Head and Neck Flashcards
Causes of tonsillitis?
Most often its viral
Bacterial causes: Streptococcus pyogens (most common), streptococcus pneumoniae, haemophilus influenzae, moraxella catarhalis, S.aureus.
Presentation of tonsillitis and how can you determine whether its bacterial?
Presentation - Sore throat, fever and pain on swallowing.
Use Centor criteria or FeverPAIN score to determine if it is likely to be bacterial:
Centor - Fever > 38 degrees, tonsillar exudates, absence of cough and tender anterior cervical lymphnodes.
What is the management of tonsillitis?
Consider admission if immunocompromised, systemically unwell, dehydrated, stridor, resp distress of has evidence of abscess.
Consider abx if centor criteria is 3+ or FeverPAIN is 4+. Abx of choice is Phenoxymethypenicillin or clarithromycin. NOT amox because it could be EBV.
Complications of tonsillitis?
Peritonsilar abscess (quinsy)
Otitis media,
Scarlet fever,
Rheumatic fever,
Post-streptococcal GN,
Post-streptococcal reactive arthritis.
What are the features of a peritonsillar abscess (presentation and management)
Presentation - Severe throat pain which lateralises to one side. Deviation of uvula to unaffected side, trismus and reduced neck mobility.
Management - All need referral to ENT where they will undergo needle aspiration/incision and drainage and IV antibiotics. Consider tonsillectomy. All offered tonsillectomy if patient gets a second abscess.
Differential diagnosis for neck lumps?
Reactive lymphadenopathy - Think about doing monospot test,
Lymphoma,
Thyroid swelling,
Thyroglossal cyst,
Pharyngeal pouch,
Cystic hygroma,
Brachial cyst,
Cervical rib
Carotid aneurysm
Carotid body tumour
What are the causes of a hoarse voice?
Laryngitits,
Vocal cord palsy,
Laryngeal cancer,
Vocal cord polyp,
VC ganuloma,
Papilloma,
Reinke’s oedema,
Vocal nodules,
Muscle tension dysphonia
Red flag for vocal cord pathology?
If symptoms have lasted for >6 weeks or progressing.
Urgent cancer referral to ENT for patients 45+ with persistent unexplained hoarseness or unexplained lump in neck.
Features of presbyphonia
Age related voice change which is caused by bowing of vocal cords due to atrophy. Tis results in incomplete glottic closure.
Features of Laryngitis
Common short lasting inflammation affecting laryngeal mucosa.
May be caused by URTI, chemical injury or physical injury.
Rx - voice rest, hydration, steam and avoid trigger.
Features of laryngopharyngeal reflux
Caused by GORD resulting in inflammatory changes.
Presents with Globus (sensation of lump in throat) which felt in midline and worse when swallowing saliva > food/drink. Hoarseness, chronic cough, dysphagia, heart burn and sore throat. Examination normal externally but may have erythema on posterior pharynx.
Ix - clinical diagnosis but referral if red flags (persistent unilateral throat discomfort, dysphagia/odynophagia with food and persistent hoarsness)
Rx - treat GORD
causes and presentation of vocal cord palsy
Causes - iatrogenic following surgery, tumours (H and neck or lung), stroke, neck/chest injury, neruological or viral infections.
Presentation - breathy voice and cough/choak after swallowing
Investigations and treatment of vocal cord palsy
Ix - Laryngoscope. If chords are abducted there may be breathier voice but no airway compromise. if adducted there may be potential for compromise.
Rx - conservative, speech and language therapy, cord mobilisation procedures or cordotomy
Features of vocal cord polyps
Often unilateral pedunculated/sessile lesions. Can be caused by chronic cough, chemicals - smoking/alcohol, infections or allergies
Vocal cord granuloma?
Little granuloma on chords caused by damage and subsequent healing (intubation, trauma, arytenoid granuloma)
features of recurrent respiratory papillomatosis?
HPV 6 and 11 - seen in children and adults.
Treatment - endoscopic removal with microdebrider, laser or mitomycin
HPV vaccine!
Features of Reinke’s oedema?
Inflammatory oedema often bilateral and caused by smoking or laryngeal reflux.
Presents with deepening of voice
Treatment - lateral cordotomy (remove fluid) and smoking cessation. Will recur if continues to smoke.
Presentation and causes of laryngeal cancer?
Mostly squamous cell carcinomas associated with smoking and alcohol. Can also be HPV related.
Main symptoms - hoarseness!! Other symptoms include: dysphagia, weight loss, haemoptysis, neck lump, pain.
Investigations and management of laryngeal cancer?
Ix - FNA of cervical lymphadenopathy/biopsy and imaging.
Rx - MDT approach with surgery (laser resection or laryngectomy) and Chemo/rads
Features of black tongue?
Decreased shedding of keratin from tongue. May be due to dehydration, dry mouth, poor oral hygiene and smoking.
Management - ensure hydrated, brushing of tongue and smoking cessation
Describe features of Ludwig’s angina?
Progressive cellulitis of floor of mouth and soft tissues of neck.
Presentation- neck swelling, dysphagia and fever.
Management - airway management and antibiotcs
Describe features of a thyroglossal cyst
More common in patients < 20 years old.
Presents as midline mass between isthmus of thyroid and hyoid bone. Move up with protrusion of tongue and can become infected and sore.
Describe features of pharyngeal pouch?
Diverticulum through Killian’s dishiscence.
Features: Dysphagia, regurgitation, aspiration, neck swelling (gurgles on palpation) and hallitosis.
Ix - barium swallow with dynamic video fluoroscopy.
Rx - surgery
Causes of gingival hyperplasia?
Ciclosporin, phenytoin, calcium channel blockers (nifedipine) and AML
What are the red flags for neck lumps?
Unexplained neck lump in someone 45+ years.
Persistent neck lump at any age.
If growing in size patients should receive an US in 48hr if under age 25 and within 2 weeks if over 25.
What is a brachial cyst and its features
- Defect of branchial arched,. Prone to infection.
- Typicall unilateral on left side, lies lateral and anterior to SCM. Slowly enlarging. Soft, smooth and fluctuant, non tender, fistula mat be seen, no movement with swallowing.
- Refer to ENT to exclude malignancy, perform US and FNA. May be treated conservatively or surgically
Differential for neck lump in children?
congenital: branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation
inflammatory: reactive lymphadenopathy, lymphadenitis,
neoplastic: lymphoma, thyroid tumour, salivary gland tumour
