Diseases of the throat

Question 1

who is commonly affected by acute throat infection

Answer 1

children (5-10)
young people (15-25)

Question 2

what is the common cause of acute throat infections

Answer 2

viral or bacteria:

• common cold
• influenza
• strep

Question 3

what are the symptoms of acute throat infections 

Answer 3

pain at the back of the mouth

physical irritation

Question 4

what is the treatment of acute throat infections

Answer 4

self-limiting

Question 5

if an acute throat infection + lethargy persists into a 2nd week what should you consider

Answer 5

mono/glandular fever

Question 6

what is the common cause of tonsillitis

Answer 6

strep pyogens (aka group A beta haemolytic strep)

Question 7

what is the Centor criteria

Answer 7

tonsillar exudate
tender anterior cervical lymph nodes
history of fever (>38)
absence of cough

Question 8

what is the modified centor criteria

Answer 8

tonsillar exudate 
tender anterior cervical lymph nodes 
history of fever (>38)
absence of cough 
<15 = + 1 point
>44 = -1 point

Question 9

what is the fever PAIN criteria

Answer 9

fever (In last 24hrs)
Purulence
Attend rapidly (getting worse)
Inflamed tonsils
No cough

Question 10

when would you treat tonsillitis with antibiotics

Answer 10

fever pain = 4 or above

centor = 2 or 3 after culture, 4 or above without culture

Question 11

what antibiotic is given in tonsillitis, for how long?

Answer 11

phenoxymethylpenicillin
clarithromycin if allergic

10 days

Question 12

what 3 criteria are used to determine the severity of tonsillitis

Answer 12

Centor
Modified Centor
Fever PAIN

Question 13

what are the complications of tonsillitis (3)

Answer 13

peritonsiliar abscess
rheumatic fever
glomerulonephritis

Question 14

what causes a peritonsiliar abscess

Answer 14

bacteria between the muscle and tonsil which produces pus

Question 15

when would a peritonsiliar abscess occur after tonsillitis

Answer 15

3-7 days

Question 16

what are the symptoms of a peritonsiliar abscess

Answer 16

unilateral throat pain and odynophagia
lockjaw
displacement of tonsils and uvula
loss of concavity of palate

Question 17

what is the treatment of a peritonsiliar abscess

Answer 17

drain + antibiotics

Question 18

when would rheumatic fever occur after tonsillitis

Answer 18

3 weeks

Question 19

what are the symptoms of rheumatic fever

Answer 19

fever
arthritis
pancreatitis

Question 20

when would glomerulonephritis occur after tonsillitis

Answer 20

1-3 weeks after

Question 21

what are the symptoms of glomerulonephritis

Answer 21

haematuria
albuminuria
oedema

Question 22

what is acute tonsillitis also known as

Answer 22

adenotonsilitis

Question 23

what is the cause of acute tonsillitis

Answer 23

usually viral:

• EBV
• rhinovirus
• influenza/parainfluenza
• enterovirus
• adenovirus

30% bacterial

Question 24

what is the treatment of acute tonsillitis

Answer 24

supportive

Question 25

what is the treatment of recurrent acute tonsillitis

Answer 25

surgery

Question 26

what are the symptoms of chronic tonsillitis

Answer 26

``` chronic sore throat bad breath tonsilliths peritonsillar erythema persistent cervical lymphadenopathy ```

Question 27

what is the treatment of chronic tonsillitis

Answer 27

surgery (rarely offered)

Question 28

what causes diphtheria

Answer 28

corynebaterium diphtheriae

Question 29

what does corynebaterium diphtheriae produce

Answer 29

an exotoxin which is cardio- and neuro-toxic

Question 30

what are the symptoms of diphtheria

Answer 30

severe sore throat | grey/white membrane across pharynx

Question 31

what is the treatment of diphtheria

Answer 31

vaccine antitoxin + supportive penicillin or erythromycin

Question 32

what type of vaccine is the diphtheria vaccine

Answer 32

toxoid vaccine

Question 33

what is infectious mononucleosis also known as

Answer 33

mono | glandular fever

Question 34

who is mainly affected by infectious mononucleosis

Answer 34

young adults

Question 35

what causes infectious mononucleosis

Answer 35

EBV

Question 36

what are the symptoms of infectious mononucleosis

Answer 36

``` fever enlarged lymph nodes sore throat/pharynigitis/tonsillitis tired jaundice/hepatitis palatal petechaiea haemorrhages = rash heptaosplenomegaly ```

Question 37

what are the investigations of infectious mononucleosis

Answer 37

EBV IgM = paul-bunell test/+ve monospot test (heterophile antibody test) LFTs FBC = low CRP, leucocytosis, atypical lymphocytes

Question 38

what is the treatment of infectious mononucleosis

Answer 38

self-limiting | severe + failing to improve = steroids

Question 39

why should ampicillin NOT be prescribed in infectious mononucleosis

Answer 39

generalised macular rash will develop

Question 40

what is the cause of candida

Answer 40

candida albicans

Question 41

who is at risk of candida

Answer 41

post-antibiotics immunosuppressed smokers inhaled steroids (asthma)

Question 42

what are the symptoms of candida

Answer 42

white patches on red, raw mucous membrane in mouth or throat pain

Question 43

when would you investigate candida

Answer 43

if recurrent

Question 44

what is the treatment of candida

Answer 44

1st line = nystatin | recurrent = fluconazole

Question 45

describe laryngeal polyps

Answer 45

unilateral and pedunculated

Question 46

describe laryngeal nodules

Answer 46

bilateral on middle 1/3 to posterior 1/3 vocal cords

Question 47

who is commonly affected by laryngeal nodules

Answer 47

young women

Question 48

what causes laryngeal nodules/polyps

Answer 48

change in laryngeal mucosa secondary to: - vocal abuse - infection - smoking - hypothyroidism (rare)

Question 49

what is a contact ulcer, where is it usually located

Answer 49

benign response to injury located in posterior vocal cord

Question 50

what causes contact ulcers

Answer 50

chronic throat clearing voice abuse GORD intubation

Question 51

what is squamous papilloma

Answer 51

rare BENIGN tumour

Question 52

who is affected by squamous papilloma

Answer 52

<5 | 20-40

Question 53

what causes squamous papilloma

Answer 53

HPV 6 | HPV 11

Question 54

what is squamous cell carcinoma

Answer 54

most common head and neck tumour non-benign

Question 55

what are the risk factors for developing squamous cell carcinoma

Answer 55

smoking drinking HPV

Question 56

what is a paraganglioma

Answer 56

tumours arising in clusters of neuroendocrine cells dispersed throughout the body

Question 57

who is usually affected by paraganglioma

Answer 57

>50

Question 58

what causes paragangliomas

Answer 58

MEN2

Question 59

what are the two types of paraganglioma

Answer 59

chromaffin positive | non-chromaffin

Question 60

where does a chromatin positive paraganglioma originate

Answer 60

nervous system

Question 61

what does a chromatin positive paraganglioma secrete

Answer 61

catecholamines

Question 62

what structures does a non-chromatin paraganglioma involve

Answer 62

carotid and aortic bodies ganglia nodosum of vagus clusters around oral cavity, nose, nasopharynx, larynx and orbit

Question 63

what causes epiglottitis

Answer 63

HiB

Question 64

what are the symptoms of epiglottitis

Answer 64

severe sore throat drooling fever stridor

Question 65

what is the treatment of mild epiglottitis

Answer 65

supportive antibiotic nebulised adrenaline/saline corticosteroids

Question 66

what is the treatment of severe epiglottitis

Answer 66

intubation and ventilation

Question 67

what are the symptoms of obstructive hyperplasia in the adenoid

Answer 67

hypo nasal voice snoring AOM/OME

Question 68

what are the symptoms of obstructive hyperplasia in the tonsils

Answer 68

muffled voice | snoring