Head and Neck

Question 1

dysphagia investigation

Answer 1

2 week-wait criteria:
Oesophageal/gastric cancer - Offer urgent OGD (to be performed within 2 weeks) in people with dysphagia or those aged 55 years and over with weight loss and any of the following: upper abdominal pain, reflux, or dyspepsia.

Question 2

what criteria is used to determine whether a sore throat is likely to have a bacterial cause?

Answer 2

CENTOR

Question 3

most common causative organism in tonsilitis?

Answer 3

The most common causative organism of tonsillitis is Streptococcus pneumoniae, especially in recurrent cases in children. Epstein-Barr virus (EBV) is another common cause.

Question 4

CENTOR criteria

Answer 4

Tonsillar exudate
Tender anterior cervical lymphadenopathy
Fever over 38 degrees Celsius
Absence of a cough

A score of 0, 1 or 2 is thought to be associated with a 3 to 17% likelihood of isolating Streptococcus. A score of 3 or 4 is thought to be associated with a 32 to 56% likelihood of isolating Streptococcus.

Question 5

management of tonsilitis

use CENTOR criteria

Answer 5

Bacterial tonsillitis with a CENTOR criteria score of 3/4 or evidence of systemic upset/immunosuppression warrants prescribing antibiotics:

1st line: Penicillin V 500mg PO QDS for 5-10 days
Alternative in penicillin allergy: Clarithromycin/Erythromycin 250-500mg PO BD for 5 days

Question 6

signs and symptoms of head and neck cancer

Answer 6

Hoarseness
Throat pain
Tongue ulcers
Painless neck lump
Weight loss
Lymphadenopathy
Symptoms of hormonal disturbance if the tumours are endocrine in origin and functional