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YEAR 3 & 5 CORE CONDITIONS > Mouth and Throat (ENT 5) > Flashcards

Mouth and Throat (ENT 5) Flashcards

1
Q

What are the two main causes of a sore throat?

A

Acute pharyngitis = inflammation of the oropharynx
Tonsillitis

Often in combination = tonsillopharyngitis

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2
Q

What is the centor criteria used for?

A

Identify the likelihood a sore throat is due to a bacterial infection

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3
Q

What makes up the centor criteria and how is it scored?

A 
C - Cough absent
E - tonsillar Exudate
N - Nodes
T - Temperature
OR - young OR old modifier

3 or 4 of these suggest strep throat and would benefit from abx

All 4 absent, unlikely to be bacterial (80% negative predictive value)

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4
Q

What causes most sore throats?

A

Viruses

eg rhinovirus, coronavirus, parainfluenza virus

Strep pyogenes

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5
Q

What is the management of a bacterial sore throat?

A

Penicillin V 500mg QDS for 10 days

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6
Q

What is the management of a bacterial sore throat if penicillin allergic?

A

Clarithromycin 250-500mg BD for 5 days

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7
Q

What is the management of a bacterial sore throat if pregnancy?

A

Erythromycin 250-500mg QDS for 5 days

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8
Q

What are some complications of tonsillitis?

A 
Otitis media
Sinusitis
Quinsy
Pharyngeal abscess
Lemierre syndrome
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9
Q

What is Lemierre syndrome?

A

Acute septicaemia and jugular vein thrombosis secondary to infection with Fusobacterium species

Septic emboli to lungs, bone, muscle, kidney, liver

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10
Q

What clinical features of tonsillitis point towards viral?

A

Headache
Earache
Nasal congestion
Cough

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11
Q

What indicates a peritonsillar abscess may be forming as a complication of tonsillitis?

A

Trismus (lockjaw due to spasms of the jaw musculature)

Changes in voice quality

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12
Q

What is the age modification of the centor criteria?

A 
3-14yrs = 1 point
15-44yr= 0 points
>45 = -1 point

(must be older than 3 years)

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13
Q

What is a submandibular space infection that can present with mouth pain?

A

Ludwig angina

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14
Q

What causative organisms Ludwig angina?

A

Mixed infection - viridans strep and anaerobes

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15
Q

Where does Ludwig angina usually arise from?

A

Infected mandibular molar, an infection of the upper airway or acute lingual tonsillitis

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16
Q

How does ludwig angina present

A 
Mouth pain
Fever
Stiff neck
Difficulty swallowing
Trismus
Airway obstruction may occur
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17
Q

How does EBV present?

A 
Fever
Pharyngitis
Enlarged erythematous tonsils with white and grey deposits
Generalised lymphadenitis
\+/- liver, spleen and skin involvement
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18
Q

What should a sore throat not be treated with? why?

A

Amoxicillin

Causes maculopapular rash if caused by EBV

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19
Q

Why are NSAIDs contraindicated for post tonsillectomy pain relief?

A

Increased risk of bleeding

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20
Q

What are options for tonsillectomy?

A

Subtotal tonsillectomy - tonsils partially removed while capsule remains

Total tonsillectomy

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21
Q

What is a risk of a total tonsillectomy?

A

Post op haemorrhage approx 5%

But now risk that too few tonsillectomies are being done as more adults and children are being hospitalised with throat infections

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22
Q

Recall tonsillectomy eligibility criteria

A

≥ 7 episodes in the past year, OR
≥ 5 episodes/year in the past 2 years, OR
≥ 3 episodes/year in the past 3 years

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23
Q

Strep PHyogenes can lead to what?

A

Streptococcus “PH”yogenes is the most common cause of bacterial pharyngitis

which can result in rheumatic “PHever”

and poststreptococcal glomerulonePHritis

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24
Q

What was the most common causative organism of epiglottis and why have rates gone down?

A

Haemophilus influenzae type b (Hib)

Vaccination programme

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25
Q

Other than Hib, what causes epiglottitis?

A

Strep pyogenes
Strep pneumoniae
Straph aureus

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26
Q

How does epiglottitis present?

A 
Stridor
Acute onset high fever
Toxic appearance
Tripod position
Sore throat
Dyshpagia / odynophaia
Drooling
Muffled hot potato voice
Resp distress
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27
Q

Why is the tripod position adopted in epiglottitis?

A

Eases respiration as the airway diameter is increased by leaning forward and extending the neck in a seated position

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28
Q

What are the 3 x D’s of epiloggittis presentation?

A

Dysphagia
Drooling
Distress

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29
Q

What is the management of epiglottitis?

A

Emergency

Keep pt upright
Do not examine throat or cause distress
ENT / anaesthetist escalation

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30
Q

What may a senior physician do in the management of epiglottitis?

A

Intubation
Video assisted laryngoscopy

Surgical airway if not possible to intubate

31
Q

What surgical airway is used in the management of epiglottitis if over and under 8yrs?

A

> 8yrs - surgical cricothryroidotomy

<8yrs - needle cricothyrotomy

32
Q

What is the medical management of epiglottitis?

A

Steroids - dexamethosone or methylprednisolone
IV fluid resusciation
IV abx - cephalosporins or fluoroquinolone

33
Q

Ddx stridor (acute and chronic)

A 
Acute:
FB inhalation
Epiglottitis
Croup
Laryngitis
Anaphylaxis
Neck space abscess
Chronic:
Laryngomalacia
Subglottic stenosis
Vocal cord paralysis
Macroglossia / micrognathia
Malignancy
34
Q

What most commonly causes subglottis stenosis?

A

Secondary to prolonged intubation

35
Q

Stridor is a red flag. What else is a red flag in terms of stridor development?

A

Volume of stridor sound decreasing

Pt becoming tired and less air is being moved into the lungs

36
Q

What two other sounds must you differentiate stridor from?

A

Stertor

Wheeze

37
Q

What is stertor?

A

A low pitched snoring sound resulting from stenosis between nasopharynx to supraglottic regions

38
Q

What is a wheeze?

A

Polyphonic expiratory airway sound caused by lower airway narrowing

39
Q

How is chronic stridor investigated?

A

Fibreoptic nasal endoscopy
CT - abscess or malignancy
Bronchoscopy - if need visualisation below vocal cords eg subglottic stenosis

40
Q

What is the acute management of stridor?

A 
O2
Suction secretions / remove FB
IV Adrenaline or steroids
Bloods +/- ABG, cultures
Emergency cricothryroidotomy / intubation
41
Q

What should be asked about in a hx of hoarseness?

A

GORD
Smoking
Stress
Singing / shouting

42
Q

What investigations are done for hoarseness?

A

Laryngoscopy to assess cord mobility, mucosa and exclude local causes

43
Q

Ddx for hoarseness?

A 
Viral URTI
Laryngeal cancer
Vocal cord palsy
Laryngitis
Reflux laryngitis
Reinke's oedema
Vocal cord nodules
Muscle tension dysphonia
Laryngeal papillomas
44
Q

How does muscle tension dysphonia present?

A

Hoarseness worsening towards the end of the day or following prolonged use

45
Q

Compare vocal cord polyps to nodules

A

Nodules - freq bilateral

Polyps - often unilateral and require surgical excision to exclude malignancy

46
Q

What are laryngeal papillomas often caused by?

A

HPV

Benign lesions

47
Q

What is Reinke’s oedema? What is it linked with?

A

Oedema of vocal cords

Linked to smoking in females

48
Q

Damage to what nerve causes hoarseness?

A

Recurrent laryngeal off the vagus

49
Q

What can cause a recurrent laryngeal nerve palsy?

A 
Thyroid cancer
Lung cancer
Aortic aneurysm
MS
Stroke
50
Q

What is spasmodic dysphnia?

A

Involuntary spasms in vocal cords

Symptoms can vary day to day and with anxiety

51
Q

What is the management ofspasmodic dysphonia?

A

Botox injections

52
Q

What advice can be given for vocal hygiene?

A 
Hydration
Sleep
Adequate breaths whilst speaking
Steam inhalation
Avoid shouting / whispering
Avoid irritants eg spicy food, smoking
Avoid eating late at night as indigestion can affect voice
Avoid throat lozenges - numb and dry throat
53
Q

What is globus pharyngeus?

A

Feeling of a lump in the throat where no true lump exists

Can lead to frequent clearing of throat

Noticed most when swallowing saliva

54
Q

How is globus diagnosed?

A

Diagnosis of exclusion

55
Q

List types of oral cavity cancers (3)

A

Oral mucosal cancer
Salivary gland cancer
Tonsillar cancer

56
Q

What are the main types of oral mucosal cancer?

A

SCC (most)

Ulcerative or verrucuous growth

57
Q

What is the most common salivary gland cancer?

A

Mucoepidermoid carcinoma

58
Q

What are the main types of tonsillar cancer?

A

SCC (>70%)

Lymphoma

59
Q

How do oral cavity cancers present?

A 
Halitosis
Pain eg earache
Dysphagia
Non healing ulcers
Unusual bleeding in mouth
Facial swelling
Lymphadenopathy
60
Q

How are oral cavity cancers investigated?

A 
Biopsy and histopathology
Panendoscopy (mouth, nose, voice box and oesophagus)
HPV testing
CXR
Axial CT
PET CT
61
Q

What is the management of oral cavity cancers?

A

Surgical resection

  • Maxillectomy
  • Mandibulectomy
  • Glossectomy
  • Laryngectomy
  • Radical neck dissection

Chemo
Radio

62
Q

Why may HPV positive tumours carry a better prognosis?

A

Better response to chemo / radiotherapy

63
Q

Red flags for neck lumps

A 
Hard / fixed lump
Associated otalgia, dysphagia, stridor, hoarseness
Epistaxis or unilateral nasal congestion
B symptoms
Cranial nerve palsies

Children:

  • Supraclavicular mass
  • Lump >2cm
64
Q 
Ddx neck lump:
Infective
Neoplastic
Vascular
Inflammatory
Traumatic
AI
Congenital
A 
Reactive lymphadenopathy
Lymphoma
Head and neck cancer
Metastatic disease
Carotid body tumour
Sarcoidosis
Haematoma
Thryoid disease eg Grave's or hashimotos
Cysts (thyrogossal, branchial, dermoid)
65
Q

How are neck lumps investigated?

A

US +/- FNA
CT
MRI

66
Q

How does a thyroglossal cyst present?

A

Painless midline mass that moves up with protrusion of tongue

67
Q

How does a carotid body tumour present?

A

Pulsatile painless neck lump
Bruit on auscultation
Slow growing but can become large enough to compress surrounding cranial nerves leading to palsies

68
Q

Where to branchial cysts arise?

A

Lateral aspect of neck

Anterior to sternocledomastoid

69
Q

How does trigeminal neuralgia present?

A

Unilateral facial pain

Severe shooting / stabbing followed by burning ache
Typically from mouth to angle of jaw
Lasts several seconds but can last up to minutes, can occur up to 100 times a day
At rest or triggered by movements eg chewing
Facial spasms may occur

70
Q

How is trigeminal neuralgia diagnosed?

A

Clinical diagnosis

MRI to exclude structural cause

71
Q

What is the management of trigeminal neuralgia?

A

Carbamazepine

Max dose 200mg 3 - 4 times a day (max 1,600mg daily)

When in remission, reduce dose and gradually withdraw

72
Q

What can present similarly to trigeminal neuralgia?

A

Tumours eg posterior fossa tumours
MS
Cysts
Aneurysms

73
Q

What are common causes of oral ulcers?

A

Apthous ulcer
Behcet ulcer
Oral lichen planus
Recurrent erythema ultiforme

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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