ENT - Throat

Question 1

Anatomy of neck form top to bottom

Answer 1

Hyoid bone
Thyroid cartilage
Cricoid cartilage
Thyroid gland

Question 2

What are you looking for on inspection

Answer 2

Changes to voice
Scars
Obvious masses/lumps
Systemic signs e.g. cachexia, exopthalmus (might need full examination of thyroid status for tremor and eye)

Question 3

What are you looking for on palpation

Answer 3

Lymph nodes

Thyroid gland - even? symmetrical?

Question 4

Which lymph nodes are you feeling?

Answer 4

Submental 
Submandibular 
Anterior cervical chain above SCM
Supraclavicular lymph nodes
Posterior cervical chain
Preauricular
post auricular

(see osceguide youtube vid)

Question 5

Thyroid gland examination

Answer 5

Palpate
Swallow water
Stick tongue out

For the last two, see if any masses move

Question 6

If you find a neck lump, how would you describe it? (rule of three)

Answer 6

3Ss - Site, size, surface/skin
3Cs - colour, contour, consistency
3Ts - Tenderness, temperature, trnasilluminaitoin
2Fs - Fluctuance, fixed

Question 7

How would lymph node enlargement feel if it was infective?

Answer 7

Firm
Tender
Mobile
Warm
Red

Question 8

How would lymph node enlargement feel if it was malignanc?

Answer 8

Firm
non-tender
Tethered
Irregular

Accompanied by other symptoms: weight loss,

Question 9

What is the sign called when you have virchow’s node and what is it suggestive of?

Answer 9

Troissier’s sign -

Gastric carcinoma

Question 10

Sebaceous cyst features

Answer 10

Cottage cheese discharge

Question 11

Lipoma features

Answer 11

Soft
Mobile
Non painful
Round appearance

Question 12

Other causes of neck lumps

Answer 12

Sebaceous cyst

Lipma

Question 13

If a midline lump doesn’t move with swallowing, what does it suggest?

Answer 13

Dermoid cyst

Chondroma

Question 14

If a midline lump does move with swallowing, what does it suggest?

Answer 14

It’s related to the thyroid gland

Question 15

If a midline lump does move with swallowing and with sticking out the tongue, what does it suggest?

Answer 15

Thryoglossal cyst

Question 16

If a midline lump does move with swallowing and NOT with sticking out the tongue, what does it suggest?

Answer 16

Thyroid enlargement

Question 17

What is the thyroglossal cyst?

Answer 17

Embryological remnant of thyroglossal duct?

Question 18

Complications of thyroglossal cyst

Answer 18

Infection

Question 19

Goitre can be caused by

Answer 19

Hypo or hyper thyroidism

• unilateral or bilateral? toxic?
  Do TFTs

Question 20

What is a chondroma?

Answer 20

Benign cartilagious tumour

Question 21

What is a dermoid cyst?

Answer 21

Teratoma (germline)

Question 22

Lumps in the anterior triangle

Answer 22

Carotid body tumour/aneurysm
Branchial cyst
Parotid gland swelling

Question 23

Lumps in the posterior triangle

Answer 23

Cervical rib

Cystic hy

Question 24

What is a carotid body tumour? How does it feel?

Answer 24

Benign tumour in the bifurcation

Pulsatile

Question 25

What is the carotid body?

Answer 25

Chemoreceptors (oxygen and co2 monitors) They release neurotransmitters

Question 26

What is a branchial cyst?

Answer 26

Congenital epithelial cyst | Failure of obliteration of 2nd branchial cleft

Question 27

Where do you get a branchial cyst?

Answer 27

Occurs in the upper third of anterior triangle

Question 28

When does it present?

Answer 28

After an infection

Question 29

What do you call blocking/inflammation of parotid duct? gland swelling names

Answer 29

Sialadenitis

Question 30

Bilateral parotid swelling causes

Answer 30

``` Mumps Bacterial TB HIV Autoimmune - sjorgrens parotid cancer (unilateral) ```

Question 31

Complication of cervical rib

Answer 31

Thoracic outlet syndrome | Compression of lower trunk of brachial plexus/subclavian artery

Question 32

What is cervical rib?

Answer 32

?literally an extra rib above the first rib?

Question 33

What is cystic hygroma?

Answer 33

Congenital malformation Lymphangioma - fluid filled sacks that contain lymph fluid in POSTERIOR triangle

Question 34

What conditions are associated with cystic hydrogma/

Answer 34

Turner's | Noonan's

Question 35

Complications of cystic hygroma

Answer 35

Airway obstruction

Question 36

What is apharyngeal pouch?

Answer 36

Diverticulum of the mucousa of the pharynx

Question 37

Symptoms of pharygneal pouch + epidemiology

Answer 37

Dysphagia Gurgling Regurgitation Halitosis older people

Question 38

What is associated with

Answer 38

Oesophageal webs

Question 39

Investigation and management of pharyngeal pouch

Answer 39

Barium swallow | Laser/stapling

Question 40

What is halitosis?

Answer 40

bad breath