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Neuro & 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

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2
Q

Name the four subdivisions of the anterior triangle

A

Carotid Triangle
Submental triangle
Submandibular triangle
Muscular triangle

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3
Q

What are the borders of the Carotid Triangle?

A

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

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4
Q

What are the contents of the Carotid Triangle?

A

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

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5
Q

What is contained within the Submental triangle?

A

Submental lymph nodes

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6
Q

What is contained within the Submandibular triangle?

A

Submandibular salivary glands
Lymph nodes
Facial Artery and Veins

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7
Q

What is contained within the Muscular Triangle?

A

Infrahyoids
Pharynx
Thyroid
Parathyroid

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8
Q

Name the four Suprahyoid muscles

A

Stylohyoid
Digastric
Myelohyoid
Geniohyoid

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9
Q

Name the four infrahyoid muscles

A

Omohyoid
Sternohyoid
Thyrohyoid
Sternothyroid

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10
Q

What are the borders of the Posterior Triangle?

A

Posterior SCM
Anterior Trapezius
Clavicle

Roof - investing fascia
Floor - prevertebral fascia

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11
Q

Name three muscles in the Posterior Triangle

A

Omohyoid
Levator Scapulae
Scalenes

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12
Q

Name three vessels in the Posterior Triangle

A

EJV Superficially
Transverse Cervical
Suprascapular

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13
Q

Name the nerves in the Posterior Triangle

A

Accessory nerve
Cervical plexus
Trunks of Brachioplexus

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14
Q

Name three distinguishing features of the cervical spine

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

(spinal nerves exit above level)

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15
Q

Name 6 ligaments of the Cervical Spine

A 
Anterior Longitudinal
Posterior Longitudinal
Ligamentum Flavum
Interspinous
Nuchal ligament
Transverse ligament of atlas
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16
Q

How is the Hyoid Bone damaged?

A

Strangulation

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17
Q

Name the three Deep Cervical Fascial Layers

A

Investing
Pre Tracheal
Pre Vertebral

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18
Q

Describe the investing layer of Deep Cervical Fascia

A

Most superficial, surrounding all structures in the neck

Splits around trapezius and SCM

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19
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

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20
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

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21
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

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22
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
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23
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

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24
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

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25
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

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26
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)

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27
Q

Describe the blood supply to the Pharynx

A

Branches of the ECA

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28
Q

Name the four roles of the Larynx

A

Phonation, Ventilation, Coughing, Protection of LRT

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29
Q

Describe the anatomy of the Larynx

A

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

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30
Q

Describe the blood supply to the Larynx

A 
Superior Laryngeal (Branch of Superior Thyroid)
Inferior Laryngeal (Branch of Inferior Thyroid)
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31
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

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32
Q

Name the three unpaired cartilages of the Larynx

A

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

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33
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

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34
Q

Name the three paired cartilages of the Larynx

A

Arytenoid
Corniculate
Cuneiform

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35
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)

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36
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

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37
Q

What is the Vestibular Ligament?

A

AKA False Vocal Cord

Lies above true vocal cord

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38
Q

What is the role of the extrinsic laryngeal muscles?

A

Suprahyoids - laryngeal elevation

Infrahyoids - laryngeal depression

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39
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)

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40
Q

What does the Cricothyroid Muscle do?

A

Stretches and tenses vocal ligament

Innervated by External Branch of Superior Laryngeal

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41
Q

Why is the Posterior Cricoarytenoid Muscle so important?

A

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

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42
Q

Describe the anatomical relations of the Thyroid Gland

A

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

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43
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
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44
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

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45
Q

Describe the lymphatic drainage of the Thyroid Gland

A

Paratracheal

Deep cervical

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46
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

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47
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)

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48
Q

Name the four tonsils in Waldeyer’s Ring

A

Lingual
Palantine
Tubal
Adenoid

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49
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

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50
Q

Describe the anatomy of the Thyrocervical Trunk

A

Branch of the Subclavian Artery

Inferior Thyroid, Ascending Cervical, Transverse Cervical, Suprascapular Artery

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51
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)

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52
Q

How do Retropharyngeal Abscesses present?

A 
Severe sore throat
Dysphagia
Trismus
Stridor
Neck stiffness and head tilted back
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53
Q

Give three differentials for a Retropharyngeal Abscess

A

Angio-oedema
Epiglottitis
Foreign Body

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54
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

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55
Q

What would a CT of Retropharyngeal Abscess show?

A

Hypodense lesion in retropharyngeal space with peripheral ring enhancement

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56
Q

How would you manage a Retropharyngeal Abscess?

A

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

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57
Q

Name three complications of Retropharyngeal Abscesses

A

Airway Obstruction
Mediastinitis
Pericarditis

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58
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

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59
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)

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60
Q

How are Parapharyngeal Abscesses investigated?

A

CT

FNE

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61
Q

How are Parapharyngeal Abscesses managed?

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

This may have to be repeated if reaccumulations

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62
Q

What is Ludwig’s Angina?

A

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

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63
Q

What is the cause of Ludwig’s Angina?

A

Usually dental infections
Oral Ulcerations
Malignancy
Penetrating Injuries

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64
Q

How does Ludwig’s Angina present?

A 
Swelling on the floor of mouth
Painful mouth
Protruding tongue
Airway compromise
Drooling
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65
Q

How is Ludwig’s Angina investigated?

A

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

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66
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

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67
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)

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68
Q

Name 5 benign causes of Hoarse Voice

A 
Vocal Cord Nodules
Muscle Tension Dysphonia
Vocal Cord Polyps
Larygneal Papilloma
Reinke's Oedema
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69
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

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70
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

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71
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

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72
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

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73
Q

What is Reinke’s Oedema?

A

Oedema of vocal cords strongly linked to female smokers

Managed by smoking cessation and voice therapy

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74
Q

Name two infective causes of Hoarse Voice

A

Larygnitis

Epiglottitis

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75
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
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76
Q

Name a neurological cause of Hoarse Voice

A

RLN palsy (stroke, MS, Thyroidectomy, malignancy)

77
Q

Name three malignant causes of Hoarse Voice

A

Laryngeal Ca
Lung Ca
Thyroid Ca

78
Q

What is Stridor?

A

Noise made by forced air through a narrow upper airway

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

79
Q

What is the Bernculli Principle?

A

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

80
Q

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

A

Inspiratory - Laryngeal
Expiratory - Tracheobronchial
Biphasic - Subglottic or Glottic

81
Q

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

A

Quiet
Trismus
Drooling

82
Q

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

A

FNE
Bronchoscopy
CT

83
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

84
Q

Give four acute causes of Stridor

A

FB Inhalation
Epiglottitis
Croup
Anaphylaxis

85
Q

State four chronic causes of Stridor

A

Laryngomalacia
Subglottic Stenosis
Vocal Cord Paralysis
Subglottic Haemangioma

86
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

87
Q

What is Subglottic Stenosis?

A

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

Managed with daily prednisolone

88
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

89
Q

Give three causes of Acute Throat Pain

A

Pharyngitis
Tonsillitis
Peritonsillar Abscess

90
Q

Give three causes of Chronic Throat Pain

A

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

91
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

92
Q

How do Peritonsillar Abscesses present?

A 
Severe throat pain which may become unilateral
Fever
Drooling
Foul Breath
Hot Potato voice 
Trismus
93
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

94
Q

Name three risk factors for Oral Candidiasis

A

Broad Spectrum Antibiotics
Immunocompromised
Steroid Inhalers

95
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

96
Q

How is Oral Candidiasis managed?

A

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

97
Q

Name four red flags associated with Neck Lumps

A

Hard and Fixed
Epistaxis
Constitutional Symptoms
Cranial Nerve Palsy

98
Q

Name two infective causes of Neck Lumps

A

Reactive Lymphadenopathy

Sialadenitis

99
Q

Name two Neoplastic causes of Neck Lumps

A

Lymphoma

H and N Cancer

100
Q

Name two Inflammatory causes of Neck Lumps

A

Sarcoidosis

Thyroid Nodule

101
Q

Name two congenital causes of Neck Lumps

A

Cystic Hygroma

Branchial Cyst

102
Q

Name a vascular cause of Neck Lumps

A

Carotid Body Tumour

103
Q

How are neck lumps investigated?

A

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

104
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

105
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)

106
Q

How are Cystic Hygromas managed?

A

Only required if symptomatic

Surgical excision or Lymphatic Sclerotherapy

107
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

108
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

109
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

110
Q

How are Thyroglossal Cysts managed?

A

Surgical intervention with Sistrunk Procedure

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

111
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

112
Q

How are Branchial Cysts managed?

A

FNA to exclude cystic metastases of SCC

Surgical Excision +/- Sclerotherapy

113
Q

How does Oral Cavity SCC present?

A

Painless mass
Bleeding
May have preceding Leukoplakia/Erythroplakia

114
Q

How does Pharyngeal Cavity SCC present?

A

Odynophagia
Dysphagia
Stertor

Often metastasise early due to extensive lymphatics

115
Q

How does Nasopharyngeal SCC present?

A

Trotter’s Triad

Unilateral conductive deafness
Trigeminal Neuralgia
Defective Soft Palate Motility

116
Q

How does Laryngeal SCC present?

A

Hoarse voice
Dysphagia
Persistent Cough

Glottis has could prognosis due to poor lymphatic drainage

117
Q

How are Head and Neck SCCs investigated?

A

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

118
Q

How is SCC of the Oral Cavity managed?

A

Small - Wide local excision +/- Neck dissection

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

119
Q

How is SCC of the Oropharynx managed?

A

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

120
Q

Name 5 subtypes of Thyroid Cancer

A 
Papillary
Follicular
Medullary
Anaplastic 
Lymphoma
121
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

122
Q

Describe Follicular Thyroid Cancer

A

Second most common
Microscopic capsular invasion
Usually Haematogenous spread

123
Q

Describe Medullary Thyroid Cancer

A

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

124
Q

Describe Anaplastic Thyroid Cancer

A

Rare, Aggressive and normally in elderly

Poor Prognosis

125
Q

Describe Lymphoma Thyroid Cancer

A

Rare

Grow Rapidly with marked compressive and B symptoms

126
Q

Name four risk factors for Thyroid Cancer

A

Female
FH (MEN)
Childhood Radiation
Hashimotos

127
Q

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

A

Rapid growth and pain
Cough/Hoarse Voice
Lump Tethering

128
Q

Name three differentials for Thyroid Cancer

A

Benign Thyroid Adenoma
Toxic Multinodular Goitre
Thyroglossal Duct Cyst

129
Q

How is Thyroid Cancer investigated?

A

TFTs
Ultrasound Thyroid
FNA

130
Q

Describe the Ultrasound features of Thyroid Cancer

A

Microcalcification
Hypoechogenicity
Irregular Margin

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

131
Q

Describe the FNA classification of Thyroid Cancer

A 
Thy1 - Inconclusive
Thy2 - Non Malignant
Thy3 - Follicular, excision and histology
Thy4 - Suspicious, Hemithyroidectomy
Thy5 - Malignant
132
Q

Describe the surgical management of Thyroid Cancer

A

Hemithyroidectomy
Total Thyroidectomy
Neck Dissection

133
Q

Describe the non surgical management of Thyroid Cancer

A

Radioiodine Theraoy (Papillary or Follicular)
External Beam Radiotherapy
Chemotherapy

134
Q

Name three complications of Thyroidectomy

A

Haematoma
RLN Damage
Hypocalcaemia

135
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
136
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

137
Q

Describe the anatomy of the Sublingual Salivary Gland

A

Located on the floor of the mouth

Secretes into Rivinus Duct

138
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

139
Q

What is Heerfordt’s Syndrome?

A

A form of Sarcoidosis

Parotid Enlargement, Anterior Uveitis, Facial Nerve Palsy

140
Q

How does Sialoadenitis present?

A

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

141
Q

How is Sialoadenitis investigated?

A

Routine bloods (inc ESR if autoimmune suspicious)

  • Blood/Pus swabs
  • FNA if suspecting malignancy
  • USS
142
Q

How is simple Sialoadenitis managed?

A
  • Initially conservative with hydration, analgesia and artificial saliva
  • Use Sialogogues
  • Abx if suspecting bacterial
143
Q

What are Sialogogues

A

Lemon Juice
Massage Gland

Promoting salivation

144
Q

How is a Sialoadenitis Abscess managed?

A

Incision and drainage

Abx

145
Q

What is Sialolithiasis?

A

Presence of calculi in the salivary glands or ducts

146
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

147
Q

Give three risk factors for Sialolithiasis

A

Medication
Dehydration
Smoking

148
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

149
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

150
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
151
Q

Give two examples of benign salivary tumours

A 
Pleomorphic Adenoma (can undergo malignant change)
Warthin's Tumour
152
Q

Give four examples of malignant salivary tumours

A

Mucoepidermoid Carcinoma
Acinic Cell Carcinoma
Adenoid Cystic Carcinoma
SCC

153
Q

Give three risk factors for Salivary Gland Malignancy

A

Radiation
EBV
Smoking

154
Q

How can a Salivary Gland Malignancy present?

A

Slowly enlarging painless mass (maybe associated facial nerve palsy)

Large - airway obstruction, dysphagia

155
Q

How are Salivary Gland Malignancies investigated?

A

USS and FNA

CT Staging

156
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

157
Q

Describe three early complications of Salivary Gland Malignancy management

A

Haematoma
Facial Nerve Injury
Marginal Mandibular/Hypoglossal/Lingual damage

158
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

159
Q

What is Sjogren’s Syndrome?

A

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

160
Q

Describe the clinical features of Sjogren’s

A

MAD FRED

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

161
Q

How is Sjogren’s investigated?

A

Autoantibodies - Anti Ro

Schirmers tear volume (reduced)

Salivary gland biopsy (lymphocytic infiltration

162
Q

How is Sjogren’s managed?

A

Avoid dry/smoky atmosphere
Hypermellose tears/artificial saliva

Beware of neonatal HB

163
Q

Define OSA

A

Obstructive Sleep Apnoea

Upper airway narrowing, provoked by sleep causing daytime sleepiness

164
Q

Describe some causes of OSA

A

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

Excess narrowing - Obesity, NMD, Muscle relaxants

165
Q

How does OSA present?

A

Excessive snoring
Daytime sleepiness
Nocturia

166
Q

How is OSA investigated?

A

Epworth Sleepiness Scale
Overnight Oximetry
Sleep Study EEG

167
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

168
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

169
Q

Give 6 Structural Causes of Dysphagia

A 
FB
Benign Stricture (eg GORD)
Pharyngeal Pouch 
Scleroderma (CREST)
Plummer Vinson Syndrome
Tumour
170
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

171
Q

What is Plummer Vinson Syndrome?

A

Long term iron deficiency leading to tissue growth

172
Q

Name 5 structural causes of Dysphagia

A 
Achalasia
Presbyoesophagus
Myasthenia Gravis
Bulbar Palsy 
ALS (Motor Neurone Disease)
173
Q

Describe the pathophysiology of Achalasia

A

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

174
Q

Name three presenting features of Achalasia

A

Dysphagia
Retrosternal Chest Pain
Bolus Impaction

175
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)

176
Q

How is Achalasia managed?

A

Heller Myotomy

Pneumatic Dilation

177
Q

What are causes of tonsillitis?

A

Group A strep, strep pyogenes

Haemophilus influenzae
Moraxella catarrhalis
staph aureus

178
Q

What is the typical presentation of tonsillitis?

A

Sore throat, fever above 38, pain on swallowing
Red inflamed enlarged tonsils

Centor criteria - score of 3 or more, offer abx
Fever over 38, tonsillar exudates, absence of cough, tender anterior cervical lymph nodes

FeverPAIN score - score of 4-5 higher probability
Fever during prev 24 hours
Purulence
Attended within 2 days of symptoms
Inflamed tonsils
No cough or coryza
179
Q

When and what abx are given for tonsillitis?

A

Penicillin V/phenoxymethylpenicillin - 10 day course or clarithromycin

If centor >3 or fever PAIN >4

180
Q

What are the complications of tonsillitis?

A 
Peritonsillar abscess - quinsy
Otitis media
Scarlet fever
Rheumatic fever
Post strep glomerulonephritis
Post strep reactive arthritis
181
Q

What is the presentation of quinsy?

A

Sore throat, painful swallow
Fever, neck pain, ear pain
Swollen tender lymph nodes

Trismus - cannot open mouth
Change in voice - hot potato
Swelling and erythema

182
Q

What is the management of quinsy?

A

Incision and drainage under GA, broad spectrum abx e.g. co-amoxiclav before and after surgery
Some give steroids e.g. dexamethasone to settle inflammation and help recovery

183
Q

What are the indications for a tonsillectomy?

A

7 or more in 1 year
5 per year for 2 years
3 per year for 3 years

Recurrent tonsillar abscesses - 2 episodes
Enlarged tonsils causing difficulty breathing, swallowing or snoring

184
Q

What is the management of a post tonsillectomy bleed?

A 
Call ENT
IV access
Send bloods - FBC, clotting, group and save
Keep patient calm, adequate analgesia
Sit up, spit out blood
Make patient NBM
IV fluids

If severe bleeding or airway compromise - anaesthetics

If less severe - hydrogen peroxide gargle, adrenalin soaked swab applied topically

185
Q

What is glossitis and some causes?

A

Inflamed tongue - red, sore, swollen, papillae of tongue shrink, tongue looks smooth

Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury/irritant

Management is to correct underlying cause

186
Q

What is geographic tongue?

A

Inflammatory condition
Patches of tongue lose epithelium and papillae

Patches are irregular
Can last days to weeks, tend to relapse and remit

Stress and mental illness
Psoriasis
Atopy
Diabetes

187
Q

What are the causes of strawberry tongue?

A

Tongue is swollen and red, papillae enlarged, white and prominent.

Scarlet fever
Kawasaki disease

188
Q

What is black hairy tongue?

A

Decreased shedding of keratine
Papillae elongate, appear as hairs
Bacteria and food cause dark pigmentation

Sticky saliva
Metallic taste

Due to dehydration, dry mouth, poor oral hygiene, smoking

Neuro & Special Senses (12 decks)

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