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Yr 3 - Core Conditions > ENT - Throat > Flashcards

ENT - Throat Flashcards

1
Q

Define tonsillitis

A

Inflammation due to infection of the tonsils

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2
Q

Give the 4 main clinical featured of tonsillitis

A
  1. Sore throat
  2. Headache
  3. Pyrexia
  4. Lymph node swelling
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3
Q

What makes up the Centor Criteria?

A
  1. Fever
  2. Tonsillar exudate
  3. Absence of a cough
  4. Tender anterior lymphadenopathy
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4
Q

What does a score of 3 or 4 on the Centor Criteria mean?

A

Likely to be bacterial infection (Group A Strep) - can consider antibiotics

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5
Q

What investigations should NOT be done with any form of throat swelling?

A

Throat swabs
Rapid antigen tests

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6
Q

When should blood tests only be considered in tonsillitis?

A

In immunodeficiency

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7
Q

Management of acute tonsillitis?

A

Paracetamol & ibuprofen (symptomatic relief)
Antibiotics only if: 3/4 Centor Criteria, marked systemic upset, immunodeficiency, history of rheumatic fever

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8
Q

What is the most common complication of acute tonsillitis?

A

Recurrent tonsillitis

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9
Q

Give 3 other complications of acute tonsillitis

A
  1. Retropharyngeal abscess
  2. Peritonsillar abscess
  3. Lemierre’s syndrome
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10
Q

Retropharyngeal vs peritonsillar abscess?

A

Retropharyngeal - develops behind the pharynx (a tissue at back of throat)
Peritonsillar - develops around the tonsils (particularly palatine)

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11
Q

What is another name for a peritonsillar abscess?

A

Quinsy

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12
Q

Retropharyngeal abscesses are more common in young children. How do they commonly present?

A

Stiff and extended neck
Failure to eat or drink
Fever

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13
Q

Presentation of quinsy?

A
  • Fever
  • Sore throat
  • Difficulty eating (dysphagia)
  • Peritonsillar bulge
  • Uvular deviation
  • Trismus
  • Muffled voice
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14
Q

What is the most common organism causing acute tonsillitis?

A
  • Strep. pyogenes (Group A Strep) is most common causative organism (especially in recurrent tonsillitis)
  • EBV (less common)
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15
Q

1st line Abx in tonsillitis (if indicated)?

A
  • Penicillin V 500mg
  • Alternative in penicillin allergy: clarithromycin/erythromycin
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16
Q

Indications for Abx in tonisillitis?

A
  • Marked systemic upset
  • 3 or more centor criteria
  • Immunodeficiency
  • History of rheumatic fever
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17
Q

What is Lemierre’s syndrome?

A

Lemierre’s syndrome is a condition characterised by thrombophlebitis of the internal jugular vein and bacteraemia following a recent oropharyngeal infection

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18
Q

Danger of Lemierre’s syndrome?

A

Septic emboli !

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19
Q

Pharmacological management of Lemierre’s syndrome?

A
  • High dose benzylpenicillin
  • Debridement
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20
Q

1st line Abx in Lemierre’s syndrome?

A

High dose benzylpenicillin

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21
Q

What is the most common head and neck cancer?

A

Squamous cell carcinomas arising from the squamous cells of the mucosa.

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22
Q

Potential locations of head and neck cancer?

A
  • Nasal cavity
  • Paranasal sinuses
  • Mouth
  • Salivary glands
  • Pharynx (throat)
  • Larynx (epiglottitis, supraglottis, vocal cords, glottis and subglottis)
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23
Q

Where do head and neck cancers usually spread to first?

A

Lymph nodes

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24
Q

What is cancer of unknown primary in regard to head and neck cancer?

A

Squamous cell carcinoma cells may be found in enlarged, abnormal lymph nodes (lymphadenopathy), and the original tumour cannot be found. This is called cancer of unknown primary.

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25
Q

Risk factors for head and neck cancer?

A
  • Smoking
  • Chewing tobacco
  • Chewing betel quid (a habit in south-east Asia)
  • Alcohol
  • Viral infections:
    • HPV (particularly strain 16)
    • EBV infection
  • Immunosuppression
  • Occupational exposure – acid mists, asbestos, wood dust
  • Chemical exposure – UV and ionizing radiation e.g. CT scans
  • FH
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26
Q

Which viral infections are risk factors for head and neck cancer?

A
  • HPV (particularly strain 16)
  • EBV
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27
Q

RED FLAGS for head and neck cancer?

A
  • Hoarseness of voice (unexplained)
  • Throat pain
  • Lump in the mouth or on the lip
  • Unexplained ulceration in the mouth lasting >3 weeks
  • Persistent, painless neck lump - can lead to stridor
  • Unexplained thyroid lump
  • Weight loss
  • Lymphadenopathy
  • Hormonal disturbance if tumours are endocrine in origin
  • Erythroplakia or erythroleukoplakia
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28
Q

What is erythroplakia of the mouth?

A

A red area that is either flat or raised. If it’s scraped, erythroplakia tends to bleed easily.

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29
Q

What is erythroleukoplakia?

A

An abnormal patch of red and white tissue that forms on mucous membranes in the mouth and may become cancer.

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30
Q

Cetuximab is a monoclonal antibody that can be used in the target treatment of head and neck cancers. How does it work?

A

targets epidermal growth factor receptor, blocking activation of this receptor and inhibiting the growth and metastasis of the tumour

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31
Q

Tumours of the salivary gland most commonly affect which gland?

A

Parotid gland (80%)

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32
Q

Are the majority of salivary tumours benign or malignant?

A

Benign (80%)

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33
Q

What is the most common type of benign salivary tumour?

A

Pleomorphic adenoma (aka mixed tumour) – 80%

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34
Q

Give some other types of benign salivary tumours

A
  • Pleomorphic adenoma (aka mixed tumour) – 80%
  • Mucoepidermoid carcinoma – 8%
  • Warthin’s tumour – 7%
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35
Q

Most common presenting feature of malignant salivary tumours?

A

These will typically present with invasion of other structures leading to focal neurology, particularly invasion of the facial nerve leading to V_II nerve palsy_.

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36
Q

Give the 3 most common types of malignant salivary tumours

A
  • Adenoid cystic carcinoma
  • Mucoepidermoid carcinoma
  • Acinic cell carcinoma
37
Q

When should salivary gland swellings be removed?

A

Salivary gland swellings that have been present for >1 month with no clear underlying cause should be removed.

38
Q

What is sialadenitis?

A

Inflammation of the salivary glands. Most commonly affects the parotid glands.

39
Q

What gland does sialadenitis most commonly affect?

A

Parotid glands

40
Q

What is the most common cause of sialadenitis?

A

Infective:

  • Bacterial (more common) → S. aureus
  • Viral → mumps
41
Q

What is the most common bacterial cause of sialadenitis?

A

S. aureus

42
Q

What is the most common viral cause of sialadenitis?

A

Mumps

43
Q

Give some other causes of sialadenitis?

A
  • Infective (bacterial/viral)
  • Stones
  • Malignancy
  • Autoimmune e.g. sarcoidosis, Wegner’s granulomatosis
44
Q

Give 2 major autoimmune causes of sialadenitis

A
  1. Sarcoidosis
  2. Wegner’s granulomatosis
45
Q

Clinical features of sialadenitis?

A
  • Parotid most commonly affected (also submandibular glands)
  • Pain
  • Tenderness
  • Redness
  • Localised swelling
  • Fever
  • Can have purulent discharge
  • Lymphadenopathy
46
Q

Management of sialadenitis?

A
  • Conservative → hydration, analgesia, moist heat
  • If bacterial → Abx and oral hygiene advice
  • Measures to encourage salivary flow – these are called sialagogues (e.g. lemon juice)
  • Incision and drainage if associated abscess
47
Q

What is sialagogues?

A

A sialogogue is a drug or substance that increases the flow rate of saliva

48
Q

Is epiglottitis an ENT emergency?

A

YES → risk of airway closing!

49
Q

What is epiglottitis?

A

A rapidly progressing infection causing inflammation of the epiglottis (the flap that covers the trachea) and tissues around the epiglottis that may lead to abrupt blockage of the upper airway and death.

50
Q

What is the most common organism causing epiglottitis?

A

Haemophilus influenza B (but now rare due to vaccination)

51
Q

Who typically gets epiglottitis?

A

Most common aged 1-6 y/o (similar age to croup) – most commonly unvaccinated child

52
Q

Onset of epiglottitis vs croup?

A

Epiglottitis has faster onset

53
Q

Clinical features of epiglottitis?

A
  • High fever, ill
  • Intensely sore throat preventing child from speaking or swallowing – child can be drooling
  • Soft inspiratory stridor and rapidly increasing respiratory difficulties over hours
    • Tripod position
  • Child sits immobile, upright with open mouth to optimise airway
  • Cough minimal or absent
  • Septic and unwell appearance
54
Q

What position may a child with epiglottitis be sat in?

A

Tripod position

55
Q

Management of epiglottitis?

A
  • Do not distress patient – this may prompt closure of airway
    • Don’t examine child and make them upset, leave them in comfort zone
  • Alert senior pediatrician, anaesthetist & ENT
  • 1) Secure airway → endotracheal intubation
  • 2) Take cultures & examine throat
  • 3) Treat with IV antibiotics (cefuroxime)
56
Q

1st line Abx in epiglottitis?

A

IV cefuroxime

57
Q

What is croup also known as?

A

Laryngotracheobronchitis

58
Q

What is croup?

A

An infection of the upper airway which obstructs breathing (due to oedema in larynx)

59
Q

What is the characteristic feature of croup?

A

barking cough

60
Q

Most common cause of croup?

A

Parainfluenza virus

61
Q

Which pathogens can cause croup?

A
  • Parainfluenza virus – most common
  • Influenza
  • Adenovirus
  • Respiratory Syncytial Virus (RSV)
  • Diphtheria – this croup can lead to epiglottitis (vaccination though)
62
Q

Age group that croup typically seen in?

A

Typically children aged 6 months to 2 years

63
Q

Presentation of croup?

A
  • Barking, seal-like cough
  • Stridor (if child upset) – important to keep child calm and avoid cannulation where possible
  • Increased work of breathing
  • Low grade fever
  • Usually improves in <48 hours and responds well to steroids e.g. dexamethasone
64
Q

Management of croup?

A

ODA

  • Oxygen
  • Dexamethasone
  • Adrenaline nebulised (5ml 1:5000)
65
Q

What does a thyroglossal cyst arise from?

A

Arises from a persistent thyroglossal duct.

66
Q

Presentation of a thyroglossal cyst?

A
  • Fluctuant, painless, midline neck mass in children
  • Mobile – move up and down with movement of tongue
  • Cyst may become infected
67
Q

How is an infected thyroglossal cyst treated?

A

Surgical excision

68
Q

Potential complication of a thyroglossal cyst?

A

Can become infected

69
Q

What is another name for a peritonsillar abscess?

A

Quinsy

70
Q

What is quinsy?

A

Abscess formation in peritonsillar space. Usually a rare complication of acute tonsillitis (often untreated or partially treated) but can arise without tonsillitis.

71
Q

Pathophysiology behind quinsy?

A

Bacterial infection with trapped pus forms an abscess in the region of the tonsils.

72
Q

What is the most common organism causing quinsy?

A

Strep. pyogenes (group A strep)

73
Q

Top 3 organisms causing quinsy?

A
  • Strep. pyogenes (group A strep) – most common
  • Staphylococcus aureus
  • Hemophilus influenzae
74
Q

Presentation of quinsy?

A
  • Sore throat
  • Painful swallowing
  • Fever
  • Neck pain
  • Referred ear pain (otalgia is normal)
  • Swollen tender lymph nodes
  • Trismus is key (restriction of range of motion of jaw) – may not even be able to open mouth at all
  • Change in voice due to pharyngeal swelling – ‘hot potato voice’
  • Swelling and erythema in area beside tonsils on exam
75
Q

What is a key symptom of quinsy?

A

Trismus

76
Q

What is trismus?

A

Trismus refers to the restriction of the range of motion of the jaws.

77
Q

What is a ‘hot potato voice’?

A

A thick, muffled voice caused by pharyngeal or laryngeal diseases characterised by severe upper airway obstruction, including acute epiglottitis and peritonsillitis.

78
Q

1st line Abx management of quinsy?

A

Co-amoxiclav (broad spectrum)

79
Q

What is stridor?

A

AIRWAY EMERGENCY!

A musical noise heard during inspiration from partial obstruction of the larynx or large airways.

80
Q

Is stridor heard on inspiration or expiration?

A

Inspiration

81
Q

Why is stridor more severe in children?

A

More severe in children as airway is narrower and more readily deformed than adult airways so obstruction happens faster.

82
Q

Give some causes of stridor

A
  • Croup
  • Epiglottitis
  • Foreign body in larynx or trachea
  • Bacterial tracheitis
83
Q

What is the radiological hallmark of a button battery inhalation?

A

A halo sign or double ring sign can be seen which eludes towards the foreign body being a button battery. In addition, there are irregularities along the borders of the battery, suggestive of corrosion.

84
Q

What is the bacteria most commonly responsible for Lemierre’s syndrome?

A

Fusobacterium necrophorum

85
Q

Stridor vs wheeze?

A

Stridor is a higher-pitched noisy that occurs with obstruction in or just below the voice box. Determination of whether stridor occurs during inspiration, expiration, or both helps to define the level of obstruction. Wheezing is a high-pitched noise that occurs during expiration.

86
Q

Which tonsils are typically affected in tonsillitis?

A

Palatine tonsils

87
Q

Who do retropharyngeal abscesses tend to present in?

A

Children <5

88
Q

What malignancy is EBV infection a risk for?

A

Head and neck cancer

Yr 3 - Core Conditions (33 decks)

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