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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
Other than Hib, what causes epiglottitis?
Strep pyogenes Strep pneumoniae Straph aureus
26
How does epiglottitis present?
``` Stridor Acute onset high fever Toxic appearance Tripod position Sore throat Dyshpagia / odynophaia Drooling Muffled hot potato voice Resp distress ```
27
Why is the tripod position adopted in epiglottitis?
Eases respiration as the airway diameter is increased by leaning forward and extending the neck in a seated position
28
What are the 3 x D's of epiloggittis presentation?
Dysphagia Drooling Distress
29
What is the management of epiglottitis?
Emergency Keep pt upright Do not examine throat or cause distress ENT / anaesthetist escalation
30
What may a senior physician do in the management of epiglottitis?
Intubation Video assisted laryngoscopy Surgical airway if not possible to intubate
31
What surgical airway is used in the management of epiglottitis if over and under 8yrs?
>8yrs - surgical cricothryroidotomy <8yrs - needle cricothyrotomy
32
What is the medical management of epiglottitis?
Steroids - dexamethosone or methylprednisolone IV fluid resusciation IV abx - cephalosporins or fluoroquinolone
33
Ddx stridor (acute and chronic)
``` Acute: FB inhalation Epiglottitis Croup Laryngitis Anaphylaxis Neck space abscess ``` ``` Chronic: Laryngomalacia Subglottic stenosis Vocal cord paralysis Macroglossia / micrognathia Malignancy ```
34
What most commonly causes subglottis stenosis?
Secondary to prolonged intubation
35
Stridor is a red flag. What else is a red flag in terms of stridor development?
Volume of stridor sound decreasing Pt becoming tired and less air is being moved into the lungs
36
What two other sounds must you differentiate stridor from?
Stertor | Wheeze
37
What is stertor?
A low pitched snoring sound resulting from stenosis between nasopharynx to supraglottic regions
38
What is a wheeze?
Polyphonic expiratory airway sound caused by lower airway narrowing
39
How is chronic stridor investigated?
Fibreoptic nasal endoscopy CT - abscess or malignancy Bronchoscopy - if need visualisation below vocal cords eg subglottic stenosis
40
What is the acute management of stridor?
``` O2 Suction secretions / remove FB IV Adrenaline or steroids Bloods +/- ABG, cultures Emergency cricothryroidotomy / intubation ```
41
What should be asked about in a hx of hoarseness?
GORD Smoking Stress Singing / shouting
42
What investigations are done for hoarseness?
Laryngoscopy to assess cord mobility, mucosa and exclude local causes
43
Ddx for hoarseness?
``` Viral URTI Laryngeal cancer Vocal cord palsy Laryngitis Reflux laryngitis Reinke's oedema Vocal cord nodules Muscle tension dysphonia Laryngeal papillomas ```
44
How does muscle tension dysphonia present?
Hoarseness worsening towards the end of the day or following prolonged use
45
Compare vocal cord polyps to nodules
Nodules - freq bilateral | Polyps - often unilateral and require surgical excision to exclude malignancy
46
What are laryngeal papillomas often caused by?
HPV | Benign lesions
47
What is Reinke's oedema? What is it linked with?
Oedema of vocal cords Linked to smoking in females
48
Damage to what nerve causes hoarseness?
Recurrent laryngeal off the vagus
49
What can cause a recurrent laryngeal nerve palsy?
``` Thyroid cancer Lung cancer Aortic aneurysm MS Stroke ```
50
What is spasmodic dysphnia?
Involuntary spasms in vocal cords Symptoms can vary day to day and with anxiety
51
What is the management ofspasmodic dysphonia?
Botox injections
52
What advice can be given for vocal hygiene?
``` 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
What is globus pharyngeus?
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
How is globus diagnosed?
Diagnosis of exclusion
55
List types of oral cavity cancers (3)
Oral mucosal cancer Salivary gland cancer Tonsillar cancer
56
What are the main types of oral mucosal cancer?
SCC (most) | Ulcerative or verrucuous growth
57
What is the most common salivary gland cancer?
Mucoepidermoid carcinoma
58
What are the main types of tonsillar cancer?
SCC (>70%) | Lymphoma
59
How do oral cavity cancers present?
``` Halitosis Pain eg earache Dysphagia Non healing ulcers Unusual bleeding in mouth Facial swelling Lymphadenopathy ```
60
How are oral cavity cancers investigated?
``` Biopsy and histopathology Panendoscopy (mouth, nose, voice box and oesophagus) HPV testing CXR Axial CT PET CT ```
61
What is the management of oral cavity cancers?
Surgical resection - Maxillectomy - Mandibulectomy - Glossectomy - Laryngectomy - Radical neck dissection Chemo Radio
62
Why may HPV positive tumours carry a better prognosis?
Better response to chemo / radiotherapy
63
Red flags for neck lumps
``` Hard / fixed lump Associated otalgia, dysphagia, stridor, hoarseness Epistaxis or unilateral nasal congestion B symptoms Cranial nerve palsies ``` Children: - Supraclavicular mass - Lump >2cm
64
``` Ddx neck lump: Infective Neoplastic Vascular Inflammatory Traumatic AI Congenital ```
``` 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
How are neck lumps investigated?
US +/- FNA CT MRI
66
How does a thyroglossal cyst present?
Painless midline mass that moves up with protrusion of tongue
67
How does a carotid body tumour present?
Pulsatile painless neck lump Bruit on auscultation Slow growing but can become large enough to compress surrounding cranial nerves leading to palsies
68
Where to branchial cysts arise?
Lateral aspect of neck | Anterior to sternocledomastoid
69
How does trigeminal neuralgia present?
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
How is trigeminal neuralgia diagnosed?
Clinical diagnosis | MRI to exclude structural cause
71
What is the management of trigeminal neuralgia?
Carbamazepine Max dose 200mg 3 - 4 times a day (max 1,600mg daily) When in remission, reduce dose and gradually withdraw
72
What can present similarly to trigeminal neuralgia?
Tumours eg posterior fossa tumours MS Cysts Aneurysms
73
What are common causes of oral ulcers?
Apthous ulcer Behcet ulcer Oral lichen planus Recurrent erythema ultiforme

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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