Head and neck

Question 1

What are the indications for a tonsillectomy?

Answer 1

More than 7 episode in 1 year
5 episodes in 2 years
3 episodes for 3 years

Question 2

What is common after a tonsillectomy?

Answer 2

Post bleed, primary may need theatre, secondary bleeds settle conservatively on admission

Question 3

What causes glandular fever?

Answer 3

Viral infection affecting tonsils and lymph nodes, caused by EBV

Question 4

What are the symptoms of glandular fever?

Answer 4

Prodromal illness
Cervical lymphadenopathy
Abdo pain
Hepatosplenomegaly

Question 5

What is the management for glandular fever?

Answer 5

Oral rehydration, analgesia
Antibiotics if presenting with tonsillitis
LFT monitoring
Avoid contact sport/alcohol
Warn may feel fatigued for some time
Do NOT give ampicillin/amoxicillin (rash?

Question 6

What is quinsy- peritonsillar abscess?

Answer 6

Shorter history
Dysphagia 
Trismus (lockjaw)
Hot potato voice
Unilateral swelling: above and lateral to tonsil 
Tonsil and uvula pushed to opposite side

Question 7

What is the management for quinsy?

Answer 7

IV antibiotics
Needle aspiration
Older smoker think neoplastic

Question 8

What are the symptoms for deep neck space infections?

Answer 8

Sore throat
Odynophagia
Dysphagia
Trismus
Drooling
Fever
Muffled voice
Septic
Poor head movement
Neck mass
Airway compromise
Displaced pharynx
Tongue swelling
Brawny induration (hardening of skin due to inflammation)

Question 9

What is the imaging used for DNSI?

Answer 9

CT-deep neck infections
U/S- abscess Vs. Cellulitis (for superficial masses)
OPG: often dental cause

Question 10

What causes a retropharyngeal infection?

Answer 10

50% aged 6-12 months, 	96%<6 yrs
Adenitis (Rouviere’s node) suppuration
(also trauma, foreign body, direct extension)
Complications:
Mediastinitis
Spread to other deep neck spaces

Question 11

What causes a parapharyngeal space (PPS) infection?

Answer 11

Odontogentic 
Tonsils
Pharynx
Nasopharynx
Parotid gland

Question 12

What causes submandibular infections?

Answer 12

Anterior neck swelling +/-floor of mouth oedema
Odontogenic (70%)
Sialadenitis: submandibular salivary gland infection +/- pus at duct opening (side of lingual frenulum)
Lymphadenitis

Question 13

What is Ludwig’s angina?

Answer 13

Submandibular/sublingual space infection
Bilateral (starts unilaterally)
Cellulitis, not abscess
Dental cause (80%)
“Woody” induration
Swollen floor of mouth
“Hot potato” voice
Airway compromise

Question 14

What are the principles of treatment for DNSI?

Answer 14

Airway protection
Observation/intubation/tachy
Intravenous antibiotics
Polymicrobial cover: guided by micro
Surgical drainage/aspiration
Trans-oral or external

Question 15

What are DNSI complications?

Answer 15

Airway compromise
Rupture: pneumonia, empyema, lung abscess
Mediastinitis
SOB, chest pain, wide mediastinum
Rx: IV abx, ?surgery; 
high mortality
Lemierre’s syndrome
IJV thrombosis + oropharynx infection
Rx: IV abx, ?heparin, ?excise
Carotid artery erosion (ICA>ECA>CCA)
“sentinel” bleeds: mouth, nose, ear
Rx: surgery; mortality 30%

Question 16

What is parotitis?

Answer 16

Mumps in children- bilateral hamster face
Bacterial parotitis
Elderly, debilitated, poor oral hygiene
Parotid swollen, tender, pus at duct opposite second upper molar
Rx: PO/IV abx, rehydrate, oral care

Question 17

What causes stridor?

Answer 17

Congenital:
Laryngomalacia, VC palsy & web

Acquired:
Supraglottitis / epiglottitis
Laryngitis & croup
Malignancy
Vocal cord palsy
Angioedema

Question 18

What causes stertor?

Answer 18

Tonsillitis
Nasal obstruction
Foreign body
Angioedema

Question 19

What is the management for supraglottis?

Answer 19

Sore throat symptoms pharynx normal
Airway compromise- intubation or trache
Most settle with IV dexamethasone and IV antibiotics
Nebulised adrenaline buys time in extremes (rebound is possible, secure airway)