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ENT > Oral Cavity and Throat Disease > Flashcards

Oral Cavity and Throat Disease Flashcards

1
Q

What is the most common cause of bacterial sore throat?

A

Streptococcus pyogenes (also known as Group A streptococcus, or Group A Beta Haemolytic Strep)

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2
Q

Explain the complications and the risks of not treating strep throat?

A

Earlier complications:
Spread to surrounding structures such as meningitis, otitis media, pneumonia

Later complications:
Rheumatic fever
Glomerulonephritis
It is thought that if the strep throat infection is untreated or inadequately treated by antibiotics, the bacteria remain in the tonsils and promote a persistent immune response from the body.

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3
Q

Describe symptoms and signs of rheumatic fever?

A

Symptoms usually appear 2 to 4 weeks after you have had a bacterial throat infection.

They include:

a high temperature of 38C or above (fever)
redness, pain and swelling of your joints (arthritis) – usually ankles, knees, wrists or elbows
pain in your chest, breathlessness and a fast heart rate
jerky, uncontrollable movements in your hands, feet and face
tiny bumps under your skin
pale-red patches on your arms and tummy

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4
Q

Treatment of strep throat?

A

Penicillin

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5
Q

Common pathogen of hand foot and mouth disease?

A

coxsackievirus (from enteroviruses group)

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6
Q

Signs and symptoms of hand foot and mouth disease?

A 
a sore throat
a high temperature, above 38C
not wanting to eat
mouth ulcers 
Ulcers on hand and feet
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7
Q

Describe apthous ulceration?

A 
Non viral, self limiting
Recurring painful ulcers of the mouth that are round or ovoid and have inflammatory halos
Confined to mouth
Absence of systemic disease
Often related to stress
Shouldn't last more than 3 weeks
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8
Q

If an ulcer lasts more than ___ weeks it needs investigated

A

3

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9
Q

If sore throat and lethargy persist into the second week, especially if the person is 15-25years of age __________________

A

infectious mononucleosis/ glandular fever (caused by Ebstein Barr Virus )should be suspected.

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10
Q

Vast majority of sore throats are caused by _________

A

viral infection AND THEREFORE DO NOT NEED ANTIBIOTICS

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11
Q

Strep pyogenes is _______

A

gram positive (PURPLE) beta haemolytic cocci in chains

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12
Q

What bacteria causes diphtheria?

A

Corynebacterium diphtheriae

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13
Q

Severe sore throat with a grey white membrane across the pharynx?

A

Diptheria

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14
Q

What are the serious complications of diphtheria?

A

Potent exotoxin is cardiotoxic and neurotoxic. It can lead to difficulty breathing, heart failure, paralysis, and even death.

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15
Q

Signs of EBV?

A 
Gross tonsillar enlargement with membranous exudate
Marked cervical lymphadenopathy
Palatal petechial haemorrhages
Generalised lymphadenopathy
Hepatosplenomegaly
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16
Q

Investigations for EBV?

A

Atypical lymphocytes in peripheral blood
+ve Monospot or Paul-Bunnell test
Low CRP (<100)

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17
Q

Don’t give amoxicillin in _____

A

throat infections > tonsillitis or EBV

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18
Q

What is tonsillitis?

A

Inflammation of the tonsils with majority due to viral infection

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19
Q

Common pathogens in tonsillitis?

A

Majority of acute cases are caused by EBV, rhinovirus, influenza, parainfluenza, enterovirus and adenovirus

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20
Q

Chronic tonsillar disease is more likely to be bacterial or viral? What pathogens?

A

Bacterial

Strep pyogenes, H influenza, S aureus and strep pneumonia

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21
Q

Viral presentation of tonsillitis vs Bacterial presentation?

A

VIRAL: Malaise, sore throat, temperature, possible lymphadenopathy, able to undertake normal activity, 3-4 days, cough

BACTERIAL: systemic upset, fever, odynophagia, halitosis, lymphadenopathy, unable to work, lasts about a week, absence of cough, presence of exudates

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22
Q

What is the centor criteria?

A

History of fever
Tonsillar exudates
Tender anterior cervical adenopathy
Absence of cough

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23
Q

Treatment of tonsillitis?

A

Supportive- eat, drink, rest, paracetamol, NSAIDs
If need antibiotic penicillin for 10 days, clarithromycin if allergic
Hospital admission- IV fluids, IV antibiotics, steroids

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24
Q

Strict guidelines for tonsillectomy?

A

Sore throats must be due to tonsillitis
Episodes must be disabling
7 or more well documented, clinically significant, adequately treated in the preceding years or 5 in 2 yrs or 3 in 3 yrs
NOTE SURGERY IS V SORE AND RISK OF COMPLICATIONS

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25
Q

Malaise, sore throat, temperature, possible lymphadenopathy, able to undertake normal activity, 3-4 days, cough …. viral or bacterial?

A

Viral

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26
Q

Systemic upset, fever, odynophagia, halitosis, lymphadenopathy, unable to work, lasts about a week, absence of cough, presence of exudates…. viral or bacterial?

A

Bacterial

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27
Q

Complication of tonsillitis?

A

Quincy/ Peritonsillar Abscess

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28
Q

Signs of quincy?

A

unilateral throat pain and odynophagia, 3-7 days preceding acute tonsillitis, medial displacement on tonsil and uvula, concavity or palate lost

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29
Q

Treatment of quincy?

A

Aspiration and antibiotics

30
Q

Unilateral throat pain and odynophagia, 3-7 days preceding acute tonsillitis?

A

Quincy- peritonsillar abscess

31
Q

South east china, unilateral hearing loss, lump in back of neck =

A

EBV driven nasopharyngeal SCC

32
Q

The predominant type of head and neck cancer is ______

A

squamous cell carcinoma

33
Q

Risks factors for head and neck cancer?

A 
Smoking
Alcohol
Hardwood dust
Betel nuts
Certain viruses e.g. HPV, EBV
34
Q

Why is there an increasing trend in development of oropharyngeal cancer in younger cohort?

A

HPV

35
Q

Why is it important to know if someone has HPV related cancer?

A

Much better prognosis

Down stage and get radio and chemo

36
Q

What virus is thought to be implicated in nasopharyngeal SCC?

A

Epstein barr virus (glandular fever/ infectious mononucleosis)

37
Q

The most common sites for head and neck cancer?

A

Oral cavity followed by the larynx

38
Q

Oral cancers tend to found?

A

On the lateral sides of the tongue

39
Q

Laryngeal cancers can be at the glottis (vocal chords), supraglottic or subglottic… what are the clinical implications?

A

Glottis- often stay on chords with minimal lymphatic drainage will get voice changes and airway obstruction
Supraglottic- drain to superior deep cervical nodes, no change to voice.
Subglottic- drain to paratracheal nodes and get voice changes and airway obstruction.

40
Q

Which category of laryngeal cancers drain to deep cervical nodes with no voice changes?

A

Supraglottic

41
Q

Which category of laryngeal cancers drain to paratracheal nodes with voice changes and airway obstruction?

A

Subglottic

42
Q

Which category of laryngeal cancers tend not to drain to lymphatics and have voice changes and airway obstruction?

A

glottic

43
Q

8 red flags for head and neck cancer?

A

1) lump in neck particularly if painless and enlarging
2) persistent hoarseness of voice for more than 3 weeks
3) Odynophagia
4) Dysphagia
5) Unexplained otalgia
6) Ulcer in oral cavity or oropharynx that doesn’t heal for more than 3 weeks or red/ white patches that don’t heal
7) Facial or cheek swelling
8) Stridor

44
Q

Investigations for head and neck cancer?

A

Few blood tests of value
Radiology is best > US of neck nodes and take needle biopsy and MRI for viewing the soft tissues
Endoscopy is done to get full biopsy before treatment

45
Q

Laryngeal polyps/ nodules are commonly found in?

A

Professionals who rely on their voice for their livelihood e.g. teachers, singers and lawyers

46
Q

Treatment of laryngeal polyps/ nodules?

A

Cured with rest and speech therapy to improve voice production techniques

47
Q

Most salivary tumours are from the parotid gland and are…

A

benign

48
Q

Most salivary tumours are from the ______ and are _____

A

parotid gland and benign

49
Q

What is the most common tumour of the salivary glands? Is it malignant or benign?

A

Benign

Pleomorphic Adenoma

50
Q

Treatment of pleomorphic adenoma?

A

Often parotidectomy is done as difficult to fully remove and can extend into surrounding tissue

51
Q

2 benign tumours of the salivary gland?

A

Pleomorphic Adenoma and Warthins Tumour

52
Q

Almost all malignant tumours of the salivary glands are ____

What are the three subtypes?

A

ADENOCARCINOMAS
Acinic cell carcinoma
Muco epidermoid carcinoma
Adenoid cystic carcinoma

53
Q

Why does nasal blockage in babies cause a lot more problems?

A

Neonates are obligate nasal breathers they can’t breathe through their mouths as their epiglottis is at the level of the palate

54
Q

Resistance in a tube is ______

A

directly proportional to liquid viscosity and length tube and inversely proportional to the radius of tube to the power 4

55
Q

Sudden distress with stridor in a child ______

A

foreign body obstruction

56
Q

_______ is high-pitched noise caused by turbulent flow in the larynx and upper trachea

A

Stridor

57
Q

________ is a lower pitched noise – much like snoring – associated with pharyngeal obstruction, and usually worse when the patient is asleep as the pharyngeal muscle tone is reduced and vibrates with respiratory activity

A

Stertor

58
Q

What is globus pharyngeus?

A

Sensation of painless lump in the throat

Might be caused by inflammation or brought on by stress

59
Q

Treatment of globus pharyngeus?

A

Treatment of underlying cause

Physiotherapy

60
Q

What is laryngeal papillomatosis?

A

Rare condition: Recurrent papillomas in the airway caused by HPV infection

61
Q

What is laryngomalacia?

A

Congenital softening of the tissues of the larynx > NOISY BREATHING IN INFANCY

62
Q

What is being described? Usually a lump located between isthmus of thyroid and hyoid bone.

A

Thyroglossal cyst

63
Q

What group of people are pharyngeal pouches common in?

A

Elderly population

Particularly older men

64
Q

What is a pharyngeal pouch?

A

Herniation of mucosa through the fibres of the inferior pharyngeal constrictor muscles. An area of weakness allows a diverticulum to form.

65
Q

How does someone with a pharyngeal pouch usually present?

A

Neck swelling
Failed swallowing
Gurgling sound in neck after food
Occasionally recurrent pneumonia due to aspiration

66
Q

What test can allow diagnosis of a pharyngeal pouch?

A

Barium swallow

67
Q

What is a cystic hygroma?

A

fluid-filled sac that results from a blockage in the lymphatic system . It is most commonly located in the neck or head area, but can be located anywhere in the body. It may be discovered in a fetus during a pregnancy ultrasound , or it may be apparent at birth as a soft bulge under the skin.

68
Q

When do most branchial cysts present?

A

Most branchial cleft cysts present in late childhood or early adulthood as a solitary, painless mass, which went previously unnoticed, that has now become infected

69
Q

What is a branchial cyst?

A

Embryological remnant. They arise from an incomplete obliteration of the cervical sinus

70
Q

In a tension pneumothorax, in what direction does the trachea deviate - towards or away from the side of the pneumothorax?

A

away

ENT (4 decks)

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