Brainscape's Knowledge GenomeTM

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


See full index

Year 4 Neuro and Special Senses > Throat > Flashcards

Throat Flashcards

1
Q

Describe the borders of the anterior triangle

A

Midline
Mandible
SCM

Roof - Investing fascia
Floor - Visceral fascia

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

Name the four subdivisions of the anterior triangle

A

Carotid Triangle
Submental triangle
Submandibular triangle
Muscular triangle

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

What are the borders of the Carotid Triangle?

A

Medial border of SCM
Posterior belly of Diagastric
Superior border of Omohyoid

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

What are the contents of the Carotid Triangle?

A

Common Carotid (bifurcates within at C4)
IJV
Hypoglossal and Vagus
Baroreceptors

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

What is contained within the Submental triangle?

A

Submental lymph nodes

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

What is contained within the Submandibular triangle?

A

Submandibular salivary glands
Lymph nodes
Facial Artery and Veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is contained within the Muscular Triangle?

A

Infrahyoids
Pharynx
Thyroid
Parathyroid

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

Name the four Suprahyoid muscles

A

Stylohyoid
Digastric
Myelohyoid
Geniohyoid

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

Name the four infrahyoid muscles

A

Omohyoid
Sternohyoid
Thyrohyoid
Sternothyroid

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

What are the borders of the Posterior Triangle?

A

Posterior SCM
Anterior Trapezius
Clavicle

Roof - investing fascia
Floor - prevertebral fascia

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

Name three muscles in the Posterior Triangle

A

Omohyoid
Levator Scapulae
Scalenes

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

Name three vessels in the Posterior Triangle

A

EJV Superficially
Transverse Cervical
Suprascapular

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

Name the nerves in the Posterior Triangle

A

Accessory nerve
Cervical plexus
Trunks of Brachioplexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name three distinguishing features of the cervical spine

A
  • Triangular Vertebral Foramen
  • Bifid Spinous Process
  • Transverse Foramina

(spinal nerves exit above level)

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

Describe the anatomy of the Atlas (C1)

A

Articulates with the occiput and C2

No vertebral body or spinous process

Anterior arch has a facet for articulation with the dens

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

Describe the anatomy of the Axis (C2)

A

Has Dens (Odontoid Process) - medial atlanto-axial joint

Superior articular facets - lateral atlanto-axial joints

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

Name 6 ligaments of the Cervical Spine

A 
Anterior Longitudinal
Posterior Longitudinal
Ligamentum Flavum
Interspinous
Nuchal ligament
Transverse ligament of atlas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The Hyoid bone doesn’t articulate with any bones. Describe its anatomy

A

Greater Horn
Lesser Horn
Body

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

How is the Hyoid Bone damaged?

A

Strangulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The Superficial Cervical Fascia lies between the dermis and Deep Cervical Fascia. Name the 5 contents

A 
Neurovascular supply to the skin
Superficial Veins
Superficial Lymph Nodes
Fat 
Platysma Muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name the three Deep Cervical Fascial Layers

A

Investing
Pre Tracheal
Pre Vertebral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the investing layer of Deep Cervical Fascia

A

Most superficial, surrounding all structures in the neck

Splits around trapezius and SCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the pre-tracheal layer of Deep Cervical Fascia

A

Spans between Hyoid and Thorax and fuses with Pericardium

Muscular part - encloses infrahyoids
Visceral part - encloses thyroid, trachea, oesophagus
Posterior Visceral - buccopharyngeal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the pre-vertebral layer of the Deep Cervical Fascia

A

Surrounds vertebral column/scalenes/prevertebral muscles

Anterolateral portion forms floor of the Posterior Triangle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the Pharynx?

A

Muscular tube connecting oronasal cavity to larynx and oesophagus
Begins at base of skull and descends to C6

Split into Nasopharynx, Oropharynx and Laryngopharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Describe the structure of the Nasopharynx

A
  • Base of skull to the soft palate
  • Lined with ciliated pseudostratified columnar epithelium with goblet cells
  • Contains Adenoids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the structure of the Oropharynx

A

From soft palate to superior border of epiglottis

Contains posterior 1/3 tongue, lingual tonsils, palantine tonsils and superior constrictor muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe the structure of the Laryngopharynx

A

Between superior border of epiglottis and inferior border of cricoid

Contains Piriform Fossae and Middle/Inferior constrictors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

The muscles of the Pharynx include Circular and Longitudinal. Describe the circular muscles

A

Superior, Middle and Inferior constrictors

Contract sequentially for Peristalsis

Inferior splits into two parts so if inferior part doesn’t relax - diverticulum

Innervated by Vagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

The muscles of the Pharynx include Circular and Longitudinal. Describe the longitudinal muscles

A

Stylopharyngeus, Palatopharyngeus, Salpingopharyngeus

Shorten and widen pharynx, and elevate larynx in swallowing

All Vagus innervation (except Stylopharyngeus - CNIX)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Describe the blood supply to the Pharynx

A

Branches of the ECA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Name the four roles of the Larynx

A

Phonation, Ventilation, Coughing, Protection of LRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe the anatomy of the Larynx

A

Spans C3-C6
Covered anteriorly by infrahyoids
Anterior to Oesophagus
3 Subsections (Supra, Glottis, Infra)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Describe the blood supply to the Larynx

A 
Superior Laryngeal (Branch of Superior Thyroid)
Inferior Laryngeal (Branch of Inferior Thyroid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Describe the innervation of the Larynx

A

RLN - Sensory to Infraglottis and Motor to all except Cricothyroid

Superior Laryngeal - Sensory to Supraglottis and Motor to Cricothyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Name the three unpaired cartilages of the Larynx

A

Thyroid Cartilage (Laryngeal Prominence)
Cricoid (complete ring)
Epiglottis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Why is the fact that the Cricoid is a complete ring relevant?

A

Pressure can be applied to occlude the oesophagus and prevent regurgitation of contents during Emergency Intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Name the three paired cartilages of the Larynx

A

Arytenoid
Corniculate
Cuneiform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

There are extrinsic and intrinsic Laryngeal ligaments. Name the two main intrinsic ligaments

A

Cricothyroid (upper margin is free edge - vocal ligament)

Quadrangular (lower margin is thickened to become vestibular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Describe the histology of vocal cords

A

Stratified Squamous Epithelium
Reinke’s Space (Watery GAG layer vibrates to make sound)
Vocal Ligament
Vocal Muscle

Relatively avascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the Vestibular Ligament?

A

AKA False Vocal Cord

Lies above true vocal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the role of the extrinsic laryngeal muscles?

A

Suprahyoids - laryngeal elevation

Infrahyoids - laryngeal depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What do the intrinsic muscles of the larynx do (except Cricothyroid)?

A

Control Rima Glottidis, and length/tension of vocal cords

Innervated by inferior laryngeal nerve (from RLN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What does the Cricothyroid Muscle do?

A

Stretches and tenses vocal ligament

Innervated by External Branch of Superior Laryngeal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Why is the Posterior Cricoarytenoid Muscle so important?

A

It is the sole Abductor of the larynx/vocal cords, allowing breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Describe the anatomical relations of the Thyroid Gland

A

Anterior - Infrahyoids
Lateral - Carotid Sheath
Medially - larynx/pharynx/RLN/External branch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Describe the blood supply of the Thyroid Gland

A
  • Superior Thyroid (first branch of ECA)
  • Inferior Thyroid (From thyrocervical trunk - branch of subclavian)
  • 10% have additional Thyroid IMA artery from Braciocephalic trunk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Describe the venous drainage of the Thyroid Gland

A

Superior Middle and Inferior Thyroid Veins form a plexus

Superior and Middle drain into IJV and Inferior drains into braciocephalic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Describe the lymphatic drainage of the Thyroid Gland

A

Paratracheal

Deep cervical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the Parathyroid Glands?

A

Located on posterior aspect of thyroid gland (between 2 and 6 in number)
Superior from fourth pharyngeal arch
Inferior from third pharyngeal arch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the Cervical Plexus?

A

Anterior Rami of C1-C4

Clinically relevant for sensory nerve block at Erb’s Point (middle of posterior SCM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Name the four tonsils in Waldeyer’s Ring

A

Lingual
Palantine
Tubal
Adenoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Describe the pathway of the Carotid Arteries

A

Right - Braciocephalic
Left - Aortic Arch

Ascend until C4 where they split in Carotid Triangle

External branches - Superior Thyroid, Ascending Pharyngeal, Lingual, Facial, Occipital, Posterior Auricular, Maxillary, Superficial Temporal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Describe the anatomy of the Thyrocervical Trunk

A

Branch of the Subclavian Artery

Inferior Thyroid, Ascending Cervical, Transverse Cervical, Suprascapular Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Retropharyngeal Abscesses are often seen in young children, describe the aetiology

A

URTI causes adenitis in retropharyngeal nodes with then causes an abscess

Normally polymicrobial (S.Aureus, H.Parainfluenza)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How do Retropharyngeal Abscesses present?

A 
Severe sore throat
Dysphagia
Trismus
Stridor
Neck stiffness and head tilted back
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Give three differentials for a Retropharyngeal Abscess

A

Angio-oedema
Epiglottitis
Foreign Body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Name four investigations for Retropharyngeal Abscess

A
  • Bloods (WCC and CRP very high)
  • Blood Cultures (often negative)
  • Pus Culture (after drainage)
  • Lateral Neck Xray (prevertebral soft tissue swelling and widening of retropharyngeal space)

If above is not diagnostic - CT with IV Contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What would a CT of Retropharyngeal Abscess show?

A

Hypodense lesion in retropharyngeal space with peripheral ring enhancement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How would you manage a Retropharyngeal Abscess?

A

?Surgical Airway
IV Fluids
Per Oral drainage under anaesthetic
IV Co-Amoxiclav

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Name three complications of Retropharyngeal Abscesses

A

Airway Obstruction
Mediastinitis
Pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Parapharyngeal Abscesses are the second most common (after Peritonsillar). Where is the Parapharyngeal Space?

A

Lateral to superior pharyngeal constrictor and medial to pterygoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How does a Parapharyngeal Abscess present?

A

Fever
Sore Throat
Neck Swelling

Anterior - Lock jaw and hard mass along mandible
Posterior - minimal lock jaw but can involve carotid sheath (rigors, high fever, carotid rupture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How are Parapharyngeal Abscesses investigated?

A

CT

FNE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How are Parapharyngeal Abscesses managed?

A 
IV Co-Amoxiclav
Surgical Drainage (usually through submaxillary fossa)

This may have to be repeated if reaccumulations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is Ludwig’s Angina?

A

Bilateral aggressive cellulitis involving the sub mandibular space. Rapidly spreading and normally without abscess formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the cause of Ludwig’s Angina?

A

Usually dental infections
Oral Ulcerations
Malignancy
Penetrating Injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How does Ludwig’s Angina present?

A 
Swelling on the floor of mouth
Painful mouth
Protruding tongue
Airway compromise
Drooling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How is Ludwig’s Angina investigated?

A

CT Neck
Orthopanomogram (wide view XRay of lower face)
Culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

How is Ludwig’s Angina managed?

A

Airway management (upright with O2 supplementation - unless surgery where nasal intubation is required)

IV Benzylpenicillin and IV Metronidazole

Surgical debridement if failing to respond to abx within 24h or if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Name three investigations for Hoarse Voice

A

Flexible Nasal Endoscopy

Microlaryngobronchoscopy (similar to FNE but under GA)

Stroboscopy (synchronised flashing lights makes vocal cord movement appear slower)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Name 5 benign causes of Hoarse Voice

A 
Vocal Cord Nodules
Muscle Tension Dysphonia
Vocal Cord Polyps
Larygneal Papilloma
Reinke's Oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are Vocal Cord Nodules?

A

Commonly secondary to Phonotrauma
Frequently bilateral
Breathy and Husky with low pitch

Managed by SALT team, rarely requires microlaryngoscopic surgery

74
Q

What is Muscle Tension Dysphonia?

A

Often caused by stress/anxiety
Hoarse voice towards EOD or after extended use
Confirmed by Stroboscopy
Managed by SALT

75
Q

What are Vocal Cord Polyps?

A

Caused by acute injury/GORD/smoke inhalation

Typically benign but unilateral so requires excision to rule out malignancy

76
Q

What is a Laryngeal Papilloma?

A

Benign lesion of the larynx, commonly caused by HPV6 and HPV11
Confirmed by histology
Requires excision as they can cause airway obstruction

77
Q

What is Reinke’s Oedema?

A

Oedema of vocal cords strongly linked to female smokers

Managed by smoking cessation and voice therapy

78
Q

Name two infective causes of Hoarse Voice

A

Larygnitis

Epiglottitis

79
Q

What is Laryngitis?

A
  • Inflammation of the vocal cords, normally following ——–Respiratory Tract Infection
  • May be associated with pain
  • Normal clinical assessment
  • FNE - inflamed larynx with dilated vessels
  • Self limiting
80
Q

Name a neurological cause of Hoarse Voice

A

RLN palsy (stroke, MS, Thyroidectomy, malignancy)

81
Q

Name three malignant causes of Hoarse Voice

A

Laryngeal Ca
Lung Ca
Thyroid Ca

82
Q

What is Stridor?

A

Noise made by forced air through a narrow upper airway

Narrowing occurs below Supraglottis (Stertor) but above Bronchioles (wheeze)

83
Q

What is the Bernculli Principle?

A

As airway begins to narrow, velocity increases and linear pressure exerted decreases, causing airway collapse

84
Q

How can the characteristics of the Stridor help to determine the location?

A

Inspiratory - Laryngeal
Expiratory - Tracheobronchial
Biphasic - Subglottic or Glottic

85
Q

Name three red flags associated with Stridor (other than Stridor itself)

A

Quiet
Trismus
Drooling

86
Q

Management should be initiated before definitive cause is found. Name three possible investigations

A

FNE
Bronchoscopy
CT

87
Q

Describe Acute Stridor management

A

1) Stabilise, Start O2, Contact specialists
2) Suction any secretions
3) Adrenaline or Steroids as necessary
4) Take bloods

88
Q

Give four acute causes of Stridor

A

FB Inhalation
Epiglottitis
Croup
Anaphylaxis

89
Q

State four chronic causes of Stridor

A

Laryngomalacia
Subglottic Stenosis
Vocal Cord Paralysis
Subglottic Haemangioma

90
Q

What is Laryngomalacia?

A

Congenital abnormality where larynx collapses in breathing

Types: 1) Tight Aryepiglottic Folds

        2) Redundant soft tissue in Supraglottis
        3) NMD/GORD

Normally self resolves

91
Q

What is Subglottic Stenosis?

A

Can be congenital, idiopathic, or acquired (eg post intubation)
Graded using Cotton Myer classification

Managed with daily prednisolone

92
Q

What is a Subglottic Haemangioma?

A

Most common head and neck tumour in children

Nasal breathing but normal cry

Diagnosed with microlaryngoscopy/bronchoscopy

Treated with Steroids/Propanolol/Excision

93
Q

Give three causes of Acute Throat Pain

A

Pharyngitis
Tonsillitis
Peritonsillar Abscess

94
Q

Give three causes of Chronic Throat Pain

A

Pharyngitis (Tobacco, Alcohol)
Gastric Reflux
Vitamin Deficiency (D,B12, Folate)

95
Q

Peritonsillar Abscesses are a complication of Tonsillitis. Describe the pathophysiology

A

Usually starts with acute follicular tonsillitis, then peritonsillitis
Pus then becomes trapped between tonsillar capsule and lateral pharyngeal wall
Normally S.Pyogenes/S.Aureus/H.Influenza

96
Q

How do Peritonsillar Abscesses present?

A 
Severe throat pain which may become unilateral
Fever
Drooling
Foul Breath
Hot Potato voice 
Trismus
97
Q

Peritonsillar Abscesses should be treated as a clinical diagnosis and referred to ENT that day. Describe the management

A

Fluids and Analgesia

Initial IV Benzylpenicillin and Metronidazole, before switching the Oral Pen V and Metronidazole

Needle aspiration and incision drainage

98
Q

Name three risk factors for Oral Candidiasis

A

Broad Spectrum Antibiotics
Immunocompromised
Steroid Inhalers

99
Q

Name three types of Oral Candidiasis

A

Oral Thrush (curd like white patches that can be rubbed off)
Erythematous (Marked erythema and soreness after oral abx)
Median Rhomboid

100
Q

How is Oral Candidiasis managed?

A

Children - Muconazole gel
Immunocompetent - Muconazole gel or Nystatin
Immunosupressive - Fluconazole

101
Q

Name four red flags associated with Neck Lumps

A

Hard and Fixed
Epistaxis
Constitutional Symptoms
Cranial Nerve Palsy

102
Q

Name two infective causes of Neck Lumps

A

Reactive Lymphadenopathy

Sialadenitis

103
Q

Name two Neoplastic causes of Neck Lumps

A

Lymphoma

H and N Cancer

104
Q

Name two Inflammatory causes of Neck Lumps

A

Sarcoidosis

Thyroid Nodule

105
Q

Name two congenital causes of Neck Lumps

A

Cystic Hygroma

Branchial Cyst

106
Q

Name a vascular cause of Neck Lumps

A

Carotid Body Tumour

107
Q

How are neck lumps investigated?

A

USS +/- FNA
Excisional Biopsy if Lymphoma
CT/MRI

108
Q

What is a Cystic Hygroma?

A

Benign fluid filled sac caused by malformation of the lymphatic system
Can be anywhere but classically posterior triangle

109
Q

How does a Cystic Hygroma present?

A

Soft painless fluctuant mass that transilluminates

Can grow large enough to cause airway compression/dyphagia

Can be associated with clinical syndromes (eg Turners)

110
Q

How are Cystic Hygromas managed?

A

Only required if symptomatic

Surgical excision or Lymphatic Sclerotherapy

111
Q

Carotid Body tumours are neuroendocrine tumours arising from Paraganglion cells. How do they present?

A

Pulsatile Painless Neck Lump

Typically can move side to side but not up and down

112
Q

How are Carotid Body Tumours managed?

A

Can be managed conservatively with active monitoring via serial imaging
May require surgical excision
Radiotherapy for unresectable tumours

113
Q

What is a Thyroglossal Cyst?

A

Congenital fluid filled sac due to remnant of Thyroglossal Duct
Painless midline cyst that moves up and down on tongue protrusion

114
Q

How are Thyroglossal Cysts managed?

A

Surgical intervention with Sistrunk Procedure

Central body of Hyoid is removed to allow complete removal of tract

115
Q

What are Branchial Cysts?

A

Congenital masses arising in the lateral aspect of the neck due to incomplete obliteration of branchial clefts (typically anterior to SCM)
If large can compress

116
Q

How are Branchial Cysts managed?

A

FNA to exclude cystic metastases of SCC

Surgical Excision +/- Sclerotherapy

117
Q

How does Oral Cavity SCC present?

A

Painless mass
Bleeding
May have preceding Leukoplakia/Erythroplakia

118
Q

How does Pharyngeal Cavity SCC present?

A

Odynophagia
Dysphagia
Stertor

Often metastasise early due to extensive lymphatics

119
Q

How does Nasopharyngeal SCC present?

A

Trotter’s Triad

Unilateral conductive deafness
Trigeminal Neuralgia
Defective Soft Palate Motility

120
Q

How does Laryngeal SCC present?

A

Hoarse voice
Dysphagia
Persistent Cough

Glottis has could prognosis due to poor lymphatic drainage

121
Q

How are Head and Neck SCCs investigated?

A

Examination under anaesthesia (+laryngopharyngooesophagoscopy)
Biopsy
CT
FNA Neck metastases

122
Q

How is SCC of the Oral Cavity managed?

A

Small - Wide local excision +/- Neck dissection

Large- Resection, Neck Dissection, Flap Reconstruction, Radio/Chemo

123
Q

How is SCC of the Oropharynx managed?

A

Small Tonsil - Resection
Large Tonsil - Solely chemoradio
Small Tongue Base - Resection
Large Tongue base - Chemoradio

124
Q

Name 5 subtypes of Thyroid Cancer

A 
Papillary
Follicular
Medullary
Anaplastic 
Lymphoma
125
Q

Describe Papillary Thyroid Cancer

A

Commonest type, usually in 40-50y
Papillary and Colloid filled follicles

May have hx of irradiation to the neck

126
Q

Describe Follicular Thyroid Cancer

A

Second most common
Microscopic capsular invasion
Usually Haematogenous spread

127
Q

Describe Medullary Thyroid Cancer

A

Arise in Parafollicular (C) cells therefore cause a rise in Calcitonin
Associated with MEN2 Syndrome

128
Q

Describe Anaplastic Thyroid Cancer

A

Rare, Aggressive and normally in elderly

Poor Prognosis

129
Q

Describe Lymphoma Thyroid Cancer

A

Rare

Grow Rapidly with marked compressive and B symptoms

130
Q

Name four risk factors for Thyroid Cancer

A

Female
FH (MEN)
Childhood Radiation
Hashimotos

131
Q

Thyroid Cancer normally presents as palpable lump (S). Describe some red flags

A

Rapid growth and pain
Cough/Hoarse Voice
Lump Tethering

132
Q

Name three differentials for Thyroid Cancer

A

Benign Thyroid Adenoma
Toxic Multinodular Goitre
Thyroglossal Duct Cyst

133
Q

How is Thyroid Cancer investigated?

A

TFTs
Ultrasound Thyroid
FNA

134
Q

Describe the Ultrasound features of Thyroid Cancer

A

Microcalcification
Hypoechogenicity
Irregular Margin

Allocated a score U1-U5 (U3-U5 requiring FNA)

135
Q

Describe the FNA classification of Thyroid Cancer

A 
Thy1 - Inconclusive
Thy2 - Non Malignant
Thy3 - Follicular, excision and histology
Thy4 - Suspicious, Hemithyroidectomy
Thy5 - Malignant
136
Q

Describe the surgical management of Thyroid Cancer

A

Hemithyroidectomy
Total Thyroidectomy
Neck Dissection

137
Q

Describe the non surgical management of Thyroid Cancer

A

Radioiodine Theraoy (Papillary or Follicular)
External Beam Radiotherapy
Chemotherapy

138
Q

Name three complications of Thyroidectomy

A

Haematoma
RLN Damage
Hypocalcaemia

139
Q

Describe the anatomy of the Parotid Salivary Gland

A
  • Anterior to Pinna and Lateral to Mandibular Ramus
  • Split into deep and superficial lobes by the facial nerve
  • Opens into Stensons duct
  • 80% Salivary Gland Neoplasms are here
140
Q

Describe the anatomy of the Submandibular Salivary Gland

A

Inferior to body of mandible and superior to Digastric

Duct opens up into Wharton’s Duct (close to tongue frenulum)

Mixed mucous and serous secretions

141
Q

Describe the anatomy of the Sublingual Salivary Gland

A

Located on the floor of the mouth

Secretes into Rivinus Duct

142
Q

What is Sialoadenitis? Give five causes

A

Inflammation of the Salivary Gland (can be acute or chronic)

Infective (eg mumps), Stones, Malignancy, Autoimmune, Idiopathic

143
Q

What is Heerfordt’s Syndrome?

A

A form of Sarcoidosis

Parotid Enlargement, Anterior Uveitis, Facial Nerve Palsy

144
Q

How does Sialoadenitis present?

A

Painful swelling and tenderness of gland
Pyrexia
Lymphadenopathy
Purulent discharge from ducts

145
Q

How is Sialoadenitis investigated?

A
  • Routine bloods (inc ESR if autoimmune suspicious)
  • Blood/Pus swabs
  • FNA if suspecting malignancy
  • USS
146
Q

How is simple Sialoadenitis managed?

A
  • Initially conservative with hydration, analgesia and artificial saliva
  • Use Sialogogues
  • Abx if suspecting bacterial
147
Q

What are Sialogogues

A

Lemon Juice
Massage Gland

Promoting salivation

148
Q

How is a Sialoadenitis Abscess managed?

A

Incision and drainage

Abx

149
Q

What is Sialolithiasis?

A

Presence of calculi in the salivary glands or ducts

150
Q

Describe the pathophysiology of Sialolithiasis

A

Typically following stagnation of saliva, and is composed of calcium phosphate and hydroxyapatite (as saliva is calcium rich)

Usually in the Submandibular gland as it has a long duct and secretions are more mucoid

151
Q

Give three risk factors for Sialolithiasis

A

Medication
Dehydration
Smoking

152
Q

How does Sialolithiasis present?

A

May be asymptomatic

Intermittent facial swelling associated with eating (can be painful or painless)

Stones may feel palpable or glands may feel tender

153
Q

What three investigations could be done for Sialolithiasis?

A

USS - normally first line
XRay - as most stones are radio-opaque
Sialography - not routinely performed as invasive

154
Q

Sialolithiasis is initially managed conservatively. How could recurrent/persistent disease managed?

A
  • Sialoendoscopy and removal
  • Transoral surgical removal
  • Extracorporeal Shock Wave Lithotripsy
  • Gland removal
155
Q

Give two examples of benign salivary tumours

A 
Pleomorphic Adenoma (can undergo malignant change)
Warthin's Tumour
156
Q

Give four examples of malignant salivary tumours

A

Mucoepidermoid Carcinoma
Acinic Cell Carcinoma
Adenoid Cystic Carcinoma
SCC

157
Q

Give three risk factors for Salivary Gland Malignancy

A

Radiation
EBV
Smoking

158
Q

How can a Salivary Gland Malignancy present?

A

Slowly enlarging painless mass (maybe associated facial nerve palsy)

Large - airway obstruction, dysphagia

159
Q

How are Salivary Gland Malignancies investigated?

A

USS and FNA

CT Staging

160
Q

Describe the management of Salivary Gland Malignancies

A
  • Surgical Excision (may have to sacrifice facial nerve if parotid)
  • Selective neck dissection
  • Radiotherapy

DO NOT RESPOND WELL TO CHEMOTHERAPY

161
Q

Describe three early complications of Salivary Gland Malignancy management

A

Haematoma
Facial Nerve Injury
Marginal Mandibular/Hypoglossal/Lingual damage

162
Q

Describe three late complications of Salivary Gland Malignancy management

A

Frey’s Syndrome (Post parotidectomy - autonomic fibres reform inappropriately, causing inappropriate redness and sweating)

Salivary Fistula

163
Q

What is Sjogren’s Syndrome?

A

Autoimmune inflammatory disorder characterised by diminished lacrimal and salivary excretion (due to lymphocytic infiltration of glands)

164
Q

Describe the clinical features of Sjogren’s

A

MAD FRED

Myalgia, Arthralgia, Dry mouth, Fatigue, Raynauds, Enlarged Parotids, Dry Eyes

165
Q

How is Sjogren’s investigated?

A

Autoantibodies - Anti Ro

Schirmers tear volume (reduced)

Salivary gland biopsy (lymphocytic infiltration)

166
Q

How is Sjogren’s managed?

A

Avoid dry/smoky atmosphere
Hypermellose tears/artificial saliva

Beware of neonatal HB

167
Q

Define OSA

A

Obstructive Sleep Apnoea

Upper airway narrowing, provoked by sleep causing daytime sleepiness

168
Q

Describe some causes of OSA

A

Small Pharyngeal Size - Neck Fat, Large Tonsils, Craniofacial abnormalities

Excess narrowing - Obesity, NMD, Muscle relaxants

169
Q

How does OSA present?

A

Excessive snoring
Daytime sleepiness
Nocturia

170
Q

How is OSA investigated?

A

Epworth Sleepiness Scale
Overnight Oximetry
Sleep Study EEG

171
Q

Describe the management options for OSA

A

Conservative - lose weight

Surgical - Pharyngeal surgery to remove excess tissue from soft palate and pharynx, and removes tonsils

CPAP/BiPAP

172
Q

How can Post Tonsillectomy Bleeds present?

A

Can occur in surgery or secondary (after 24h)

Herald bleed (small and stops itself) signals an incoming larger haemorrhage so should be treated as an emergency

173
Q

Give 6 Structural Causes of Dysphagia

A 
FB
Benign Stricture (eg GORD)
Pharyngeal Pouch 
Scleroderma (CREST)
Plummer Vinson Syndrome
Tumour
174
Q

What is a Pharyngeal Pouch?

A
  • Inferior pharyngeal constrictor is split into two parts (thyropharyngeus and cricopharyngeus)
  • Normally in swallowing cricopharyngeus will relax when thyropharyngeus contracts (if not then high pressure and diverticulum forms)
  • Halitosis, Regurgitiation, Palpable lump

Req surgery

175
Q

What is Plummer Vinson Syndrome?

A

Long term iron deficiency leading to tissue growth

176
Q

Name 5 neuromuscular causes of Dysphagia

A 
Achalasia
Presbyoesophagus
Myasthenia Gravis
Bulbar Palsy 
ALS (Motor Neurone Disease)
177
Q

Describe the pathophysiology of Achalasia

A

Impaired peristalsis and increased lower oesophageal sphincter pressure (with inadequate relaxation on swallowing)

178
Q

Name three presenting features of Achalasia

A

Dysphagia
Retrosternal Chest Pain
Bolus Impaction

179
Q

How is Achalasia investigated? What would they show?

A

Barium Swallow (dilation of oesophagus behind heart - bird’s beak)

Oesophageal Manometry (abnormal peristalsis and high LOS pressure)

180
Q

How is Achalasia managed?

A

Heller Myotomy

Pneumatic Dilation

Year 4 Neuro and Special Senses (8 decks)

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