Non-Malignant Head and Neck

Question 1

What are the two main questions to ask about a sore throat?

Answer 1

Can you swallow spit?

Can you swallow food?

Question 2

Definition of odynophagia

Answer 2

Painful to swallow

Question 3

Definition of dysphagia

Answer 3

Cannot swallow

Question 4

Drainage of the middle ear

Answer 4

Middle ear -> eustachian tube -> adenoids

Question 5

What antibiotic should be given usually for infections? What antibiotic should be avoided?

Answer 5

Penicillin V should be given

Amoxicillin avoided

Question 6

What will FBC tell you in terms of infection?

Answer 6

The type of infection

Question 7

What should you check to see if the patient is dehydrated?

Answer 7

Renal function

Question 8

What is a monospot a test for?

Answer 8

Glandular fever

Question 9

What is CRP a marker of?

Answer 9

Inflammation

Question 10

Which type of infection does CRP tend to be higher in, bacterial or viral?

Answer 10

Bacterial

Question 11

What other organs can glandular fever affect?

Answer 11

Liver

Spleen

Question 12

What additional test should be done in glandular fever?

Answer 12

LFTs

Question 13

What is penicillin IV?

Answer 13

Benzylpenicillin

Question 14

Where do you get very sore pain in quinsy?

Answer 14

Throat

Up to ear

Question 15

Symptoms of quinsy

Answer 15

Very painful
Pain spread up to ear
Cannot open mouth very well

Question 16

Why is it difficult to open your mouth when you have a quinsy?

Answer 16

The pterygoid can go into spasm

Question 17

Treatment of quinsy

Answer 17

Analgesia
Antibiotics
May need to drain

Question 18

What is there a significant risk of during tonsillectomy? What % of people struggle with this after the operation and have to come back into hospital?

Answer 18

Bleeding

10%

Question 19

What % of patients need a further operation or transfusion after tonsillectomy?

Answer 19

1%

Question 20

Why is it important to give good painkillers after tonsillectomy?

Answer 20

If the throat is sore, patients tend not to eat. This means the mouth isn’t cleaned properly naturally, which leads to infection and bleeding

Question 21

Progression to get OSA

Answer 21

Hypotonic collapsing of airway
Leads to snoring
Then get OSA

Question 22

Definition of apnoea

Answer 22

A pause in the breath

Question 23

What does OSA stand for?

Answer 23

Obstructive sleep apnoea

Question 24

What level does a sturtor come from?

Answer 24

Oropharyngeal

Question 25

What does a sturtor produce?

Answer 25

A snoring noise

Question 26

What level does a stridor come from?

Answer 26

Laryngeal level

Question 27

What level does a wheeze come from?

Answer 27

Lungs

Question 28

What does nebulised adrenaline do?

Answer 28

Reduces oedema

Question 29

What causes supraglottitis?

Answer 29

Haemophilus type B

Question 30

Causes of hoarseness

Answer 30

``` Age Infective laryngitis Voice overuse Reflux laryngitis Emotional factors RLN palsy (iatrogenic or neoplastic) CVA Fixation of joint e.g. RA Laryngeal tumour ```

Question 31

Indications for consideration for recurrent acute sore throat in both children and adults

Answer 31

Sore throat due to acute tonsillitis The episodes of sore throat are disabling and prevent normal functioning Seven or more well documented, clinically significant, adequately treated sore throats in the preceding year or Five or more such episodes in each of the preceding two years or Three or more such episodes in each of the preceding 3 years

Question 32

What should be done when there is doubt whether tonsillectomy would be beneficial?

Answer 32

A six month period of watchful waiting

Question 33

The pain can increase for how long after a tonsillectomy?

Answer 33

6 days

Question 34

What drugs are recommended after tonsillectomy?

Answer 34

Analgesics Anti emetics NSAIDs

Question 35

What is recommended to be given intraoperatively in children having a tonsillectomy or adenoidectomy to prevent post op vomiting? And at induction of anaesthesia in adults

Answer 35

Single dose of dexamethasone

Question 36

What feature favours a diagnosis of tonsillitis?

Answer 36

ABSENCE of a cough

Question 37

What criteria is used to determine if a tonsillitis episode is bacterial?

Answer 37

Centor criteria

Question 38

What is the Centor criteria for bacterial tonsillitis?

Answer 38

3 out of 4 of - Temp > 38 C - Tender anterior cervical lymphadenopathy - Absence of a cough - Exudate present on the tonsils

Question 39

Antibiotic of choice for acute sinusitis

Answer 39

Oral phenoxymethylpenicillin

Question 40

Cause of ramsey hunt syndrome

Answer 40

Reactivation of the VZV in the geniculate ganglion of the seventh CN

Question 41

Another name for ramsey hunt syndrome

Answer 41

Herpes zoster oticus

Question 42

Presentation of ramsey hunt syndrome

Answer 42

``` Auricular pain often first feature Facial nerve palsy Vesicular rash around the ear Vertigo Tinnitus ```

Question 43

Treatment of ramsey hunt syndrome

Answer 43

Oral acyclovir | Corticosteroids

Question 44

What is the FEVERPAIN score and what does it predict?

Answer 44

Likelihood of sore throat caused by isolating strep Criteria - Fever > 38C - Purulence (pharyngeal/tonsillar exudate) - Attend rapidly (3 days or less) - Severely inflamed tonsils - No cough or coryza

Question 45

What is sialadenitis?

Answer 45

Inflammation of the salivary gland

Question 46

What is sialadenitis usually due to?

Answer 46

A stone impacted in the duct

Question 47

Causes of swelling of the submandibular gland

Answer 47

Obstruction by stone | Tumour - benign or malignant

Question 48

Most common cause of inflammation of parotid gland

Answer 48

Tumours

Question 49

Most common cause of inflammation of submandibular gland

Answer 49

Stones

Question 50

Who gets pleomorphic adenomas?

Answer 50

Middle aged

Question 51

Presentation of pleomorphic adenoma

Answer 51

Slow growing | Painless lump

Question 52

Presentation of salivary duct stones

Answer 52

Recurrent unilateral pain and swelling on eating

Question 53

Which salivary gland are 80% of stones found in?

Answer 53

Submandibular gland

Question 54

Causes of salivary gland enlargement

Answer 54

``` Stone Tumour Acute viral infection e.g. mumps Acute bacterial infection e.g. secondary to dehydration DM Sicca syndrome and sjrogens (e.g. RA) ```

Question 55

Treatment of quinsy

Answer 55

IV antibiotics Surgical drainage Tonsillectomy should be considered within 6 weeks