ENT - Throat Flashcards
TONSILITIS
i) what is the most common cause of bacterial? how is it treated? what is the second most common cause
ii) which tonsils are typically infected? name three ways it can px?
iii) what does centor criteria comprise of? over what score is 40-60% prob of bacterial tonsilitis? what other score can be used? over what score are abx advised
iv) in what case may a pt be admitted? (4)
after how many days of not resolving should aabx be considered?
v) what abx is first line? for how long? what is given in pen allergy? name four complications
i) group A strep (strep pyogenes) tx with pen V
second most common is strep pneum
ii) palatine tonsils
sore throat, fever above 38, pain on swallow
iii) centor - fever >38, exudates, absence of vough, tender ant cervical LNs, score >3
fever pain score
abx if centor >3 or fever pain >4
iv) admit if imm comp, sys ynwell, dehy, stridor, resp distress, signs of peritons abscess
consider abx after not resolving for 3 daays or fever over 38
v) phenoxymethylpen for 10 days
clarithromycin for pen allergy
complicaats - peritons abscess, otitis media, scarlett, rheum fever, post strep glomneph, post strep reactive arthritis
PERITONSILLAR ABSCESS
i) when does it arise? what is it a complicatio of?
ii) name four ways it can px? name three additional symp seen in PT abscess
iii) what is the most common bacterial organism? name two others
iv) how should it be managed? (2) what abx should be given? what other medication may also be given?
i) arises when there is a bac infecrtion with trapped pus > abscess formation
ii) px with sore throat, pain swallow, fever, neck pain, referred ear pain, LNs
abscess - trismus (cant open mouth), change in voice due to pharyngeal swelling (hot potato voice), swelling/erythema beside tonsils
iii) strep pyogenes, staph aureus, haemoph influenzae
iv) mx with needle aspiration or surgical lexcise and drain by ENT to remove pus
co amox
may give dex to settle inflam and help recovery
TONSILLECTOMY
i) what are the indications - tonsilitis more than X number of times per year? name two other indications
ii) name three complications
iii) when can post tonsilectomy bleeding occur up until? what must be done to mx this?
iv) name two ways that less severe bleeds can be stopped
i) 7 or more in 1 year, 5 per year for 2 years
also recurrent tonsilar abscess (2 episodes), enlarged tonsils causing difficulty breathing
ii) complicats - sore throaat, damage to teeth, infection, post tonsillectomy bleeding
iii) bleeding can occur up to 2 wweeks agyer surgery - can be life threat
involve ENT early, IV access, analgesia, spit out blood, NBM, IV fluid
iv ) less severe - hydrogen peroxide gargle or adrenaline soaked swab topically
TONGUE DISORDERS
i) what is glossitis? what happens to papillae of tongue? name four causes? how is it mx?
ii) what is angioedemaa? what aare the top three causes?
iii) name three things that pre dispose to oral candida? name three tx options?
iv) name two things that cause strawberry tongue?
v) what causes a black hairy tongue? name three things that can cause it? how is it mx?
i) inflammed tongie - papilae atrophy - smooth beefy appearance
causes - fe defic anaemia, b12 defic, folate defic, coeliac
mx by correcting underlying cause
ii) fluid accum in tissues - allergic reac, ACE inhibitors, C1 esterase inhibitor defic (hered angio)
iii) pre dis - oral CS, antibiotics, diabetes, HIV, smoking
mx with miconazole gel, nystatin suspension, fluconazole tablets
iv) kawasaki and scarlett fever
v) decreased shedding of keratin from tongue surfacce
papillae elongate to take on aappearnce of hairs
may be due to dehydration, dry mouth, poor hygiene
mx by adequate hydrate, brush tongue and stop smoking
MOUTH AND GUM CONDITIONS 1
i) what is leucoplakia? what is the pt at risk of developing? what ix needs to be done? what does mx involve?
ii) what is erythroplakia? what is it assoc with?
iii) what is lichen planus? how does it look? what are wickhams striae? who does it usually occ in?
iv) what three patterns can lichen planus take in the mouth? how is it managed? (3)
i) white patches in the mouth - precancerous SCC > fixed and dont scrape off
do biopsy and mx - stop smoking, reduce ETOH, close monitoring
ii) erythro - similar to leucoplakia but lesions are red and white
assoc with SCC > urgent refer
iii) LP - autoimm cond that causes localised chronic inflaam
shiny, purple, flat topped raaised areas
white lines across surf = wickhaams striae
more common >45yrs and in women
iv) reticcular - net like web wickhams striae
erosive - surf layer of mucosa is eroded, bright red sore areas of mucosa
plaque - large continuous areas of white mucosa
mx with good oral hygiene, stop smoking and topical steroids
MOUTH AND GUM CONDITIONS 2
i) what is gingivitis? how does it present? (3) what can it lead to? name three RF
ii) what is acute necrotising ulcerative gingivitis? what is it caused by? what is tartar on teeth name four ways gingivitis can be mx?
iii) what is gingival hyperplasia? name three causes? name two medicine causes
iv) what are apthous ulcers? name three underlying conds they may be linked to? how quick do they usually heal?
v) name two topical tx for ulcers? what can be used if more severe - give two examples
vi) when should two week wait referral be made?
i) gum inflammation - swollen gums, bleed after brush, bad breath
can lead to peridontiis - sever inflam > teeth loss
Rf = plaque build up on teeth, smoking, diabetes, malnutrition, stress
ii) acute - severe painful inflam caused by anerobic bacteria
tartar is hardended plaque where bacteria can live
mx with good oral hygiene, stop smoking, hygieneist to remove plaque and tartar, chlorhexidine mouthwsh, abx if necrotising
iii) GH = abnormal growth of gums
causes - gingivitis, pregnancy, vit C defic, AML
medicines - CCB, pheytoin, ciclosporin
iv) ap ulcers - small painful ulcers on mouth mucosa
underlying: IBD, coeliac, bechets, vit defic, HIV
usually heal within 2 weeks
v) topical - choline salicyclate (bonjela), benzydamine (difflam), llidocaine
severe - topical corticosteroids eg hydrocortisone buccal tablets, betaamethsone soluble tablets, beclo inhaler spray
vi) 2WW if patients have unexplained ulceration lasting over three weeks
