Nose And Throat Conditions Flashcards
Nasal polyp
Ciliated col epith with thickened bm and avasc oedematous stroma.
-sites- middle turbinates and meatus. Maxillary antrum. Antrochoanal NP polyps.
Worry if unilat obstruc esp if pain or bleed. Eg NP CA, glioma, lymphoma, neuroblastoma, sarcoma.
-px- watery rhonorrhoea, purulent post nasal drip, obstruc, vice change, anosmia, taste change, sinusitis, headache, mouth breathing, snoring, mucocoele, pain. Pale, mobile and insesntivie to gentle palpat.
-assocs- rhinitis, chronic ethmoid sinusitis, CF, asp hypersens, asthma.
-tx-
Drugs- 1% betamethasone drops or spray. 1-2wk oral prednisolone poor ev. Antileukotrienes and contin clarithromycin 2wk.
Endoscopic polypectomy.
Epistaxis
-causes/assoc-
Trauma, HTN, infec, dyscrasia/haemophilia, alc, septal perforat, neop.
-types-
Ant us septal, esp little area. (Anast of ant ethmoidal, sphenopalatine, and facial As). Tx- silver nitrate cauterisation if recurr.
Post is more serious. Tx- packing, diathermy, corec septal deviat, ligation sphenopalatine/maxilary A.
Nasal vestibulitis
Skin staph infec.
AB lotion.
Tonsillitis
Viral vs bact centor score- (not disting glandular fever from bact tonsillitis but gland fever will not resp to AB). Nodes, lack cough, pus. Viral red and inflamed only.
Gland fever dx by EBV blood test, FBC and LFT. Cant tx. Is recurr. Can last 18mnth. So dx not to treat but for LT mx.
-tonsillitis- sore throat with or w/o lymphadenop (esp jugulodigastric). Often grp A strep eg pyogenes. Also staph, moraxella catarhalis, mycoplasma, chlamydia, haemphilus.
-tx-
Paracetamol
Pen if centor pos and ill. Eryhtromycin if pen allergic.
-diff- EBV, agranulocytosis, leukaemia, scarlet fever, diptheria, tum eg SCC if unilat enlargem.
-complics- retropharyngeal abcess, peritonsillar abcess, para or hypopharyngeal abcess, lernieres synd.
-tonsillectomy- sore throat defin due to tonsillitis, 5 or more episodes per yr, symps for at least 1 yr.
Peritonsillar abcess
-px-
Sore throat, dysphagia, unilat peritonsillar bulge, uvular deviat, trismus, muffled voice.
-tx-
AB and aspiration. Occas steroids or immed tonsillectomy.
Tonsillectomy after.
Salivary gland stones
Mostly submandib.
Red swollen tender gland, esp after eat.
Stridor
High pitch on inspiration due to partial obstruc larynx or large airways.
-causes-
Congenital- laryngomalacia, stenosis, vasc rings.
Inflamm- laryngitis, epiglottitis, bronchtitis, anaph.
Tum- haemangioma, papilloma.
Trauma- therma, chem.
FB, vocal cord paral.
-laryngotracheobronchtis/croup-
Barking cough and stridor. Us viral, parainflu. Us self lim.
If sev and steeple sign CXR then- AB, O2, neb adrenaline, dexamethasone or budesonide.
Hoarseness (dysphonia)
Over 3wk, esp in smokers think laryng carcinoma.
-causes-
Voice overue, GORD, smok, stress.
Less comm- granuloma, sarcoid, TB, syphilis, goitre, carotid body tum, pancoast, larynx or thymus CA, lymphoma, vom, fumes, inj, epiglottitis, diptheria, guillain barre, MG, voc cord paral, acromegaly, addisons, myxoedema.
Emergency- epiglottitis, aortic dissec, anaph, acid/alk ingest, trauma, FB.
-ix- laryngoscope, acoustic anal.
-specif causes- reflux laryngitis, laryngitis, aphonia, spasmodic dysphonia, laryngeal N palsy.
-RLN palsy-
Hoarse, breathy, asp cough, dysp.
CA eg larynx, thyr, oes, pharyng, bronchus, LN.
Iatrogenic due to surg eg thyr.
Other eg polio, syringomyelia, TB, AA.
Ix CXR, barium swallow, MRI, panendoscopy.
Dysphagia
Causes-
-malig- oes, pharyng, gastric CA. Ext press eg lung CA, LN.
-neuro- bulbar palsy, lat medullary, syn, MG, syringomyelia.
-other- stricture, pharyng pouch, achalasia, oesophagitis, iron defic anaem.
Qs- dyspepsia, wl lumps, fluid, swallowing movem diffic (bulbar), constant, pain, neck bulge or gurgle when drink (pouch).
Ix- FBC, ESR, barium, oes motil, CXR.
Nutrit supp.
Centor
Over 14, tender cervical lymphad, exudate, over 38 deg, no cough.
If score 3 or more then pen V QDS 10 days.
