Oral Cavity and Throat Disease Flashcards
What is the most common cause of bacterial sore throat?
Streptococcus pyogenes (also known as Group A streptococcus, or Group A Beta Haemolytic Strep)
Explain the complications and the risks of not treating strep throat?
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.
Describe symptoms and signs of rheumatic fever?
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
Treatment of strep throat?
Penicillin
Common pathogen of hand foot and mouth disease?
coxsackievirus (from enteroviruses group)
Signs and symptoms of hand foot and mouth disease?
a sore throat a high temperature, above 38C not wanting to eat mouth ulcers Ulcers on hand and feet
Describe apthous ulceration?
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
If an ulcer lasts more than ___ weeks it needs investigated
3
If sore throat and lethargy persist into the second week, especially if the person is 15-25years of age __________________
infectious mononucleosis/ glandular fever (caused by Ebstein Barr Virus )should be suspected.
Vast majority of sore throats are caused by _________
viral infection AND THEREFORE DO NOT NEED ANTIBIOTICS
Strep pyogenes is _______
gram positive (PURPLE) beta haemolytic cocci in chains
What bacteria causes diphtheria?
Corynebacterium diphtheriae
Severe sore throat with a grey white membrane across the pharynx?
Diptheria
What are the serious complications of diphtheria?
Potent exotoxin is cardiotoxic and neurotoxic. It can lead to difficulty breathing, heart failure, paralysis, and even death.
Signs of EBV?
Gross tonsillar enlargement with membranous exudate Marked cervical lymphadenopathy Palatal petechial haemorrhages Generalised lymphadenopathy Hepatosplenomegaly
Investigations for EBV?
Atypical lymphocytes in peripheral blood
+ve Monospot or Paul-Bunnell test
Low CRP (<100)
Don’t give amoxicillin in _____
throat infections > tonsillitis or EBV
What is tonsillitis?
Inflammation of the tonsils with majority due to viral infection
Common pathogens in tonsillitis?
Majority of acute cases are caused by EBV, rhinovirus, influenza, parainfluenza, enterovirus and adenovirus
Chronic tonsillar disease is more likely to be bacterial or viral? What pathogens?
Bacterial
Strep pyogenes, H influenza, S aureus and strep pneumonia
Viral presentation of tonsillitis vs Bacterial presentation?
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
What is the centor criteria?
History of fever
Tonsillar exudates
Tender anterior cervical adenopathy
Absence of cough
Treatment of tonsillitis?
Supportive- eat, drink, rest, paracetamol, NSAIDs
If need antibiotic penicillin for 10 days, clarithromycin if allergic
Hospital admission- IV fluids, IV antibiotics, steroids
Strict guidelines for tonsillectomy?
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
Malaise, sore throat, temperature, possible lymphadenopathy, able to undertake normal activity, 3-4 days, cough …. viral or bacterial?
Viral
Systemic upset, fever, odynophagia, halitosis, lymphadenopathy, unable to work, lasts about a week, absence of cough, presence of exudates…. viral or bacterial?
Bacterial
Complication of tonsillitis?
Quincy/ Peritonsillar Abscess
Signs of quincy?
unilateral throat pain and odynophagia, 3-7 days preceding acute tonsillitis, medial displacement on tonsil and uvula, concavity or palate lost
Treatment of quincy?
Aspiration and antibiotics
Unilateral throat pain and odynophagia, 3-7 days preceding acute tonsillitis?
Quincy- peritonsillar abscess
South east china, unilateral hearing loss, lump in back of neck =
EBV driven nasopharyngeal SCC
The predominant type of head and neck cancer is ______
squamous cell carcinoma
Risks factors for head and neck cancer?
Smoking Alcohol Hardwood dust Betel nuts Certain viruses e.g. HPV, EBV
Why is there an increasing trend in development of oropharyngeal cancer in younger cohort?
HPV
Why is it important to know if someone has HPV related cancer?
Much better prognosis
Down stage and get radio and chemo
What virus is thought to be implicated in nasopharyngeal SCC?
Epstein barr virus (glandular fever/ infectious mononucleosis)
The most common sites for head and neck cancer?
Oral cavity followed by the larynx
Oral cancers tend to found?
On the lateral sides of the tongue
Laryngeal cancers can be at the glottis (vocal chords), supraglottic or subglottic… what are the clinical implications?
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.
Which category of laryngeal cancers drain to deep cervical nodes with no voice changes?
Supraglottic
Which category of laryngeal cancers drain to paratracheal nodes with voice changes and airway obstruction?
Subglottic
Which category of laryngeal cancers tend not to drain to lymphatics and have voice changes and airway obstruction?
glottic
8 red flags for head and neck cancer?
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
Investigations for head and neck cancer?
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
Laryngeal polyps/ nodules are commonly found in?
Professionals who rely on their voice for their livelihood e.g. teachers, singers and lawyers
Treatment of laryngeal polyps/ nodules?
Cured with rest and speech therapy to improve voice production techniques
Most salivary tumours are from the parotid gland and are…
benign
Most salivary tumours are from the ______ and are _____
parotid gland and benign
What is the most common tumour of the salivary glands? Is it malignant or benign?
Benign
Pleomorphic Adenoma
Treatment of pleomorphic adenoma?
Often parotidectomy is done as difficult to fully remove and can extend into surrounding tissue
2 benign tumours of the salivary gland?
Pleomorphic Adenoma and Warthins Tumour
Almost all malignant tumours of the salivary glands are ____
What are the three subtypes?
ADENOCARCINOMAS
Acinic cell carcinoma
Muco epidermoid carcinoma
Adenoid cystic carcinoma
Why does nasal blockage in babies cause a lot more problems?
Neonates are obligate nasal breathers they can’t breathe through their mouths as their epiglottis is at the level of the palate
Resistance in a tube is ______
directly proportional to liquid viscosity and length tube and inversely proportional to the radius of tube to the power 4
Sudden distress with stridor in a child ______
foreign body obstruction
_______ is high-pitched noise caused by turbulent flow in the larynx and upper trachea
Stridor
________ 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
Stertor
What is globus pharyngeus?
Sensation of painless lump in the throat
Might be caused by inflammation or brought on by stress
Treatment of globus pharyngeus?
Treatment of underlying cause
Physiotherapy
What is laryngeal papillomatosis?
Rare condition: Recurrent papillomas in the airway caused by HPV infection
What is laryngomalacia?
Congenital softening of the tissues of the larynx > NOISY BREATHING IN INFANCY
What is being described? Usually a lump located between isthmus of thyroid and hyoid bone.
Thyroglossal cyst
What group of people are pharyngeal pouches common in?
Elderly population
Particularly older men
What is a pharyngeal pouch?
Herniation of mucosa through the fibres of the inferior pharyngeal constrictor muscles. An area of weakness allows a diverticulum to form.
How does someone with a pharyngeal pouch usually present?
Neck swelling
Failed swallowing
Gurgling sound in neck after food
Occasionally recurrent pneumonia due to aspiration
What test can allow diagnosis of a pharyngeal pouch?
Barium swallow
What is a cystic hygroma?
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.
When do most branchial cysts present?
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
What is a branchial cyst?
Embryological remnant. They arise from an incomplete obliteration of the cervical sinus
In a tension pneumothorax, in what direction does the trachea deviate - towards or away from the side of the pneumothorax?
away
