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Year 3 > ENT - neck lumps,tonsils and stridor > Flashcards

ENT - neck lumps,tonsils and stridor Flashcards

1
Q

Where are the tonsils located

A

Either side of the uvula

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2
Q

4 main pathologies of the tonsils

A

Too large
Neoplasticism change
Tonsil stones and foreign bodies
Infections and abscesses

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3
Q

What are the 2 main types of neoplasticism change to the tonsils

A

Lymphoma
Squamous cell carcinoma

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4
Q

Patient has nasal blockage, unilateral otitis media with effusion and frequent nose bleeds what most likely

A.tonsils enlarged
B.squamous cell carcinoma of tonsils
C.squamous cell carcinoma of adenoids
D.tonsil stones
E.peritonsilar abcess

A

C.squamous cell carcinoma of adenoids

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5
Q

Patient presents with sore throat, pain on swallowing and a unilateral neck mass , examination shows tonsils swelling what is the most likely diagnosis

A.tonsils enlarged
B.squamous cell carcinoma of tonsils
C.squamous cell carcinoma of adenoids
D.tonsil stones
E.peritonsilar abcess

A

.squamous cell carcinoma of tonsils

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6
Q

Quinsy is an abcess of which gland

A.parotid
B.Webers
C.submental
D.submandibular

A

B.webers

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7
Q

Patient with pain in throat , examination shows the uvula is pushed to one side (opposite to the A.tonsils enlarged
B.squamous cell carcinoma of tonsils
C.squamous cell carcinoma of adenoids
D.tonsil stones
E.peritonsilar abcess painful side) which diagnosis most likely

A

E.peritonsilar abcess

Treated with drainage as can develop into parapharyngeal abcess and septicaemia

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8
Q

Patient with pain in throat , generalised cervical lymphadenopathy and raised temp examinations shows petechiae on the soft palate what diagnosis most likely

A.glandular fever
B.squamous cell carcinoma of tonsils
C.squamous cell carcinoma of adenoids
D.tonsil stones
E.peritonsilar abcess

A

A.glandular fever

Petechiae indicate Epstein Barr virus
Can also be caused by rubella or HIV

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9
Q

Where are the adenoids located

A

Post nasal space

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10
Q

Patient with snoring, nasal blockage and discharge and unilateral otitis media

A

Adenoids hypertrophy
Needs further investigation in adults lymphoma/ss carcinoma may present as unilateral otitis medi with effusion in adults

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11
Q

Red flag presentation in adults

A

UnilaterL otitis media with effusion in adults

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12
Q

Criteria for tonsilectomy

A

Sleep apnoea
Adult with unilateral enlarged tonsil
2+ episodes of peritonsilar abcess
Severely symptomatic tonsillitis
Recurrent tonsillitis

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13
Q

Complications of tonsilectomy

A

Haemorrhage - emergency theatre
Blood transfusion
Mortality
Sore throat / taste disturbance

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14
Q

Stridor

A

Monophasic inspiratory noise

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15
Q

paediatric causes of stridor

A

laryngomalacia&raquo_space;
acute epiglottis
subglotic haemangioma

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16
Q

in which paediatric cause of stridor does soft larangeal tissues collapse in during inspiration leading to partial obstruction

a.larangyoma
b.acute epiglottitis
c.subglottic hemangioma

A

a.larangyoma

usually mild and self resolving

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17
Q

which paediatric cause of stridor is caused by infection with haemophilus influenzae

a.laryngomalacia
b.acute epiglottitis
c.subglottic haemangioma

A

b.acute epiglottitis
no crying and a typical tripod position

EMERGENCY AIRWAY TEAM
DO NOT PERFORM VENEPUNCTURE

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18
Q

young child with stridor on exam sitting in tripod position and does not cry what condition most likely

a.laryngomalacia
b.acute epiglotitis
c.subglottic haemangioma

A

b.acute epiglotitis

Bacterial infection with haemophilus influenzae
call emergency airway team

19
Q

where does a subglottic haemangioma occur

a.pharynx
b.larynx
c.tonsils
d.trachea

A

b.larynx

20
Q

what is the first line treatment for subglottic haemangioma

a.propanolol
b.sotalol
c.bisoprolol
d.emergency airway team
c.antibiotics

A

a.propanolol

21
Q

5 causes of adult stridor

A

Anaphylaxis
foreign body
supraglottitis
larangeal tumour
bilateral vocal cord paralysis

22
Q

infection at the upper larynx above vocal cords

A

supraglottitis

23
Q

bilateral vocal cord paralysis causes

A

surgery
malignancy
infection (viral - guillian barre)

24
Q

what is the first line treatment for adult stridor

a.propanolol
b.call airway emergency team
c.give o2
d.give nebulised adrenaline
e.give dexamethosone
f.intubation

A

b.call airway emergency team

then
c.give o2
d.give nebulised adrenaline
e.give dexamethosone
f.intubation

25
Q

which of these are all examples of midline neck lumps

a.thyroglossal cyst, dermoid, thyroid swelling

b.mycobacterial adenitis, bronchial cyst ,salivary gland swelling

A

a.thyroglossal cyst, dermoid, thyroid swelling

26
Q

which of these are all examples of lateral neck lumps

a.thyroglossal cyst, dermoid, thyroid swelling

b.mycobacterial adenitis, bronchial cyst ,salivary gland swelling

A

b.mycobacterial adenitis, bronchial cyst ,salivary gland swelling

27
Q

5 year old with lump under chin, a sudden onset 3 months ago . the lump is intermittently red and sore and is treated with antibiotics when this occurs. the lump moves upwards when the patient is asked to stick out their tongue .
what is the most likely diagnosis

a.thyroglossal cyst
b.dermoid
c.thyroid swelling
d.bronchial cyst
e.mycobacterial adenitis

A

a.thyroglossal cyst

ultrasound of tyroid done to look for normal gland

28
Q

child with a lump in the middle of the neck/nasal dorsum there is a small tuft of hair over the lump and it is painless what is the most likely diagnosis

a.thyroglossal cyst
b.dermoid
c.thyroid swelling
d.bronchial cyst
e.mycobacterial adenitis

A

b.dermoid

CT/MRI needed before further decision

29
Q

30 year old with painless neck lump in the midline. moves on swallowing and is accompanied by hoarseness of the voice
what is the most likely diagnosis

a.thyroglossal cyst
b.dermoid
c.thyroid swelling
d.bronchial cyst
e.mycobacterial adenitis

A

c.thyroid swelling

DO NOT REQUEST ULTRASOUND IN PRIMARY CARE

REFER TO ENT CLINIC

30
Q

child with a lump in the middle of the neck/nasal dorsum there is a small tuft of hair over the lump and it is painless . the patient is diagnosed with a dermoid. what is the most APPROPRIATE NEXT INVESTIGATION

a.ultrasound thyroid
b.referall to ENT clinic
c.CT/MRI

A

c.CT/MRI

31
Q

30 year old with painless neck lump in the midline. moves on swallowing and is accompanied by hoarseness of the voice
what is the best course of action

a.ultrasound thyroid
b.referall to ENT clinic
c.CT/MRI

A

b.referall to ENT clinic

they will do ultrasound and fna

then can do thyroid function tests, autoantibodies TSI and TPA

for graves and hashimotos

32
Q

children with a firm fixed erythematous lymphadenopathy
what is the most likely diagnosis

a.thyroglossal cyst
b.dermoid
c.thyroid swelling
d.bronchial cyst
e.mycobacterial adenitis

A

e.mycobacterial adenitis

may suparate and discharge through skin

caused by atypical TB or epsteinn barr virus

give macrolide/tetracycline for 6 weeks in hopsital

if ineffective debridement required

33
Q

what is the first line treatment for mycobacterial adenitis in children

a.macrolide / tetracycline antibiotic
b.propanolol
c.fine needle aspiration
d. removal of adenoids

A

a.macrolide / tetracycline antibiotic

34
Q

what can cause mycobacterial adenitis

A

atypical TB
epsteinn barr virus

35
Q

inflammatory lateral neck swelling

A

sarcoidosis

36
Q

14 year old sudden soft neck swelling on one side , red and sore treated with antibiotics the swelling transilluminates and the patient has no other ENT signs or symptoms
what is the most likely diagnosis

a.thyroglossal cyst
b.dermoid
c.thyroid swelling
d.bronchial cyst
e.mycobacterial adenitis

A

d.bronchial cyst

1- fine needle aspiration
2- MRI/CT Chest and neck

if over 40 yrs
1- PET CT
concerned about metastases from a primary oropharangeal cancer

37
Q

what should be done for a investigation of a suspected bronchial cyst if over 40 years

a.thyroid ultrasound
b.neck and chest ct
c.fine needle aspiration
d.ct pet

A

d.ct pet

concerned about any metastases from a primary oropharangeal cancer

38
Q

patient with lump on one side below the jaw, acute onset over a few minutes and worsens on eating what investigation should be done first

a.ultrasound
b.neck and chest ct
c.fine needle aspiration
d.ct pet

A

a.ultrasound

39
Q

patient with lump on one side below the jaw, acute onset over a few minutes and worsens on eating what diagnosis is most likely

a.thyroglossal cyst
b.dermoid
c.salivary gland swelling
d.bronchial cyst
e.mycobacterial adenitis

A

c.salivary gland swelling

many causes

1 sided - tumour,sialadenitis

2 sided- mumps, diabetes, acromegaly,fatty infiltration

40
Q

how does a paraganglioma of the carotid sinus move

A

laterally but not up and down

41
Q

50 year old firm mass at angle of mandible, throat and neck clear with no skin changes patient also has weight loss and unilateral facial nerve weakness what is the most likely diagnosis

a.thyroglossal cyst
b.parotid gland mass
c.salivary gland swelling
d.bronchial cyst
e.mycobacterial adenitis

A

b.parotid gland mass

malignant as accompanied by weakness and weight loss

42
Q

50 year old firm mass at angle of mandible, throat and neck clear with no skin changes patient also has weight loss and unilateral facial nerve weakness what is the most appropriate investigation

a.fine needle aspiration
b.ct neck and chest
c.pet ct
d.ultrasound

A

d.ultrasound

43
Q

complications of a thyroidectomy

A

recurrent larangeal nerve injury
hypocalcaemia
bleeding - haematoma
tracheomalacia

can all cause stridor except hypocal

Year 3 (25 decks)

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