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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
Slow onset dysphagia with food sticking immediately after swallowing - doesn't leave the throat easily
Benign stricture or web - of pharynx
26
Dysphagia where leaves the throat easily - gets progressively more difficult to swallow and develops over a short period, with relentless progression and impact pain
Carcinoma of oesophagus
27
Dysphagia where leaves throat easily - gets progressively more difficult to swallow and has a longer more intermittent progression. Also odonophagia
Benign peptic stricture
28
Dysphagia + ear pain on swallowing (weight loss)
Cancer!!!
29
3 ways for voice rehabilitation after laryngectomy
Electromechanical speech Oesophageal speech Tracheo-oesophageal (shunt) speech - puncture into oesophagus therefore communication from lungs to mouth
30
When to admit/refer a sore throat/tonsillitis x3
Airway compromise Dysphagia (saliva very urgent because means more than tonsillitis eg. abscess) Systemic involvement - sepsis
31
Traumatic causes of sore throat x4
Thermal | Chemical - alcohol, reflux, TB
32
Infective causes of sore throat x5
``` Tonsillitis Glandular fever Epiglottitis Diptheria Candida ```
33
Complicatative causes of sore throat x3
Peritonsillar abscess Parapharyngeal abscess Retropharyngeal abscess (may lead to acute airway obstruction therefore emergency)
34
Causes of oral ulceration x5
``` Apthous ulcers Trauma HSV Leukaemia pemphigus Pemphigoid ```
35
Viral causes of throat infection
Influenza, parainfluenza, Adenovirus, Rhinovirus, RSV, EBV, Herpes Simplex
36
Bacterial causes of throat infection
``` B-haemolytic strep Haemophilus influenzae Staph aureus Anaerobes Diptheria ```
37
Fungal causes of throat infection
Candida
38
What is trismus - what is it a key symptom of?
Jaw claudication following throat infection - causing muscle inflammation Key symptom of peritonsillar abscess
39
Risk factors for head and neck cancer
Smoking Alcohol Betel nut HPV
40
Sore throat + hepatosplenomegaly
Glandular fever
41
Management of admitted tonsillitis - unable to swallow
IV fluid Analgesia Antipyretic Benzylpenicillin
42
What can you add if no improvement with benzylpenicillin after 48 hours
Metronidazole
43
What do you not give to treat sore throat? Why not?
Ampiciilin or amoxicillin because if it is glandular fever - they will come out with a big macular papular rash
44
Treatment if significant airway compromise in tonsilitis
Steroids
45
Local complications of tonsilitis x4
Para/retropharyngeal abscess Quinsy - peritonsillar abscess Otitis media (rarely) Airway obstruction
46
Systemic complications of tonsilitis SSMR
Septicaemia Streptococcus: glomerulonephritis Meningitis Rheumatic fever
47
What is quinsy?
Peritonsillar abscess
48
Presentation of quinsy
Unilateral pain Otalgia on that side Trismus "hot potato voice"
49
Where does the uvula deviate in quinsy
away from the peritonsillar abscess
50
Treatment of quinsy
Aspiration of pus in abscess
51
Indications for tonsillectomy x4
Recurrent acute tonsillitis (6 episodes of severe tonsillitis in a year) Quinsy >2x in a year OSA Suspected malignancy (asymmetrical tonsils)
52
Features of glandular fever x4
Usually huge tonsils White sloppy goo covering them Huge nodes in neck Systemically unwell
53
Main infective cause of epiglottitis
Mainly haemophilus influnzae B
54
Presentation of epiglottitis x4
Sudden onset High fever Dysphagia Sore throat
55
Who typically gets epiglottitis?
Children 2-6 years | Older immigrants
56
Signs of epiglottitis?
Inspiratory stridor Drooling - because can't swallow Rapid progression Hot potato voice
57
Management of epiglottitis?
IV cefotaxime + steroids
58
What is croup?
Laryngotracheobronchitis
59
Symptoms of croup
Barking cough and inspiratory stridor | Not as severe as epiglottitis
60
Treatment of croup
1 dose prednisolone
61
Can candida be wiped off?
Yes - Lichen Planus can't
62
How does hypopharyngeal cancer present?
Sore throat and pain on swallowing | Can also have ear ache on that side
63
Signs of tonsillar cancer
Swollen tonsil and will look abnormal | But if unilateral swelling - suspect it
64
What is dysphonia?
Hoarseness of voice
65
What is dysarthria
Motor speech disorder causing difficulty in articulation of speech
66
What is dysphasia? 2 types
Central impairment of language Receptive - Wernickes Expressive - Brocas
67
Muscle supplied by superior laryngeal nerve
Cricothyroid muscle and above vocal cords
68
Muscle supplied by recurrent laryngeal nerve
All other including vocal cord abductors and adductors
69
Most common cause of hoarse voice
URTI - laryngitis
70
Treatment of vocal cord palsy
SLT | Vocal cord medialisation - thyroplasty
71
Presentation of acute laryngitis
Short duration History of URTI Aphonia and sore throat
72
Treatment of acute laryngitis
Voice rest Hydration Humidification Antibiotics - maybe
73
Chronic laryngitis presentation
Persistent dysphonia
74
Causes of chronic laryngitis
GORD Airborne irritants Sinonasal disease
75
Smoker + hoarse voice
Reinkes oedema | Gelatinous material laid down in lamina propria
76
Presentation of reinkes oedema
Deep masculine voice
77
Treatment of reinkes oedema
Stop smoking Treat GORD (will make worse) Surgery to drain excess fluid
78
People who use voice professionally and hoarse voice?
Vocal cord nodules | Fibrovascular tissue
79
DX of vocal cord nodules
Video laryngostroboscopy
80
Treatment of vocal cord nodules
Used to be surgery Now last resort SLT
81
Hoarse voice + inappropriate voice use - shouting
Vocal cord polyps Usually from people shouting when have URTI Get a haemorrhage which organises into a polyp
82
Treatment of vocal cord polyp
Surgical excision | SLT to prevent recurrence
83
Vocal cord polyps, nodules and reinkes oedema
Nodules and RO - usually bilateral | Polyps - contralateral damage is common
84
Papillomatosis features
Infection caused by human papilloma virus 6 and 11
85
Treatment of papillomatosis
Surgical microdebrider Microspot CO2 laser Cidofovir
86
Treatment of vocal cord cyst
Surgical removal and need to remove entire cyst wall to prevent recurrence
87
Laryngeal carcinoma male to female ratio
M:F 4:1
88
Risk factors for laryngeal carincoma
Smoking, alcohol and HPV
89
When do you do refer for suspected laryngeal carcinoma
Persistent unexplained hoarseness Unexplained neck lump 2 week referral

ENT (5 decks)

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