in which gender are HNSCC more common
Male
65
why is incidence of oral cancer thought to be increasing
Increased immigration - with other countries chewing more betel quid
66
why is incidence of oropharyngeal cancer increasing
Associated with HPV in younger people
67
why is incidence of laryngeal cancer decreasing
Decrease smoking rates
68
What is strongly linked to oropharyngeal cancer
HPV16
69
What is linked to oral cancer
Betel Quid
70
What is linked to sinonasal cancer
wood dust exposure
71
What is linked to nasopharyngeal cancer
EBV
72
What is a hoarse voice
Weak or altered voice
73
What is the most common cause of hoarse voice
Laryngitis
74
What are the 4 categories for dividing the aetiology of hoarse voice
1. Benign 2. Malignant 3. Infective 4. Neurological
75
What are the 6 benign causes of hoarse voice
1. Vocal cord nodules 2. Vocal cord papilloma 3. Muscle tension dysphonia 4. Vocal cord polyps 5. Laryngeal papilloma 6. Reflux laryngitis 7. Reinke's Oedema
76
What causes vocal cord nodules
Chronic vocal cord abuse
77
How do vocal cord nodules present clinically
Husky variable voice
78
How do vocal cord nodules present on the vocal cords
Bilateral. | Commonly located between anterior and middle third of the vocal cords
79
How are vocal cord nodules managed
SALT
80
What causes progressive muscle tension dysphonia
Habitual mis-use of larynx
81
How does muscle tension dysphonia present clinically
Hoarse voice worse towards end of the day
82
How is muscle tension dysphonia managed
SALT
83
How do vocal cord polyps present on the vocal cords
Unilateral, Benign
84
What is the difference in presentation between vocal cord polyps and vocal cord nodules
Vocal cord polyp = unilateral Vocal cord nodules = bilateral
85
How are vocal cord polyps managed and why
Surgical excision to exclude cancer
86
What is laryngeal papilloma
Benign lesions caused by HPV
87
What is the problem with laryngeal papilloma
Can grow to cause airway obstruction
88
How are laryngeal papilloma's managed
Regular surgical debunking
89
What is reflux laryngitis
GORD - cause hoarse voice
90
What is Reinke's oedema
Inflammation of the vocal cords
91
What is the stereotypical presentation for Reinke's oedema
Female, Smoker
92
What are two risk factors for Reinke's oedema
Hypothyroidism | Elderly
93
How is Reinke's oedema managed
Smoking cessation | Voice therapy
94
What are the two infective causes of hoarse voice
Laryngitis | Acute epiglottis
95
What is a malignant cause of hoarse voice
Laryngeal Cancer
96
How will hoarse voice in laryngeal cancer present
Progressive hoarse voice
97
What is a neurological cause of hoarse voice
Recurrent laryngeal nerve palsy
98
What muscles of the larynx does the recurrent laryngeal nerve innervate
All intrinsic muscles of the larynx except the cricothyroid
99
What are the symptoms of recurrent laryngeal nerve palsy
- Bovine cough - Exertional Dyspnoea - Aspiration
100
Why do individuals with recurrent laryngeal nerve palsy get exertion dyspnoea
At rest the other vocal cord (if intact recurrent laryngeal nerve) can compensate by abducting to let air through. On exertion, not enough air can pass
101
What is bovine cough
Non-explosive cough when one of vocal cords cannot close
102
What causes majority of recurrent laryngeal nerve palsies
Cancer (30%) - larynx, thyroid, oesophagus, hypo pharynx
103
What is the second most-common cause of recurrent laryngeal nervepalsy
Iatrogenic (25%)
104
What 3 iatrogenic procedures can cause recurrent laryngeal nerve palsy
Parathyroidectomy Thyroidectomy Oesophageal pouch surgery
105
What CNS causes of recurrent laryngeal nerve palsy
MS Polio
106
What are 3 other causes of recurrent laryngeal nerve palsy
TB Aortic aneurysm Idiopathic (post-viral neuropathy)
107
If someone has symptoms of recurrent laryngeal nerve palsy, with no recent history of surgery, what is first-line investigation
CXR
108
If CXR is negative, what three investigations should be ordered
1. CT Chest 2. US Thyroid 3. OGD
109
Who should be investigated with hoarseness of voice
Any smoker with hoarseness for more than 3W should be investigated as this is the chief and only presenting symptom of laryngeal cancer
110
What is first-line investigation for laryngeal carcinoma
Flexible nasoendoscopy
111
What does flexible nasoendoscopy enable visualisation of
Vocal cords and larynx
112
What is second-line investigation for laryngeal cancer
Microlaryngotracheobronchoscopy
113
What does microlaryngealbronchoscopy enable visualisation of
Visualisation vocal cords, larynx and bronchioles
114
Where is microlaryngobronchoscopy performed
In theatres - as it needs GA
115
What is stroboscopy
Enables visualisation of function of vocal cords
116
What enables voice
Abduction and adduction of vocal cords innervated by recurrent laryngeal and superior laryngeal nerves
117
What is the most common head and neck cancer
Laryngeal cancer
118
What is laryngeal cancer
SCC of the larynx
119
In which age does laryngeal cancer occur
Elderly
120
If laryngeal cancer occurs young patients what is it associated with
HPV
121
What are 3 risk factors for laryngeal cancer
Smoking Alcohol Irradiation to head + neck
122
How does laryngeal cancer present clinically
- Progressive hoarseness - Dysphagia - Cough - Referred Otalgia - Stridor = late sign
123
When will laryngeal cancer cause hoarse voice
If in glotting or on vocal cords
124
How is the larynx divided
Supraglottis Glottis Subglottis
125
When should a patient be referred in 2W pathway for laryngeal cancer
Unexplained neck lump | Hoarse voice
126
What is first-line investigation for laryngeal cancer
Laryngoscopy and biopsy
127
What is second-line investigation for laryngeal cancer
CXR
128
What is third-line investigation for laryngeal cancer
CT Chest
129
What is fourth-line investigation for laryngeal cancer
MRI Neck
130
What is CT chest used to investigate for
Lung metastses
131
What is MRI neck used to look for
Erosion thyroid cartilage and enlarged lymph nodes
132
How are small tumours (T1,T2) of the supra glottis managed
Resection via trans-oral microsurgery with neck dissection.
133
How are large tumours (T3,T4) of the supra glottis managed
Laryngectomy with chemoradiotherapy
134
How are small tumours of the glottis (T1, T2) managed
Resection via trans-oral microsurgery with neck dissection.
135
How are large tumours of the glottis (T4) managed
Laryngectomy with chemoradiotherapy and neck dissection
136
How are small tumours of the subglottis (T1, T2) managed
Resection via trans-oral microsurgery with neck dissection.
137
How are large tumours of the subglottis (T4) managed
Laryngectomy with chemoradiotherapy and neck dissection
138
Explain laryngectomy
Removal of the larynx. The trachea is then brought out to the skin to enable voice. The pharynx is attached to the oesophagus.
139
What are the two methods of voice restoration following laryngectomy
- Trans-oesophageal puncture | - Artificial larynx
140
Explain trans-oesophageal puncture
One-way prosthesis is inserted between the trachea and oesophageal/larynx segment. When patient occludes their stoma and breathes out, this prosthesis vibrates enabling speech.
141
What is used of a trans-oesephageal puncture cannot be used
Artificial larynx (Servox)
142
What is a servox
Vibrating larynx is placed against patients stoma - this enables vibration of pharynx to produce speech.
143
Which laryngeal cancer patients have a better prognosis and why
Those with glottis tumours, as they present with hoarse voice earlier. Glottis also has poor lymphatic drainage preventing metastases.
144
What are two complications of radiotherapy to the head and neck
Mucositis | Xerostomia
145
What is oropharyngeal cancer
SCC of the oropharynx
146
In which gender is oropharyngeal cancer more common
Male (4:1)
147
Why is incidence of oropharyngeal cancer increasing in young people
Due to HPV
148
What is a main risk factor for oropharyngeal cancer
HPV16
149
What head and neck cancers is HPV16 associated with
Tongue Tonsil Oropharynx
150
What are two risk factors for oropharyngeal cancers
Pipe smoking | Chewing tobacco
151
What are the clinical signs of oropharyngeal cancer
``` Odynophagia Dysphagia Stertor Referred otalgia Enlarged cervical lymph nodes ```
152
If there is a neck lump what should be performed
FNA | Core biopsy
153
What is used to grade oropharyngeal cancer
Panendoscopy and biopsy
154
What is a panendoscopy
``` Investigation of upper aerodigestive tract: Larynx Pharynx Trachea Oeseophagus ```
155
What is a CT Chest used for
Staging
156
What is an MRI neck used for
Staging
157
How are small oropharyngeal cancers managed
Surgical resection with neck dissection and radiotherapy
158
How are large oropharyngeal cancers managed
Chemoradiotherapy
159
What is nasopharyngeal cancer
SCC of the nasopharynx
160
What is the peak age for nasopharyngeal cancer
40-60
161
What ethnicity is nasopharyngeal cancer more common
China | Mediterranean
162
What is the syndrome classical for nasopharyngeal cancer
Trotter's syndrome
163
What is trotter's syndrome
1. Unilateral conductive deafness 2. Unilateral trigeminal neuralgia 3. Impaired mobility of the soft-palate
164
What causes unilateral conductive deafness in nasopharyngeal cancer
Due to obstruction of the Eustachian tube results in effusion of the middle ear
165
What causes trigeminal neuralgia in nasopharyngeal cancer
Peri-neural invasion
166
What is the most common symptom of nasopharyngeal cancer
Enlarged painless cervical lymphandeopathy
167
What are 3 other nasal symptoms of nasopharyngeal cancer
Bleeding Obstruction Discharge
168
What investigations are used for nasopharyngeal cancer
Nasoendoscopy MRI Neck US-guided FNA of lymph nodes
169
What is used to manage nasopharyngeal cancer
Chemoradiotherapy and surgical neck dissection
170
What is hypo pharyngeal cancer
SCC of the hypo pharynx
171
How common is hypo pharyngeal cancer
Rare
172
Why do hypo pharyngeal cancers often present at a late stage
Due to rich lymphatic drainage of the hypopharynx
173
How will hypo-pharyngeal cancers present
- Lump in the throat which may cause dysphagia and odynophagia - Referred otalgia - Hoarse voice
174
What is a pre-malignant condition of hypo pharyngeal cancer
Leucoplakia | Plummer-vinson
175
How are hypo pharyngeal cancers investigated
Panendoscopy | CT Head and Neck
176
What are oral cancers
SCC of oral mucosa, salivary glands or tonsils
177
What are 4 risk factors for oral cancer
1. HPV16 2. Chewing betel quid 3. Pre-malignant lesions (erythroplakia, leukoplakia or erythroleukoplakia) 4. Smoking
178
How may oral cancers present clinically
- Painless mass - Bleeding - Jaw swelling - Referred otalgia - Enlarged lymph nodes - Pre-malignant conditions
179
What are 4 reasons to refer someone under 2W pathway for oral cancer
1. Persistent non-healing oral ulcer for more than 3W 2. Oral lump 3. Unexplained neck swelling 4. Erythroplakia or erythroleukoplakia
180
What four-investigations are ordered for oral cancer
1. Biopsy 2. Panendoscopy 3. CT head and neck 4. MRI head and neck
181
Why is MRI ordered as well as CT
As MRI is superior for assessing oral and oropharyngeal cancers
182
How are T1-T2 oral tumours managed
WLE | Neck dissection
183
How are T3-T4 oral tumours managed
Surgical excision - w/flap Neck dissection Chemoradiotherapy
184
How are metastatic tumours managed in oral cancer
Cetuximab
185
What are two causes of parotid carcinoma
HPV | Previous irradiation
186
How will parotid carcinoma present
Painless swelling | Facial paralysis - if infiltrates facial nerve
187
What is used to diagnose parotid carcinoma
US-guided FNA | CT neck and chest
188
How is parotid carcinoma removed
Parotidectomy, neck dissection and radiotherapy
189
What is an early complication of parotidectomy
Facial paralysis
190
What are two syndromes that are complications of parotidectomy
Frey Syndrome | Crocodile tears
191
What is Frey Syndrome
Where gustatory stimuli cause facial flushing and sweating
192
What are crocodile tears
Gustatory stimuli cause lacrimation

ENT (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions