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FFP ENT > Head and neck > Flashcards

Head and neck Flashcards

1
Q

Swallowing stages

A

1) Oral
2) Pharyngeal
3) Oesophageal

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2
Q

Stages of voice production

A

Column of air pressure moves up. Causes vocal ford vibration. This causes resonance. Then you articulate sounds

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3
Q

Differentials for 20yo with a 5 day history of sore throat, temp, difficulty swallowing, painful swallowing, swollen glands

A

Tonsillitis
Glandular fever
Quinsy
Supra/epiglottitis
Deep neck space infection (DNSI)

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4
Q

What should you be wary of in someone with significant sore throat but normal pharynx exam

A

Supraglottitis

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5
Q

Management of tonsillitis

A

Analgesia, PO abx, drink plenty, soft foods or soups

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6
Q

When would a tonsillectomy be required

A

More than 7 episodes per year in 1 year

5/year for 2 years

2/year for 3 years or more

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7
Q

Management of post tonsillectomy

A

Painful for 1-2 weeks so advise regular analgesia and normal diet

Bleeds are common. Primary bleeds may need theatre but secondary bleeds settle conservatively on admission

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8
Q

Are swabs used for tonsillitis

A

No

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9
Q

Symptoms of tonsillitis

A

White pus on tonsils
Painful
Fever
Unwell

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10
Q

What is glandular fever

A

Viral infection affecting tonsils and lymph nodes caused by EBV

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11
Q

Symptoms of glandular fever

A

IT is a prodromal illness therefore:
-Cervical lymphadenopathy
-Abdominal pain
-HEpatosplenomegaly
-Check: FBC, LFTs, mono spot-glandular fever test

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12
Q

Management glandular fever

A

-symptomatic: oral rehydration, analgesia (soluble)
-Abx if presenting with possible tonsillitis
-LFT monitoring if abnormal
-Avoid contact sport/ alcohol: hepatosplenomegaly-rupture
-Warn may feel washed out

Do not give ampicillin/amoxicillin- rash

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13
Q

What is quinsy

A

Peritonsillar abscess

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14
Q

Symptoms of quinsy

A

-Shorter history
-Dysphagia (maybe absolute)
-Trismus (can’t open mouth fully)
-Unilateral swelling: above and lateral to tonsil
-Tonsil and uvula pushed to opposite side

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15
Q

Management of quinsy

A

Involve ENT
IV fluids and abx
Needle aspiration or formal insertion and drainage

If an older person who is a smoker, and who is otherwise well but has progressive symptoms consider a neoplastic lesion

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16
Q

How do complications of throat infections arise

A

Throat infection leads to lymphadenitis (inflammation in lymph nodes). This leads to suppuration (pus in lymph nodes). This leads to Neck abscess so a Deep Neck Space Infection [parapharyngeal or retropharyngeal]

17
Q

What is parapharyngeal DNSI

A

Lateral to pharynx

18
Q

What is retropharyngeal DNSI

A

Behind pharynx

19
Q

Symptoms and signs of DNSI

A

Difficulty moving head from left to right as extremely painful !!!
Sore throat
Odynophagia (painful swallow)
Dysphagia
Trismus
Drooling
Fever
Muffled voice
Septic
Neck mass
Airway compromise
Displaced pharynx
Tongue swelling
Brawny induration

20
Q

Imaging for DNSI

A

CT
USS to check for abscess vs cellulitis when there is a superficial mass

21
Q

Who does retropharyngeal infections mostly affect

A

Children

22
Q

How does a retropharyngeal infection develop

A

Adenitis of ROuviere’s nodes which leads to suppuration.

trauma, foreign body ingestion may also cause this

23
Q

Complications of retropharyngeal infection

A

Mediastinitis

Spread to other deep neck spaces

24
Q

Where is the parapharyngeal space

A

Mandible is lateral to it

25
Q

What can cause parapharyngeal space infection

A

Commonly: dental infection (odontogentic)
Tonsillitis
Pharyngitis
NAsopharyngitis
Infection in parotid gland

26
Q

What does a submandibular infection look like

A

Anterior neck swelling +/- floor of mouth oedema

27
Q

What causes submandibular infections

A

Odontogenic (dental infection)

Sialadenitis (submandibular salivary gland infection+- pus at duct opening (side of lingual frenulum))

Lymphadenitis

28
Q

What is Ludwig’s angina

A

Submandibular and sublingual space infection

Swollen floor of mouth

Bilateral but starts unilaterally. Leads to airway compromise

Hot potato voice

29
Q

What causes Ludwig’s angina

A

Cellulitis, not abscess.

Dental cause

30
Q

Principles of DNSI

A

Airway protection (observe/intubation/trache)

IV abx talk to microbiology

Surgical drainage/aspiration either trans-oral or external

FFP ENT (9 decks)

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