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Year 4: Special Senses > Laryngology > Flashcards

Laryngology Flashcards

1
Q

Name the medial, lateral and superior boundaries of the anterior triangle of the neck.

A
  • Medial: Midline of the neck
  • Lateral: Anterior border of sternocleidomastoid
  • Superior: Lower border of the mandible
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2
Q

Name the medial, lateral and superior boundaries of the posterior triangle of the neck.

A
  • Anterior: Posterior border of sternocleidomastoid
  • Posterior: Anterior edge of trapezius
  • Base: Middle third of clavicle
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3
Q

Describe the anatomical location of a retropharyngeal abscess.

A

Anterior to the prevertebral fascia, behind the pharynx.

This space extends from the base of the skull to the mediastinum.

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4
Q

Describe how a patient with a retropharyngeal abscess would present.

A
  • Commonly in young children
  • Commonly after an URTI
  • Neck held rigid and upright with reluctance to move
  • Systemically unwell
  • Airway compromise
  • Dysphagia/ Odynophagia
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5
Q

What investigation would you order if you suspected a patient has a retropharyngeal abscess?

A
  • CT Neck (preferably)

- Widening of the retropharyngeal space on lateral X-Ray

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6
Q

Describe how you would manage a patient with a retropharyngeal abscess.

A
  • Secure airway if any concerns
  • IV antibiotics
  • Surgery: Incision and drainage
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7
Q

What is ludwig’s angina?

A

Infection of the space between the floor of the mouth and mylohyoid.

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8
Q

What is ludwig’s angina most commonly associated with?

A

Dental infection

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9
Q

Describe how a patient with ludwig’s angina would present.

A
  • Swelling of the floor of the mouth
  • Painful mouth
  • Protruding tongue
  • Airway compromise
  • Drooling
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10
Q

What investigation would you order if you suspected a patient had ludwig’s angina?

A
  • CT neck

- OPG (Orthopantomogram is a scan that gives a panoramic view of your jaw and teeth)

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11
Q

Describe how you would manage a patient with ludwig’s angina.

A
  • Secure airway if any concerns
  • IV antibiotics
  • Surgery to drain any collection
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12
Q

Where is the parapharyngeal space?

A

A potential space postero-lateral to the oropharynx and nasopharynx which is divided by the styloid process

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13
Q

Describe how a patient with a parapharyngeal abscesses would present.

A
  • Febrile illness
  • Odynophagia
  • Trismus (reduced opening of the jaws)
  • Reduced neck movement
  • A swelling in the neck around the upper part of the sternocleidomastoid.
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14
Q

Describe how you would manage a patient with a parapharyngeal abscesses.

A
  • Secure airway if any concerns
  • IV Antibiotics
  • Surgical drainage
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15
Q

Name the causative organism of epiglottitis.

A

Haemophylis influenza

NOTE: Incidence has reduced with introduction of HIB vaccine

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16
Q

Describe the demographics of patients commonly affected by epiglottitis.

A

Mainly seen in children aged 2 - 6

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17
Q

Is epiglottitis an emergency?

A

Yes

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18
Q

Describe how a patient with epiglottitis would present.

A
  • Stridor
  • Drooling
  • Pyrexia
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19
Q

Describe how you would manage a patient with epiglottitis.

A
  • Secure the airway
  • Don’t examine (this may precipitate airway obstruction)
  • Calm child
  • Intubated in theatre (preferable)
  • IV antibitoitcs
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20
Q

How should neck masses (except

for pulsatile masses) be investigated?

A

Ultrasound guided fine needle aspiration

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21
Q

Name the 4 muscles of the pharynx.

A

Superior, middle, and inferior constrictors, and cricopharyngeus.

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22
Q

What is Killian’s dehiscence?

A

A pharyngeal pouch formation.

Between inferior constrictor and cricopharyngeus, there is an area deficient of muscle at which herniation may occur.

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23
Q

Describe how a patient with a pharyngeal touch would present.

A
  • Dysphagia
  • Delayed regurgitation of food
  • Sometimes recurrent chest infections from aspirated food
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24
Q

Name the 3 pairs of muscles that cause elevation and depression of the pharynx.

A
  1. Stylopharyngeus
  2. Salpingopharyngeus
  3. Palatopharyngeus
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25
Q

What is the commonest cause of obstructive sleep apnoea in children?

A

Adenotonsillar hypertrophy

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26
Q

What is the commonest cause of obstructive sleep apnoea in adults?

A

Obesity

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27
Q

Describe how you would manage obstructive sleep apnoea in children.

A

Adenotonsillectomy

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28
Q

Describe how you would manage obstructive sleep apnoea in adults.

A
  • Advice and lifestyle changes including weight loss
  • CPAP: Continuous Positive Airway Pressure
  • Mandibular positioning devices in selected cases
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29
Q

Name 5 causative organisms of bacterial tonsillitis.

A
  1. Beta-haemolytic Streptococci
  2. Staphylococci
  3. Streptococcus pneumoniae
  4. Haemophilus influenzae
  5. Escherischia coli
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30
Q

Name 4 causative organisms of viral tonsillitis.

A
  1. Rhinovirus
  2. Adenovirus
  3. Enterovirus
  4. Epstein-Barr virus (EBV)
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31
Q

Describe how a patient with a tonsillitis would present.

A
  • Pyrexia
  • Dysphagia
  • Lymphadenopathy
  • Odynophagia
  • Trismus
  • Swollen tonsils with or without exudate
  • Otalgia (Referred pain)
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32
Q

Describe how you would manage a patient with tonsillitis.

A
  • Analgesia
  • Antibiotics
  • Drainage of any peritonsillar abscess
  • Tonsillectomy for recurrent tonsillitis
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33
Q

Why should treatment with amoxicillin in patients with tonsillitis be avoid?

A

This would cause a maculopapular rash in the

presence of EBV (glandular fever)

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34
Q

Why should patients with EBV be advised to

avoid contact sports for 2-3 months?

A

The virus commonly causes hepatosplenomegaly

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35
Q

What is a ‘hot potato’ voice?

A

The “hot potato voice” is widely recognised as a symptom of peritonsillar cellulitis or abscess.

It is a term for a defect of resonance in which the speech has muffled quality.

36
Q

Describe how a patient with a head and neck cancer would present.

A
  • Dysphonia (esp laryngeal malignancy which may cause hoarseness)
  • Dysphagia/odynaphagia
  • Dyspnoea –stridor from narrowing of airway, especially laryngeal tumours
  • Neck Mass
  • Pain from site of pathology or referred e.g. to ear
  • Bleeding from nose or mouth depending on site of primary (rare presentation)
  • Nasal blockage: normally unilateral progressive for nasal/nasopharyngeal
    pathology
37
Q

Describe the commonest histopathology of head and neck cancers.

A

SSC

38
Q

Are women or men more greatly affected by head and neck cancers?

A

Men are affected twice as much as females

39
Q

Name 4 risk factors for head and neck cancers.

A
  • Alcohol
  • Tobacco
  • Beetle nut chewing for oral cavity malignancies
  • Chinese ethnic origin for nasopharyngeal malignancy
40
Q

What staging is most commonly used for head and neck cancers?

A

TNM

41
Q

Describe how TNM staging is applied to head and neck cancers.

A

T= Tumour size, 1 (small) – 4 (big)

N= Nodal Metastasis, 0 (no nodes) - N3 (big/multiple nodes)

M= Distant metastasis 0 (none) – 1 (present)

42
Q

Name 3 investigations that are carried out for patients with a suspected head/ neck cancer.

A
  1. Panendoscopy/ laryngopharyngo-oesophagoscopy (under anaesthetic
    )
  2. Biopsy for histological diagnosis
  3. CT/ MRI Neck
43
Q

Why are head and neck lymph nodes not routinely biopsied via an open incision?

A

This can lead to seeding of the tumour through the wound onto the skin and end up in a worse prognosis for the patient.

44
Q

In what cases would the risk of seeding be considered an acceptable risk for the patient to undergo an open biopsy of their head and neck lymph nodes?

A

Although FNA is very good at diagnosing squamous cell carcinoma it is not so good for other causes of cervical lymphadenopathy such as tuberculosis and lymphoma which often require an open biopsy so in these cases an FNA should be carried out to exclude SCC before an open biopsy is done.

45
Q

Name the arteries, veins and nerves most at risk from thyroid surgery.

A

A: Superior and `inferior arteries

V: Superior, middle, and inferior thyroid veins

N: Recurrent laryngeal nerves

46
Q

Name the neck groove that the recurrent laryngeal nerves run through.

A

Tracheo- oesophageal groove

47
Q

What clinical signs are caused by injury to the recurrent laryngeal nerves?

A
  • Vocal chord palsy
  • Associated voice hoarseness
  • Airway obstruction
48
Q

Describe the investigations that you would carry out to assess a thyroid nodule.

A
  • Thyroid function tests
  • Ultrasound guided fine needle aspiration
  • If there is any diagnostic doubt a hemithyroidectomy should be carried out to give definitive histology
49
Q

Explain why lumpectomies are not done on the thyroid.

A

Because if it is a malignant nodule this will not give adequate margins on the mass and it would also make further surgery very difficult due to scarring and put the recurrent laryngeal nerve at an unacceptably high risk

50
Q

Name the definitive investigation for differentiating between a follicular carcinoma of the thyroid from a follicular adenoma of the thyroid.

A

Hemithyroidectomy

51
Q

Name 3 histological types of non-neoplastic thyroid nodules.

A
  1. Colloid
  2. Cystic
  3. Multinodular

(NOTE: Any dominant nodule should have an FNA)

52
Q

What is the most common type of malignant thyroid neoplasm?

A

Papillary adenocarcinoma – 70% - Often seen in younger patients, or where there is a history of radiation of the neck

53
Q

Name the type of malignant thyroid neoplasm that has a preponderance to metastasis to the bones and lungs.

A

Follicular carcinoma – 20%

54
Q

Name the type of malignant thyroid neoplasm that is a neoplasm of the calcitonin regulating C-cells and has a genetic component.

A

Medullary carcinoma – 5%

55
Q

Name the type of malignant thyroid neoplasm that is typically seen in multiple endocrine neoplasia (MEN).

A

Medullary carcinoma – 5%

(NOTE: therefore screening of other organs involved in MEN syndromes is
required)

56
Q

Name the type of malignant thyroid neoplasm that is typically seen in older patients. It has a poor prognosis and by the time of diagnosis the prognosis if often a matter of weeks to months.

A

Anaplastic carcinoma - 5%

57
Q

Describe why one should aim to restrict management of non-neoplastic thyroid nodules to hemithyroidectomy, rather than a total thyroidectomy.

A

Due to the increased morbidity from a total thyroidectomy and the need for lifelong thyroxine replacement

58
Q

Describe how you would manage a patient with a neoplasia thyroid adenoma.

A

These patients require no further treatment after diagnostic hemithyroidectomy

59
Q

Describe how you would manage a patient with a neoplasia thyroid carcinoma of the papillary, follicular or medullary subtype.

A

Total Thyroidectomy

NOTE: includes Radio-iodine therapy for papillary and follicular carcinoma after surgery

60
Q

Describe how you would manage a patient with a neoplasia thyroid carcinoma of the anaplastic subtype.

A

Anaplastic disease is normally too far advanced for curative surgery

61
Q

Name 4 complications of thyroid surgery.

A
  • Post-operative haemorrhage
  • Airway obstruction
  • Vocal cord palsy
  • Hypocalcaemia
62
Q

Which cranial nerve is most at risk from parotid surgery and parotid malignancy?

A

Facial Nerve (CNVII)

63
Q

Where do 80% of salivary gland neoplasms occur?

A

The parotid gland

64
Q

What percentage of period neoplasms are benign in nature?

A

80%

65
Q

What subtype make up 80% of benign parotid neoplasms?

A

Pleomorphic adenomas

66
Q

In which salivary gland are infections most common?

A

Submandibular

67
Q

Describe the anatomical location of the submandibular gland.

A

inferior to the body of the mandible and superior to the digastric muscle

68
Q

Where does the submandibular gland open?

A

Into the mouth close to the frenulum of the tongue

69
Q

Describe the secretions of of the parotid, submandibular and sublingual glands.

A

Parotid: Serous

Submandibular: Mixed serous and mucous

Sublingual: Mucous

70
Q

Name the 2 nerves that are at risk during submandibular gland surgery.

A
  1. Hypoglossal nerve

2. Lingual nerves

71
Q

What percentage of neoplasms occurring in the submandibular gland are malignant?

A

50%

72
Q

What percentage of neoplasms occurring in the sublingual gland are malignant?

A

80%

73
Q

Name the most common causative bacteria in acute sialadenitis.

A

Staphylococcal infection

74
Q

Name 2 categories of patients in which sialadenitis is typically seen.

A
  1. Dehydrated

2. Immunocompromised

75
Q

Name 4 causative viruses in acute sialadenitis.

A
  1. Paramyxovirus – Mumps
  2. Coxsackievirus
  3. Echovirus
  4. HIV
76
Q

Although rare, name 4 conditions where chronic sialadenitis is seen.

A
  1. TB
  2. Sarcoidosis
  3. HIV
  4. Syphilis
77
Q

Name the salivary gland most likely to be involved with sialolithiasis.

A

Submandibular

78
Q

Describe how a patient with sialolithiasis would present.

A
  • Pain

- Swelling which is worse during meals

79
Q

Describe how to investigate a patient with sialolithiasis.

A

Ultrasound/ sialogram

80
Q

Describe how to manage a patient with sialolithiasis.

A
  • Conservative: analgesia, hydration, sialogogues (a drug that promotes the secretion of saliva)
  • Endoscopy
  • Radiological removal
  • Surgery: Intra-oral removal of palpable stones, removal of salivary gland
81
Q

Name 2 complications of sialolithiasis.

A
  1. Sialadenitis

2. Abscess formation

82
Q

What is Sjögren’s Syndrome?

A

An autoimmune disease causing lymphocytic infiltration into the ductal tissue of secretary glands

83
Q

Describe how a patient with Sjögren’s Syndrome would present.

A
  • Dry eyes
  • Dry mouth
  • Enlarged salivary glands
84
Q

What type of cancer are patients with Sjögren’s Syndrome at an increased risk of developing?

A

Developing lymphoma.

85
Q

What is meant by primary Sjögren’s Syndrome?

A

Xerostomia (dry mouth resulting from reduced or absent saliva flow) and xerophthalmia (abnormal dryness of the conjunctiva and cornea of the eye) without connective tissue abnormality

86
Q

What is meant by secondary Sjögren’s Syndrome?

A

As primary disease, with connective tissue disease, most commonly rheumatoid arthritis.

Year 4: Special Senses (6 decks)

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