Non-Malignant Head and Neck Flashcards
What are the two main questions to ask about a sore throat?
Can you swallow spit?
Can you swallow food?
Definition of odynophagia
Painful to swallow
Definition of dysphagia
Cannot swallow
Drainage of the middle ear
Middle ear -> eustachian tube -> adenoids
What antibiotic should be given usually for infections? What antibiotic should be avoided?
Penicillin V should be given
Amoxicillin avoided
What will FBC tell you in terms of infection?
The type of infection
What should you check to see if the patient is dehydrated?
Renal function
What is a monospot a test for?
Glandular fever
What is CRP a marker of?
Inflammation
Which type of infection does CRP tend to be higher in, bacterial or viral?
Bacterial
What other organs can glandular fever affect?
Liver
Spleen
What additional test should be done in glandular fever?
LFTs
What is penicillin IV?
Benzylpenicillin
Where do you get very sore pain in quinsy?
Throat
Up to ear
Symptoms of quinsy
Very painful
Pain spread up to ear
Cannot open mouth very well
Why is it difficult to open your mouth when you have a quinsy?
The pterygoid can go into spasm
Treatment of quinsy
Analgesia
Antibiotics
May need to drain
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?
Bleeding
10%
What % of patients need a further operation or transfusion after tonsillectomy?
1%
Why is it important to give good painkillers after tonsillectomy?
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
Progression to get OSA
Hypotonic collapsing of airway
Leads to snoring
Then get OSA
Definition of apnoea
A pause in the breath
What does OSA stand for?
Obstructive sleep apnoea
What level does a sturtor come from?
Oropharyngeal
What does a sturtor produce?
A snoring noise
What level does a stridor come from?
Laryngeal level
What level does a wheeze come from?
Lungs
What does nebulised adrenaline do?
Reduces oedema
What causes supraglottitis?
Haemophilus type B
Causes of hoarseness
Age Infective laryngitis Voice overuse Reflux laryngitis Emotional factors RLN palsy (iatrogenic or neoplastic) CVA Fixation of joint e.g. RA Laryngeal tumour
Indications for consideration for recurrent acute sore throat in both children and adults
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
What should be done when there is doubt whether tonsillectomy would be beneficial?
A six month period of watchful waiting
The pain can increase for how long after a tonsillectomy?
6 days
What drugs are recommended after tonsillectomy?
Analgesics
Anti emetics
NSAIDs
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
Single dose of dexamethasone
What feature favours a diagnosis of tonsillitis?
ABSENCE of a cough
What criteria is used to determine if a tonsillitis episode is bacterial?
Centor criteria
What is the Centor criteria for bacterial tonsillitis?
3 out of 4 of
- Temp > 38 C
- Tender anterior cervical lymphadenopathy
- Absence of a cough
- Exudate present on the tonsils
Antibiotic of choice for acute sinusitis
Oral phenoxymethylpenicillin
Cause of ramsey hunt syndrome
Reactivation of the VZV in the geniculate ganglion of the seventh CN
Another name for ramsey hunt syndrome
Herpes zoster oticus
Presentation of ramsey hunt syndrome
Auricular pain often first feature Facial nerve palsy Vesicular rash around the ear Vertigo Tinnitus
Treatment of ramsey hunt syndrome
Oral acyclovir
Corticosteroids
What is the FEVERPAIN score and what does it predict?
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
What is sialadenitis?
Inflammation of the salivary gland
What is sialadenitis usually due to?
A stone impacted in the duct
Causes of swelling of the submandibular gland
Obstruction by stone
Tumour - benign or malignant
Most common cause of inflammation of parotid gland
Tumours
Most common cause of inflammation of submandibular gland
Stones
Who gets pleomorphic adenomas?
Middle aged
Presentation of pleomorphic adenoma
Slow growing
Painless lump
Presentation of salivary duct stones
Recurrent unilateral pain and swelling on eating
Which salivary gland are 80% of stones found in?
Submandibular gland
Causes of salivary gland enlargement
Stone Tumour Acute viral infection e.g. mumps Acute bacterial infection e.g. secondary to dehydration DM Sicca syndrome and sjrogens (e.g. RA)
Treatment of quinsy
IV antibiotics
Surgical drainage
Tonsillectomy should be considered within 6 weeks
