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Yr4 - Neuro + SS > Throat > Flashcards

Throat Flashcards

1
Q

Define retropharyngeal abscess

A

Neck infection involving abscess formation in the space between the pre-vertebral fascia and the constrictor muscles

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2
Q

Epidemiology of retropharyngeal abscess

A

Peak incidence in children between 3-5 years
- increased incidence of URTIs and oropharyngeal trauma
More common in males

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3
Q

Pathophysiology of retropharyngeal abscess

A 
45% occur secondary to URTI
- strep viridians
- staph aureus
- strep epidermis
- beta-haemolytic strep
Occur with accidental trauma - foreign body ingestion
28% idiopathic
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4
Q

Presentation of RPA

A

Spiking fever
Neck pain or torticollis - irritation of sternocleidomastoid
Odynophagia/dysphagia - difficult to swallow past abscess, drooling may occur
Neck/oropharyngeal swelling
Lymphadenopathy
Stridor
Decreased oral intake, malaise, irritability

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5
Q

Ix for RPA

A

FBC
- raised WCC especially neutrophils
CT neck with contrast - ring-enhancing lesion in retropharyngeal space
X-ray of neck - if CT unavailable
USS - lymphadenopathy and fluid collection
Culture of pus from surgical drainage

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6
Q

Mx of RPA

A 
Emergency - airway compromise
- IV corticosteroid
- nebulised adrenaline
- surgical drainage
- ceftriaxone + clindamycin
- supportive care and analgesia
No airway compromise
- ceftriaxone + clindamycin
- IV corticosteroid
- surgical drainage
- supportive care + analgesia
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7
Q

Complications of RPA

A

Recurrence of abscess
Necrotising fasciitis
Mediastinitis

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8
Q

Define Ludwig’s Angina

A

Infection of space between floor of mouth and mylohyoid

- most commonly a/w dental infection

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9
Q

Presentation of Ludwig’s Angina

A 
Swelling of floor of mouth
Painful mouth
Protruding tongue
Airway compromise
Drooling
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10
Q

Ix for Ludwig’s Angina

A

CT neck

Panoramic x-ray - periapical radiolucency around abscesses and periodontal bone loss

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11
Q

Mx of Ludwig’s Angina

A

Secure airway
IV abx
Surgery to drain

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12
Q

Define parapharyngeal abscess

A 
Collection in parapharyngeal space
- potential space postero-lateral to oropharynx and nasopharynx divided by styloid process
Risk of damage to carotid sheath
- common carotid artery
- internal carotid artery
- internal jugular vein
- vagus nerve
- deep cervical lymph nodes
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13
Q

Presentation of parapharyngeal abscess

A 
Hx of febrile illness
Odynophagia
Trismus (reduced opening of the jaw)
Reduced neck movement
Swelling in neck around upper part of SCM
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14
Q

Mx of parapharyngeal abscess

A

Secure airway
IV abx
Surgical drainage

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15
Q

Define acute epiglottitis

A

Cellulitis of supraglottis that may cause airway compromise

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16
Q

Epidemiology of acute epiglottis

A

Most common between 3-5

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17
Q

Pathophysiology of acute epiglottitis

A

Supraglottis becomes infected
- most commonly haemophilus influenzea
- strep pneumoniae, staph aureus and MRSA
- may occur secondary to trauma, ingestion or thermal injury
Inflammatory pathways lead to oedema and intense swelling of epiglottis

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18
Q

Classification of acute epiglottitis

A 
Class 1
- slight swelling
- entire vocal cord visualised
Class 2 
- moderate swelling of epiglottitis
- >50% posterior cord visible
Class 3
- severe swelling
- < 50% of posterior cord visible
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19
Q

Presentation of epiglottitis

A 
Acute onset
High fever in very ill toxic looking child
Intensely painful throat - prevents speaking and swallowing, may cause drooling
Soft inspiratory stridor
Rapidly increasing resp difficulty
Tripod position
Decreased oral intake
Hot potato voice
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20
Q

Ix for epiglottitis

A

Laryngoscopy - swelling of supraglottic structures
Lateral neck radiograph - enlarged epiglottitis
Blood cultures

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21
Q

Mx of epiglottitis

A 
Urgent hospital admission 
- call senior anaesthetist, paediatrician and ENT surgeon
Secure airway
Supplemental O2
IV abx
Dexamethasone
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22
Q

Prevention of epiglottitis

A

HiB vaccine
- part of 6 in 1 at 8, 12 and 16 weeks
HiB/MenC at 1 year

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23
Q

Complications of epiglottitis

A

Resp failure

Mediastinitis - infection spreads to retropharyngeal then mediastinal space

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24
Q

Features of parotid swelling

A

Anterior to ear
Swelling may be due to neoplasm, infection, obstruction or autoimmune
75% of tumours are benign
Surgical removal 1st line for neoplasms

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25
Q

Features of jugulodigastric node swelling

A

Angle of mandible

Commonly enlarged in tonsillitis

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26
Q

Features of submandibular node swelling

A

Inferior border of mandible
May be enlarged due to salivary duct stones, sialadenitis, Sjogren’s syndrome, cysts or infections
50% of neoplasms are malignant

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27
Q

Features of carotid body swelling

A 
Tumour or aneurysm
At bifurcation of common carotid artery
Aneurysm mx
- watchful waiting - regular CT/MRI, anti-hypertensives, statins, thrombolysis
- surgical repair
- stent graphting
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28
Q

Features of thyroglossal cyst

A

Midline between hyoid bone and thyroid gland
Painless, smooth and cystic
Painful if infected
Caused by birth defect - remnant of thyroglossal duct cyst
Moves up on protrusion of tongue and swallowing
Only remove if affects breathing/swallowing or infected

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29
Q

Features of Branchial cyst

A

Anterior border of SCM
Generally present in late childhood/early adulthood
Painless mass that is noticed when becomes infected secondary to URTI
Remnant of brachial cleft - squamous epithelium surrounded by lymphoid tissue
Does not move on swallowing
Conservative mx of surgical excision - risk of damage to IJV, ICA, CN VII

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30
Q

Features of a thyroid nodule

A

At level of thyroid
Tissue or fluid within otherwise normal thyroid gland
Malignancy rare
- worrying symptoms = hoarse voice, rapid increase in size
- more common in males or prior radiotherapy
Located at edge of thyroid gland, often felt in a lump in throat
Measure TSH and anti-thyroid antibodies
Consider excision or treatment of thyroid disease

31
Q

Features of Virchow’s node

A

Left-sided supraclavicular lymph node
Metastases of malignancy
- abdo - gastric, kidney, ovarian, testicular
- lymphoma - Hodgkin’s

32
Q

Ix for neck masses

A

Neck USS
CXR
Bloods - FBC, TFTs
USS guided fine needle aspiration

33
Q

Define obstructive sleep apnoea

A

Episodic complete or partial upper airway obstruction during sleep

34
Q

Epidemiology obstructive sleep apnoea

A

4% of men
2% of women
Increases with age

35
Q

Risk factors for OSA

A 
Obesity
Large neck circumference
Maxillomadibular anomalies - excessive protrusion of upper or lower incisors
Adenotonsillar or tongue hypertrophy
FHx
Hypothyroidism
Down's syndrome
Smoking
36
Q

Pathophysiology of OSA

A

Episodic apnoea caused by dynamic narrowing of upper airway during sleep
Upper pharyngeal dilator muscle activity decreases with sleep onset and more in REM sleep
Pharynx vulnerable to collapse at end of expiration due to loss of neural tone of dilators and loss of positive intraluminal pressure

37
Q

Presentation of OSA

A 
Collateral hx from bed partner
Episodic apnoea - terminated by loud snore
Episodic gasping
Restless sleep
Excessive daytime sleepiness
38
Q

Ix for OSA

A 
Polysomnography - apnoea hypopnea index
Portable multichannel sleep tests - assess nasal pressure, oximetry, thoracoabdominal effort sensors, HR
Fibreoptic endoscopy 
TFTs
CXR - obstructive lung disease
ECG - right ventricular failure
39
Q

Mx of OSA

A 
CPAP
Upper airway surgery 
Mandibular position devices
Weight loss
Modafinil - reduce persistent hypersomnolence
Positional therapy
40
Q

Define tonsillitis

A

Acute infection of parenchyma of palatine tonsils

41
Q

Epidemiology of tonsillitis

A

15-30% of children with sore throat have bacterial tonsillitis
Most common in ages -
Most common in winter and early spring

42
Q

Pathophysiology of tonsillitis

A 
Usually viral
- rhinovirus
- coronavirus
- adenovirus
Common bacteria
- group A beta haemolytic strep
- strep pneumoniae
- haemophilus influenzae
Local inflammatory pathways result in oropharyngeal swelling, oedema, erythema and pain
43
Q

Presentation of tonsillitis

A 
Pain on swallowing
Fever
Tonsillar exudate
Sudden onset sore throat
Headache
N+V
Abdo pain
Cough
Runny nose
Tonsillar erythema and enlargement
Swollen, painful anterior cervical lymph nodes
44
Q

Ix for tonsillitis

A

Throat culture

Rapid streptococcal antigen test

45
Q

Criteria for Fever PAIN score

A

1 point for

  • fever
  • purulent tonsils
  • acute onset - less than 3 days
  • inflamed tonsils
  • no cough/coryzal symptoms
46
Q

Significance of fever pain score

A 
0-1 = unlikely bacterial
- no abx
2-3 = possible bacterial
- delayed abx
4+ = likely bacterial 
- abx
47
Q

Mx of tonsillitis

A 
Phenoxymethylpenicillin
- amoxicillin will cause maculopapular rash in presence of EBV
Supportive care
- paracetamol and ibuprofen
Corticosteroids
- severe swelling in children > 12
Tonsillectomy 
- recurrent episodes
48
Q

Differentials for tonsillitis

A 
Infectious mononucleosis
- doesn't resolve within 1 week
- associated with generalised lymphadenopathy, splenomegaly, hepatomegaly, persistent weight loss
- avoid contact sports
Peri-tonsillar abscess (quinsy)
- more severe symptoms
- sore throat lateralised to one side
- hot potato voice
- confirmed by aspirate
- mx by draining abscess
49
Q

Epidemiology of head and neck cancers

A

M:F = 2:1

50
Q

Risk factors for head and neck cancers

A

Alcohol
Tobacco
Beetle nut chewing - oral cavity
Chinses ethnic origin - nasopharyngeal

51
Q

Pathophysiology of head and neck cancers

A

90% squamous cell

52
Q

Presentation of head and neck cancers

A 
Dysphonia 
Dysphagia
Stridor /  dyspnoea
Neck mass/lump
Pain
Bleeding from nose/mouth
Nasal blockage
53
Q

Ix for head and neck cancers

A 
Examination under anaesthetic
- laryngopharyngoesophagoscopy
CT neck
USS guided fine needle aspiration
Open biopsy
CT chest
54
Q

Mx of head and neck cancers

A 
Palliation
Curative
- radiotherapy
- chemotherapy
surgery
55
Q

Approach to a goitre

A

Confirm whether intra or extra thyroidal
Neck USS
Cervical lymph node USS to exclude malignancies
Assess hormonal activity

56
Q

Presentation of a goitre

A 
Hyperthyroidism
Hypothyroidism
Local compressive symptoms
- dysphonia
- dysphagia
- stridor
57
Q

Risk factors for thyroid malignancy

A 
Male
< 20 or > 60
Rapid growth
Prior neck radiotherapy
FHx
58
Q

Causes of thyroid swelling

A 
Benign, euthyroid hyperplasia/neoplasm
- colloid nodules - overgrowth of thyroid tissue
- thyroid adenomas - homogenous, solitary, well-encapsulated tumours of follicular epithelium
Benign, hyperthyroidic hyperplasia
- toxic adenoma - autonomously hyper-functioning thyroid nodules, increased uptake of radioactive iodine
Malignant neoplasm
- papillary thyroid cancer
- follicular thyroid cancer
- medullary thyroid cancer
- anaplastic thyroid cancer
Congenital 
- thyroid cysts
- thyroglossal duct cysts
Infections/inflammatory
- acute suppurative thyroiditis
- subacute granulomatous thyroiditis
- hasimoto's
- graves
Non-thyroidal
- enlarged parathyroid glands
- metastasis
59
Q

Mx of goitre

A 
Non-neoplastic
- conservative
- surgery - compressive symptoms, cosmesis or patient preference
    - hemithyroidectomy preferable
Neoplastic
- adenomas 
     - no further treatment after diagnostic hemithyroidectomy
- carcinoma 
     - total thyroidectomy 
     - post op radio-iodine
60
Q

Complications of thyroid surgery

A

Post-op haemorrhage
Vocal cord palsy
Airway obstruction
Hypocalcaemia

61
Q

Define acute sialadenitis

A

Inflammation and swelling of salivary glands

62
Q

Causes of acute sialadenitis

A 
Viral
- mumps
- coxsackievirus
- echovirus
- HIV
Bacterial
- staphylococcus
Chronic sialadenitis is rare
- TB
- sarcoidosis
- HIV
- syphilis
63
Q

Presentation of acute sialadentits

A 
Fever
Pain
Dysphagia
Facial swelling - unilateral 
Exudates of pus from salivary gland opening
64
Q

Ix of acute sialadenitis

A

Culture and sensitivities of exudate from duct
FBC - raised WCC
Facial radiographs - sialoiths

65
Q

Mx of acute sialadentitis

A 
Broad spec abx
Conservative
- hydration
- pain relief
- sialagogues
66
Q

Define sialoliths

A

Stones in salivary duct causes obstruction and subsequently to pain and swelling
- worse during meals
Most likely in submandibular gland

67
Q

Ix for sialoliths

A

USS

Sialogram - x-ray looking at glands and ducts

68
Q

Mx for sialoliths

A 
Conservative
- analgesia
- hydration
- sialagogues
Radiological removal
Surgery
- intraoral removal of palpable stones
- removal of salivary gland
69
Q

Complications of sialothis

A

Sialadenitis

Abscess formation

70
Q

Define Sjogren syndrome

A

Autoimmune lymphocytic inflammation into ductal tissue of secretory glands

71
Q

Presentation of sjogren syndrome

A

Dry eyes
Dry mouth
Enlarged salivary glands
Increased risk of lymphoma

72
Q

Types of Sjogrens syndrome

A

Primary
- without connective tissue disease
Secondary
- with connective tissue disease - RA

73
Q

Diagnosis of Sjogrens syndrome

A

Schirmer’s test - measures tears
Anti-Ro and anti-La antibodies
Minor salivary gland biopsy

74
Q

Mx of Sjogrens syndrome

A

Artificial tears

Salivary subsitutes

Yr4 - Neuro + SS (9 decks)

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