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ENT > T > Flashcards

T Flashcards

1
Q

What is dysphagia

A

Difficulty in swallowing

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2
Q

What is odynophagia

A

Painful swallowing - red flag symptom for cancer

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3
Q

Which nerve is involved with pharyngeal phase of swallowing?

A

Glossopharygneal

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4
Q

Congenital causes of dysphagia

A

Tracheo-oesophageal fistula

Oesophageal stricture

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5
Q

Acquired pre-oesophgeal inflammatory causes of dysphagia

A 
Tonsilitis
Pharyngitis
Quinsy 
Parapharyngeal abscess
Ludwing's Angina
Glandular Fever
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6
Q

Inflammatory and infective acquired oesophageal cause of dysphagia

A

Infective - Candidiasis

Inflammatory - Oesophagitis - GORD

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7
Q

Neurological acquired oesophageal cause of dysphagia

A

Achalasia

Diffuse spasm

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8
Q

Compressive acquired oesophageal cause of dysphagia

A

Mediastinal mets
Aortic aneurysm
Osteophytes - in the neck

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9
Q

Psychological cause of dysphagia

A

Globus pharyngeus = “lump in the throat” - related to anxiety
Will present as not being able to initiate swallowing - the only dysphagia that presents with this

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10
Q

Dysphagia in the older patient - protrusion at neck

A

Pharyngeal pouch

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11
Q

What is Ludwigs angina?

A

Adontogenic infection causing a spreading cellulitis in the floor of the mouth, means that tongue is being pushed up to the soft palate

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12
Q

Dysphagia obstruction felt at the level of the sternal notch

A

Globus pharyngeus

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13
Q

Presentation of tonsilitis

A

Hx of pyrexia, dysphagia, lymphadenopathy and severe malaise

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14
Q

Usual cause of tonsilitis

A

Usually bacterial - B-haemolytic strep is the commonest organism
Also viral are common

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15
Q

Criteria for antibiotic prescription in tonsilitis

A

Centor Criteria
Presence of all 4 of the following indicate need to antibiotic treatment
3 or less - just supportive treatment

1) History of fever >38
2) Tonsillar exudates
3) No cough
4) Tender anterior cervical lymphadenopathy

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16
Q

What is a pharyngeal pouch

A

Weakness between the pharyngeal constrictor muscles (Kilian’s dehiscence) through which the pharyngeal mucosa bulges

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17
Q

Where does pharyngeal pouch lie?

A

Originally it lies posteriorly but then as it enlarges it moves laterally - usually to the left
Further enlargement pushes the oesophagus aside and food passes into the pouch not down

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18
Q

When and in who do pharyngeal pouches occur most commonly?

A

6th-9th decade

M:F = 3/2:1

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19
Q

Symptoms of pharyngeal pouch

A

Dysphagia
Immediate regurgitation
Aspiration
Neck Lump

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20
Q

Treatment of pharyngeal pouch

A

Endoscopic stapling

Or external approach with excision of the pouch

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21
Q

What is Plummer-Vinson or Paterson-Brown-Kelly syndrome?

A

Epithelial changes occuring in the oesophagitis due to iron deficiency causing glossitis
May be fine web or membrance encircling the oesophagus

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22
Q

Who does PV or PBK syndrome occur most frequently in?

A

Middle-aged women

associated with other signs of iron deficiency

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23
Q

Dysphagia where food and liquid does not leave the throat easily and regurgitates through the nose and/or causes a cough

A

Neurological

eg. bulbar or pseudobulbar palsy or MG

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24
Q

Rapid onset dysphagia with food sticking immediately after swallowing - doesn’t leave the throat easily

A

Carcinoma of pharynx

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25
Q

Slow onset dysphagia with food sticking immediately after swallowing - doesn’t leave the throat easily

A

Benign stricture or web - of pharynx

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26
Q

Dysphagia where leaves the throat easily - gets progressively more difficult to swallow and develops over a short period, with relentless progression and impact pain

A

Carcinoma of oesophagus

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27
Q

Dysphagia where leaves throat easily - gets progressively more difficult to swallow and has a longer more intermittent progression. Also odonophagia

A

Benign peptic stricture

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28
Q

Dysphagia + ear pain on swallowing (weight loss)

A

Cancer!!!

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29
Q

3 ways for voice rehabilitation after laryngectomy

A

Electromechanical speech
Oesophageal speech
Tracheo-oesophageal (shunt) speech - puncture into oesophagus therefore communication from lungs to mouth

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30
Q

When to admit/refer a sore throat/tonsillitis x3

A

Airway compromise
Dysphagia (saliva very urgent because means more than tonsillitis eg. abscess)
Systemic involvement - sepsis

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31
Q

Traumatic causes of sore throat x4

A

Thermal

Chemical - alcohol, reflux, TB

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32
Q

Infective causes of sore throat x5

A 
Tonsillitis 
Glandular fever 
Epiglottitis 
Diptheria 
Candida
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33
Q

Complicatative causes of sore throat x3

A

Peritonsillar abscess
Parapharyngeal abscess
Retropharyngeal abscess (may lead to acute airway obstruction therefore emergency)

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34
Q

Causes of oral ulceration x5

A 
Apthous ulcers 
Trauma
HSV
Leukaemia pemphigus
Pemphigoid
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35
Q

Viral causes of throat infection

A

Influenza, parainfluenza, Adenovirus, Rhinovirus, RSV, EBV, Herpes Simplex

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36
Q

Bacterial causes of throat infection

A 
B-haemolytic strep 
Haemophilus influenzae 
Staph aureus 
Anaerobes 
Diptheria
37
Q

Fungal causes of throat infection

A

Candida

38
Q

What is trismus - what is it a key symptom of?

A

Jaw claudication following throat infection - causing muscle inflammation
Key symptom of peritonsillar abscess

39
Q

Risk factors for head and neck cancer

A

Smoking
Alcohol
Betel nut
HPV

40
Q

Sore throat + hepatosplenomegaly

A

Glandular fever

41
Q

Management of admitted tonsillitis - unable to swallow

A

IV fluid
Analgesia
Antipyretic
Benzylpenicillin

42
Q

What can you add if no improvement with benzylpenicillin after 48 hours

A

Metronidazole

43
Q

What do you not give to treat sore throat? Why not?

A

Ampiciilin or amoxicillin because if it is glandular fever - they will come out with a big macular papular rash

44
Q

Treatment if significant airway compromise in tonsilitis

A

Steroids

45
Q

Local complications of tonsilitis x4

A

Para/retropharyngeal abscess
Quinsy - peritonsillar abscess
Otitis media (rarely)
Airway obstruction

46
Q

Systemic complications of tonsilitis SSMR

A

Septicaemia
Streptococcus: glomerulonephritis
Meningitis
Rheumatic fever

47
Q

What is quinsy?

A

Peritonsillar abscess

48
Q

Presentation of quinsy

A

Unilateral pain
Otalgia on that side
Trismus “hot potato voice”

49
Q

Where does the uvula deviate in quinsy

A

away from the peritonsillar abscess

50
Q

Treatment of quinsy

A

Aspiration of pus in abscess

51
Q

Indications for tonsillectomy x4

A

Recurrent acute tonsillitis (6 episodes of severe tonsillitis in a year)
Quinsy >2x in a year
OSA
Suspected malignancy (asymmetrical tonsils)

52
Q

Features of glandular fever x4

A

Usually huge tonsils
White sloppy goo covering them
Huge nodes in neck
Systemically unwell

53
Q

Main infective cause of epiglottitis

A

Mainly haemophilus influnzae B

54
Q

Presentation of epiglottitis x4

A

Sudden onset
High fever
Dysphagia
Sore throat

55
Q

Who typically gets epiglottitis?

A

Children 2-6 years

Older immigrants

56
Q

Signs of epiglottitis?

A

Inspiratory stridor
Drooling - because can’t swallow
Rapid progression
Hot potato voice

57
Q

Management of epiglottitis?

A

IV cefotaxime + steroids

58
Q

What is croup?

A

Laryngotracheobronchitis

59
Q

Symptoms of croup

A

Barking cough and inspiratory stridor

Not as severe as epiglottitis

60
Q

Treatment of croup

A

1 dose prednisolone

61
Q

Can candida be wiped off?

A

Yes - Lichen Planus can’t

62
Q

How does hypopharyngeal cancer present?

A

Sore throat and pain on swallowing

Can also have ear ache on that side

63
Q

Signs of tonsillar cancer

A

Swollen tonsil and will look abnormal

But if unilateral swelling - suspect it

64
Q

What is dysphonia?

A

Hoarseness of voice

65
Q

What is dysarthria

A

Motor speech disorder causing difficulty in articulation of speech

66
Q

What is dysphasia? 2 types

A

Central impairment of language
Receptive - Wernickes
Expressive - Brocas

67
Q

Muscle supplied by superior laryngeal nerve

A

Cricothyroid muscle and above vocal cords

68
Q

Muscle supplied by recurrent laryngeal nerve

A

All other including vocal cord abductors and adductors

69
Q

Most common cause of hoarse voice

A

URTI - laryngitis

70
Q

Treatment of vocal cord palsy

A

SLT

Vocal cord medialisation - thyroplasty

71
Q

Presentation of acute laryngitis

A

Short duration
History of URTI
Aphonia and sore throat

72
Q

Treatment of acute laryngitis

A

Voice rest
Hydration
Humidification
Antibiotics - maybe

73
Q

Chronic laryngitis presentation

A

Persistent dysphonia

74
Q

Causes of chronic laryngitis

A

GORD
Airborne irritants
Sinonasal disease

75
Q

Smoker + hoarse voice

A

Reinkes oedema

Gelatinous material laid down in lamina propria

76
Q

Presentation of reinkes oedema

A

Deep masculine voice

77
Q

Treatment of reinkes oedema

A

Stop smoking
Treat GORD (will make worse)
Surgery to drain excess fluid

78
Q

People who use voice professionally and hoarse voice?

A

Vocal cord nodules

Fibrovascular tissue

79
Q

DX of vocal cord nodules

A

Video laryngostroboscopy

80
Q

Treatment of vocal cord nodules

A

Used to be surgery
Now last resort
SLT

81
Q

Hoarse voice + inappropriate voice use - shouting

A

Vocal cord polyps
Usually from people shouting when have URTI
Get a haemorrhage which organises into a polyp

82
Q

Treatment of vocal cord polyp

A

Surgical excision

SLT to prevent recurrence

83
Q

Vocal cord polyps, nodules and reinkes oedema

A

Nodules and RO - usually bilateral

Polyps - contralateral damage is common

84
Q

Papillomatosis features

A

Infection caused by human papilloma virus 6 and 11

85
Q

Treatment of papillomatosis

A

Surgical microdebrider
Microspot CO2 laser
Cidofovir

86
Q

Treatment of vocal cord cyst

A

Surgical removal and need to remove entire cyst wall to prevent recurrence

87
Q

Laryngeal carcinoma male to female ratio

A

M:F 4:1

88
Q

Risk factors for laryngeal carincoma

A

Smoking, alcohol and HPV

89
Q

When do you do refer for suspected laryngeal carcinoma

A

Persistent unexplained hoarseness
Unexplained neck lump
2 week referral

ENT (5 decks)

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