Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

m4 ENT > Painful Throat > Flashcards

Painful Throat Flashcards

1
Q

Anatomy of throat

A

Throat refers to pharynx
Extends from base of skull to lower border of cricoid cartilage
- Nasopharynx
- Oropharynx: Posterior 1/3 of tongue and behind you
- Hypopharynx: Posterior to larynx where pyriform sinus is at
- Palatine tonsil lies between palatopharyngeus and palatoglossus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where do sore throats arise from?

A

Oropharynx and hypopharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pain from throat is sensed by?

A

Pain is sensed by CN IX and X (via pharyngeal plexus) which also supply middle and external ear -> referred otalgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of painful throat

A

Acute
Infection:
1. Pharyngitis
- Viral
- Bacterial
- Fungal: Candida albicans
2. Tonsillitis
3. Deep neck space infection
- Retropharyngeal abscess
- Parapharyngeal abscess
- Peritonsillar abscess
4. Acute epiglottitis/supraglottitis

Foreign body throat
Caustic ingestion

Chronic
1. Tumour
2. Post-nasal drip (AR, chronic sinusitis)
3. Irritants (smoking/alcohol/chemicals)
4. Laryngopharyngeal reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Infective cause: Clinical features acute pharyngitis

A

Sore throat (<1week)
Rhinitis (Rhinorrhea, blocked nose)
Laryngitis (Hoarseness of voice) symptoms
Systemic symptoms:
- Malaise
- Myalgia
- Fever

Mx: symptomatic tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Physical findings in acute pharyngitis

A
  • Generalized erythema in oropharynx
  • Lymphoid tissues at back of throat might be hypertrophied with exudates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causative organisms of acute pharyngitis

A

Viral: Influenca/Adenovirus
Bacterial: Group A streptococcus (Strep pyogenes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to determine between bacterial vs viral cause of acute pharyngitis?

A

CENTOR score
- Age: 3-14yo
- Exudate/swelling of tonsils
- Tender/swelling cervical lymph nodes
- Temperature > 38 degrees
- Absence of cough

2-3 points: Perform rapid antigen test or culture
4 points or more: Start empiric abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causative organisms of acute tonsillitis

A

Bacterial: Group A beta-haemolytic strep (strep pyogenes)
Viral: EBV (infectious mononucleosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What constitutes recurrent tonsillitis?

A

> 1x/year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What criteria to use for indication of tonsillectomy?

A

Paradise criteria
- >7x/year
or
- >5x/year for 2 consecutive years
or
- >3x/year for 3 consecutive years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical features of acute tonsillitis

A

Commoner in young
- Severe (Worse than URTI) sore throat
- Fever, C&R
- Poor oral intake due to odynophagia
- Dysphagia
- Hoarse voice
- Halitosis (Bad breath)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Physical findings in acute tonsillitis

A
  • Bilateral erythematous enlarged tonsils with purulent exudates (In lacey-white pattern) in tonsillar crypts
  • Tender jugulodigastric LN (Along SCM; rest of neck is okay)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of acute tonsillitis

A

Supportive:
- Adequate hydration
- Analgesia
- Antipyretics
- Anesthetic gargle
- Abx
1st line: Penicillin (GABHS) for 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Complications of acute tonsillitis

A

Septic:
- Quinsy (Peritonsillar abscess)
- Lemierre’s syndrome (Anaerobic bacteria in Quinsy flourishes, abscess wall ruptures and spreads to IJV –> IJV thrombophlebitis –> Sepsis, lung abscess)
- Deep neck abscess and necrotizing fasciitis
-> Parapharyngeal or retropharyngeal abscesses

Immunological:
- Acute rheumatic fever
- Glomerulonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causative organism of infectious mononucleosis

A

Epstein-Barr virus, transmitted by saliva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Clinical features of infectious mononucleosis

A
  • High fever, marked fatigue
  • Sore throat of longer duration than bacterial tonsillitis
  • Tender, symmetric posterior cervical lymphadenopathy
  • Hepatosplenomegaly and atypical lymphocytosis
  • Rash after amoxicillin/ampicillin abx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can be observed in infectious mononucleosis if given penicillin abx?

A

Rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Physical findings in infectious mononucleosis

A
  • Bilateral exudative tonsillitis
  • Palatal petechiae
  • Uvular edema
  • Multiple bilateral enlarged tender posterior cervical LNs (Not just jugulodigastric!)
  • Hepatosplenomegaly
20
Q

What advice to give patients with infectious mononucleosis?

A

Avoid contact sports for 6 weeks -> splenic rupture

21
Q

Peak incidence of epiglottitis/supraglottitis

A

4 years old

22
Q

Most common causative organism of epiglottitis in Paeds

A

Haemophilus Influenza Type B

*other organisms:
Streptococcus pneumonia
B-hemolytic streptococcus
Staphylococcus aureus

23
Q

Risk factors of epiglottitis

A

Unvaccinated against Hib
Immunocompromised
DM

24
Q

Symptoms of epiglottitis in Paeds

A

Fever
Stridor
Sore throat
Drooling
Respiratory distress
Sitting in tripod position
Sniffing posture
Dysphagia
Muffled voice
Anxiety, restlessness

25
Q

Lateral neck x-ray findings in epiglottitis

A
  • Thumbprint/ Thumb sign
  • Loss of cervical lordosis (due to pre-vertebral muscle spasm)
  • Overdistended/ Dilated hypopharynx
26
Q

Management of epiglottitis

A
  • Avoid triggering patient
  • Maintenance of airway/ Secure airway (ETT/ Surgical cricothyroidotomy/ tracheostomy)/ Bag-Valve-Mask while waiting
  • Humidified oxygen
  • Blood culture and epiglottic culture, followed by IV 3rd generation cephalosporin (Ceftriaxone/ Cefotaxime) with cover for MRSA via vancomycin
  • IV Steroids (Dexamethasone 8mg STAT) to reduce airway edema
27
Q

Clinical features of peritonsillar abscess aka Quinsy

A

!Medical emergency!

  • Worsening unilateral sore throat that’s not better despite Abx (pus shld be drained)
  • Fever
  • Trismus (Irritation and spasm of pterygoid muscles which help to open mouth –> Lockjaw (Normal mouth opening is 3 fingerbreadths)
  • Hot potato voice (Muffled due to obstruction in oropharynx)
28
Q

Physical findings in Quinsy

A
  • Unilateral tonsillar erythema and enlargement (Medialisation of tonsil)
  • Soft palate swelling
  • Uvula deviation to contralateral side
29
Q

Definitive management for peritonsillar abscess aka Quinsy

A

Incision and drainage under LA
- instant relief
- tonsillectomy for recurrent quinsy (>1x/year)

30
Q

Specific physical finding for patients with retropharyngeal abscess

A

Neck stiffness

31
Q

Difference between retropharyngeal and parapharyngeal abscess

A

Retropharyngeal abscess
- Presents with odynophagia
- Child < 4 yo
- Behind pharynx
- Bulge in posterior pharyngeal wall
- Widened prevertebral soft tissue

Parapharyngeal abscess
- Presents with neck swelling
- Immunocompromised adult
- Lateral to pharynx
- Tender neck swelling

32
Q

Common sites of foreign body lodgement

A

Tonsil
Vallecula
Tongue base
Pyriform sinus
Upper esophageal sphincter (Cricopharyngeus)

33
Q

Eagle syndrome

A

Elongated styloid process impinging on glossopharyngeal nerve –> Glossopharyngeal neuralgia
- Throat and neck pain

34
Q

Management of Infectious mononucleosis

A

Symptomatic tx

35
Q

Investigations for infectious mononucleosis

A

Monospot test
Positive EBV viral capsid antigen IgM
Atypical lymphocytosis
LFT transaminitis

36
Q

Most common FB in throat

A

Fish bone

37
Q

Clinical features of FB throat

A

Immediate throat pain
Odynophagia
Dysphagia
Haemoptysis
Retrosternal discomfort

38
Q

Removal of FB from throat

A

FB in oropharynx and hypopharynx: remove in clinic using forceps/nasoendoscopy

FB in cricopharynx and oesophagus: rigid esophagoscopy

39
Q

Laryngopharyngeal reflux

A

Laryngeal manifestation of GERD
- Globus feeling
- Hoarseness
- Chronic cough
- Chronic sore throat

40
Q

Superficial cervical fascia

A

Lies between dermis and deep cervical fascia
Contains:
- facial muscles of expression
- platysma muscle

41
Q

Deep cervical fascia is divided into

A

Investing layer
Pretracheal layer
Prevertebral layer
Carotid sheaths

42
Q

Investing layer of deep cervical fascia

A
  • Most superficial
  • Trapezius, SCM, submandibular and parotid glands
43
Q

Pretracheal layer of deep cervical fascia

A
  • Middle layer
  • Split into 2 parts
    1. Muscular - strap muscles
    2. Visceral - thyroid gland, pharynx, larynx, trachea and oesophagus
44
Q

Prevertebral layer of deep cervical fascia

A
  • Surrounds vertebral column and muscles of the back
  • Brachial plexus and subclavian artery
45
Q

Carotid sheaths

A
  • Runs from BOS to thoracic mediastinum
  • Contents:
    1. Common carotid artery
    2. Internal jugular vein
    3. Vagus nerve
46
Q

Most common cause of deep neck infections

A

Dental infections and dental caries

47
Q

What is Ludwig’s angina?

A

Cellulitis of submental, sublingual and submandibular spaces

m4 ENT (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions