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Y2 ENT > Mouth and throat > Flashcards

Mouth and throat Flashcards

1
Q

2 types of HSV

A

HSV1
HSV2

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2
Q

Which type of HSV does not cause oral lesions? What lesion does it cause instead?

A

HSV2
It causes genital lesions

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3
Q

What is the hallmark feature of all herpes viruses

A

They can establish latent infections that can be reactivated and persist for the life of the individual

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4
Q

Primary HSV presentation

A

Primary gingivostomatis - painful ulcers on lips, hard palate, buccal mucosa (inner lining of cheeks)
Fever
Local lymphadenopathy

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5
Q

Where does HSV1 establish a latent infection

A

Trigeminal ganglia

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6
Q

What triggers the reactivation of latent HSV1 in trigeminal ganglia

A

Stress
Trauma
Febrile illnesses
UV radiation

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7
Q

Presentation of latent HSV

A

Herpes labials - cold sores

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8
Q

What is herpetic whitlow

A

HSV infection of the finger

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9
Q

How to prevent herpetic whitlow from spreading

A

Use of gloves

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10
Q

What is herpes simplex encephalitis

A

Inflammation of the brain due to HSV1

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11
Q

Symptoms of herpes simplex encephalitis

A

Fever
Headache
Seizures
Impaired consciousness
Sudden behavioural change

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12
Q

Investigations for HSV

A

Swab of lesion

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13
Q

Management for HSV

A

Aciclovir

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14
Q

HSV can cause which condition in a patient with atopic dermatitis

A

Eczema herpeticum

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15
Q

Management of eczema herpeticum

A

IV acyclovir

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16
Q

What is hand, foot and mouth disease

A

Oral enanthum + macular/vesicular/maculopapular rash of the hands and feet

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17
Q

Most common cause of hand, foot and mouth disease in children

A

Coxsackie virus A16

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18
Q

Hand, foot and mouth disease is usually preceded by

A

One day history of fever and lethargy

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19
Q

Management of hand, foot and mouth disease

A

Self-limiting - usually resolves within 10 days
Does not need to be isolated

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20
Q

Is hand, foot and mouth disease contagious

A

yes, most contagious in the first 5 days
Avoid sharing towels / items
Keep off school until the child is feeling better, no need to wait for the blisters to heal

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21
Q

What is aphthous ulcer

A

Recurrent ulcer in the mouth such as inside the lips / underneath the tongue / inside cheeks

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22
Q

Difference between aphthous ulcer and cold sores

A

Aphthous ulcers are not contagious
Aphthous ulcers do not occur on surface of lips
Aphthous ulcers are not caused by viruses

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23
Q

Management of aphthous ulcer

A

Self-limiting - resolves in less than 3 weeks

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24
Q

What is the causative pathogen of oral candidiasis

A

Candida albicans - fungus

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25
Q

Risk factors of oral candidiasis

A

Post antibiotics
Immunosuppresed
Smokers
Inhaled steroids

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26
Q

Management of oral candidiasis

A

Nystatin
Fluconazole

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27
Q

What is Behçet’s disease

A

Multi-organ disease caused by systemic vasculitis

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28
Q

What is the most common symptom presented in Behçet’s disease

A

Recurrent oral ulcers

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29
Q

Symptoms of Behçet’s disease

A

Recurrent oral ulcers
Recurrent genital ulcers
Uveitis
Erythema nodosum

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30
Q

Behect’s disease is common in which part of the world

A

Middle East
Asia

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31
Q

Which GI disease can cause recurrent aphthous ulcers

A

Coeliac
IBD

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32
Q

Which skin conditions can cause oral ulcers

A

Pemphigus vulgaris (almost always causes oral ulcers)
Lichen planus

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33
Q

Which age groups do squamous cell papilloma of the mouth affect

A

<5 years old
20-40 years old

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34
Q

Which disease is squamous cell papilloma of the mouth related to

A

HPV

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35
Q

Presentation of squamous cell papilloma of the mouth

A

Painless lesion in mouth

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36
Q

Where does squamous cell papilloma of the mouth usually affect

A

Soft palate
Hard palate
Tongue
Lips
Tonsils
Oesophagus

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37
Q

Management of squamous cell papilloma of the mouth

A

most do not need treatment
cryotherapy
Topical salicylic acid
Surgical excision

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38
Q

Which salivary gland is the most common site for tumours

A

Parotid gland

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39
Q

Are most of the parotid gland tumours malignant

A

No - 60% are benign
Tumours at smaller salivary glands are more likely to be malignant

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40
Q

What are the types of benign tumours of the salivary gland

A

Pleomorphic adenoma
Warthin’s tumour

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41
Q

What is the most common benign salivary gland tumour

A

Pleomorphic adenoma

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42
Q

Is there a risk of malignant transformation for pleomorphic adenoma

A

Yes, if the tumour has been there for a long time

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43
Q

Pleomorphic adenoma most commonly occurs in

A

Females
30-60 years old

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44
Q

Histological appearance for pleomorphic adenoma

A

Epithelial + myoepithelial cells
Chondromyxoid stroma
With an outer fibrous capsule

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45
Q

Warthin’s tumour is most commonly seen in

A

Males
Over 50
Smokers - strongly associated with smoking

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46
Q

What are the malignant tumours of salivary gland

A

Mucoepidermoid carcinoma
Adenoid cyst carcinoma

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47
Q

Who should you suspect to have malignant tumour of salivary gland

A

Young patients
w Painful mass

48
Q

Most common type of malignant salivary gland tumour worldwide

A

Mucoepidermoid carcinoma

49
Q

most common type of malignant salivary gland in UK

A

Adenoid cystic carcinoma

50
Q

Adenoid cystic carcinoma usually affects

A

Those over 40

51
Q

Which structures can adenoid cystic carcinoma affect

A

Parotid gland
Palate

52
Q

Malignant tumours of the salivary gland usually causes

A

Facial nerve palsy

53
Q

Management of tumours of salivary glands

A

Resection of tumours - no matter benign or malignant

54
Q

What structures may be damaged in parotidectomy

A

Facial nerve
External carotid artery
Retromandibular vein

55
Q

Acute tonsillitis often occurs with

A

Pharyngitis

56
Q

Most common cause of acute tonsillitis

A

Viral tonsillitis

57
Q

What are the viral causes of acute tonsillitis

A

EBV
Rhinovirus
Influenza
Parainfluenza
Enterovirus
Adenovirus

58
Q

What are the bacterial causes of acute tonsillitis

A

Strep pyogenes
Strep pneumoniae
H. influenza

59
Q

Pharyngitis can be due to non-infectious causes as well. What are the non-infectious causes of pharyngitis

A

GORD
Chronic irritation from smoking

60
Q

Symptoms of viral tonsillitis

A

Malaise
Sore throat
Cough
Able to undertake normal activity
Mild fever

61
Q

Symptoms of bacterial tonsillitis

A

Fever >38
Odynophagia
Halitosis
Unable to work / school
Lymphadenopathy

62
Q

How long does viral tonsillitis usually last

A

3-4 days

63
Q

How long does bacterial tonsillitis usually last

A

1 week

64
Q

How to differentiate between viral and bacterial tonsillitis

A

Bacterial
- NO COUGH
- Higher fever
- Tonsillar exudate
- presence of lymphadenopathy

65
Q

Which criteria are used for tonsillitis that suggests a bacterial cause

A

CENTOR criteria
FeverPAIN

66
Q

What are the factors in CENTOR criteria that suggests bacterial tonsillitis

A
  1. Tonsillar exudate
  2. Tender cervical lymphadenopathy
  3. Fever >38
  4. No cough
67
Q

A score of 3-4 in CENTOR criteria suggests

A

32-56% likelihood of strep causing tonsillitis

68
Q

What are the factors of FeverPAIN criteria that suggests bacterial tonsillitis

A

Fever
Purulence
Attend rapidly within 3 days (onset)
very Inflamed tonsils
No cough

69
Q

Investigations for acute tonsillitis

A

History and clinical examination
CENTOR and FeverPAIN criteria

70
Q

What are the scoring criteria used for in acute tonsillitis

A

To see who is more likely to benefit from antibiotics

71
Q

What CENTOR score would indicate prescribing antibiotics

A

3/4

72
Q

What FeverPAIN score would indicate prescribing antibiotics

A

4/5
2-3 suggests moderate association w strep hence consider delayed prescription for antibiotics

73
Q

Management of acute tonsillitis

A

Eat and drink
Rest
Regular analgesia
Lozenges
Antibiotics if indicated by scoring system

74
Q

Antibiotics used for acute tonsillitis

A

Penicillin or clarithromycin if allergic

75
Q

When should you admit a patient with acute tonsillitis

A

If present with
- stridor
- breathing difficulty
- dehydration
- persistent sore throat that lasts for 3-4 weeks
- persistent sore throat with neck mass
- persistent lesions in oral / pharyngeal mucosa

76
Q

Management of tonsillitis in hospital

A

IV fluids
IV antibiotics
Tonsillectomy for recurrent tonsillitis in adults

77
Q

Complications of tonsillitis

A

Otitis media
Quincy - peritonsillar abscess
Parapharyngeal abscess
Rheumatic fever
Glomerulonephritis

78
Q

Symptoms of rheumatic fever

A

fever
arthritis
pancarditis

3 weeks post strep pyogene infection

79
Q

What is quinsy

A

When abscess forms between one of the tonsils and wall of throat due to spread of infection

80
Q

When does quinsy usually occur

A

3-7 days after onset of tonsillitis

81
Q

Presentation of quinsy

A

Displacement of tonsil and uvula
Loss of concavity of palate

82
Q

Management of quinsy

A

Aspiration
IV antibiotics

83
Q

What is considered as chronic tonsillitis

A

Infection of the tonsils that persist beyond 2 weeks

84
Q

Presentation of chronic tonsillitis

A

Chronic sore throat
Very unpleasant breath
Tonsil stones
Persistent cervical lymphadenopathy

85
Q

Management of chronic tonsillitis

A

Dental mouthwash

86
Q

Neutropenia can be caused by

A

Severe sepsis
Bone marrow failure due to malignancy
Drugs
Felty’s syndrome
Hypersplenism

87
Q

Which drugs are associated as cause of neutropenia

A

Carbamazepine
Carbimazole / propythiouracil
Clozapine
DMARD - methotrexate, azathioprine, sulfasalazine, hydroxychloroquine

88
Q

Diphtheria is caused by

A

Corynebacterium diphtheria

89
Q

Presentation of diphtheria

A

Severe sore throat
Grey-white coating over pharynx / nose / tonsils (pseudomembrane)

90
Q

What can happen to pseudomembrane in diphtheria if left untreated

A

Becomes very large and obstruct airway

91
Q

Management of diphtheria

A

Penicillin or erythromycin
Diphtheria antitoxin if severe

92
Q

What is glandular fever (infectious mononucleosis)

A

infection caused by EBV

93
Q

Glandular fever most commonly affects which age group

A

young adults

94
Q

Primary glandular fever present in different ages has different severity. At which age does glandular fever cause more severe infection

A

Teenagers > 10 years old

95
Q

How does glandular fever spread

A

By saliva

96
Q

What is the classic triad of glandular fever

A

Fever
Pharyngitis
Lymphadenopathy

97
Q

Symptoms of glandular fever

A

Fever
Pharyngitis / sore throat / tonsillitis
Malaise

98
Q

Signs of glandular fever

A

Tonsillar enlargement with membranous exudates
Cervical lymphadenopathy
Palatal petechial haemorrhage
Hepatomegaly
Splenomegaly
Jaundice
Rash

99
Q

What are palatal petechial haemorrhage

A

Pinpoint red macule in oral cavity

100
Q

Investigations for glandular fever

A

Bloods - low CRP
EBV serology
Deranged liver function tests

101
Q

Management for glandular fever

A

Self limiting - paracetamol
Systemic steroids if severe
Avoid sports for 6 weeks

102
Q

Complications of glandular fever

A

Anaemia
Thrombocytopenia
Splenic rupture
Upper airway obstruction
Increased risk of lymphoma

103
Q

Cause of Acute epiglottitis

A

H influenza B (not common anymore due to vaccines)
Strep pneumoniae
Strep pyogenes
S aureus

104
Q

Children can still present with acute epiglottitis if

A

Missed the vaccination
Born overseas with poor immunisation coverage

105
Q

Symptoms of acute epiglottitis

A

Severe sore throat - cannot speak or swallow
Drooling saliva
High fever
Stridor
Breathing difficulty
Child sits immobile / upright with open mouth

106
Q

What are the 4Ds that suggest acute epiglottitis

A

Dysphagia
Dysphonia
Drooling
Distress

107
Q

Acute epiglottitis most commonly affects which age group

A

1-6 years olds

108
Q

Investigations for acute epiglottitis

A

DO NOT EXAMINE the child without seniors / sufficient staff
Urgent referral to ENT

109
Q

Why shouldn’t you examine a child with acute epiglottitis without seniors around

A

High risk of laryngeal spasm causing total airway obstruction

110
Q

Management of mild acute epiglottitis

A

Supportive
Oral antibiotics
Nebulisers

111
Q

Management of severe acute epiglottitis

A

Secure airway via intubation
Take cultures and examine the throat
IV cefuroxime

112
Q

What is Reinke’s oedema

A

Swelling of vocal cords due to fluid collected in Reinke’s space

113
Q

Where is Reinke’s space

A

The space right below the squamous epithelium of vocal cord

114
Q

Most common cause of Reinke’s oedema

A

Smoking

115
Q

Symptoms of Reinke’s oedema

A

Hoarse voice
Dysphonia
Throat discomfort

116
Q

Management of Reinke’s oedema

A

Smoking cessation
Voice therapy
Surgery

Y2 ENT (7 decks)

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