ENT - neck lumps,tonsils and stridor Flashcards
Where are the tonsils located
Either side of the uvula
4 main pathologies of the tonsils
Too large
Neoplasticism change
Tonsil stones and foreign bodies
Infections and abscesses
What are the 2 main types of neoplasticism change to the tonsils
Lymphoma
Squamous cell carcinoma
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
C.squamous cell carcinoma of adenoids
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
.squamous cell carcinoma of tonsils
Quinsy is an abcess of which gland
A.parotid
B.Webers
C.submental
D.submandibular
B.webers
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
E.peritonsilar abcess
Treated with drainage as can develop into parapharyngeal abcess and septicaemia
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.glandular fever
Petechiae indicate Epstein Barr virus
Can also be caused by rubella or HIV
Where are the adenoids located
Post nasal space
Patient with snoring, nasal blockage and discharge and unilateral otitis media
Adenoids hypertrophy
Needs further investigation in adults lymphoma/ss carcinoma may present as unilateral otitis medi with effusion in adults
Red flag presentation in adults
UnilaterL otitis media with effusion in adults
Criteria for tonsilectomy
Sleep apnoea
Adult with unilateral enlarged tonsil
2+ episodes of peritonsilar abcess
Severely symptomatic tonsillitis
Recurrent tonsillitis
Complications of tonsilectomy
Haemorrhage - emergency theatre
Blood transfusion
Mortality
Sore throat / taste disturbance
Stridor
Monophasic inspiratory noise
paediatric causes of stridor
laryngomalacia»_space;
acute epiglottis
subglotic haemangioma
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.larangyoma
usually mild and self resolving
which paediatric cause of stridor is caused by infection with haemophilus influenzae
a.laryngomalacia
b.acute epiglottitis
c.subglottic haemangioma
b.acute epiglottitis
no crying and a typical tripod position
EMERGENCY AIRWAY TEAM
DO NOT PERFORM VENEPUNCTURE
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
b.acute epiglotitis
Bacterial infection with haemophilus influenzae
call emergency airway team
where does a subglottic haemangioma occur
a.pharynx
b.larynx
c.tonsils
d.trachea
b.larynx
what is the first line treatment for subglottic haemangioma
a.propanolol
b.sotalol
c.bisoprolol
d.emergency airway team
c.antibiotics
a.propanolol
5 causes of adult stridor
Anaphylaxis
foreign body
supraglottitis
larangeal tumour
bilateral vocal cord paralysis
infection at the upper larynx above vocal cords
supraglottitis
bilateral vocal cord paralysis causes
surgery
malignancy
infection (viral - guillian barre)
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
b.call airway emergency team
then
c.give o2
d.give nebulised adrenaline
e.give dexamethosone
f.intubation
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.thyroglossal cyst, dermoid, thyroid swelling
which of these are all examples of lateral neck lumps
a.thyroglossal cyst, dermoid, thyroid swelling
b.mycobacterial adenitis, bronchial cyst ,salivary gland swelling
b.mycobacterial adenitis, bronchial cyst ,salivary gland swelling
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.thyroglossal cyst
ultrasound of tyroid done to look for normal gland
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
b.dermoid
CT/MRI needed before further decision
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
c.thyroid swelling
DO NOT REQUEST ULTRASOUND IN PRIMARY CARE
REFER TO ENT CLINIC
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
c.CT/MRI
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
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
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
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
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.macrolide / tetracycline antibiotic
what can cause mycobacterial adenitis
atypical TB
epsteinn barr virus
inflammatory lateral neck swelling
sarcoidosis
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
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
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
d.ct pet
concerned about any metastases from a primary oropharangeal cancer
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.ultrasound
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
c.salivary gland swelling
many causes
1 sided - tumour,sialadenitis
2 sided- mumps, diabetes, acromegaly,fatty infiltration
how does a paraganglioma of the carotid sinus move
laterally but not up and down
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
b.parotid gland mass
malignant as accompanied by weakness and weight loss
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
d.ultrasound
complications of a thyroidectomy
recurrent larangeal nerve injury
hypocalcaemia
bleeding - haematoma
tracheomalacia
can all cause stridor except hypocal
