Throat

Question 1

What are some complications of a thyroidectomy?

Answer 1

Laryngeal oedema (bleeding - SCOOP)
Recurrent laryngeal nerve damage
Damage to parathyroid glands (hypocalcaemia - QTc elongation)

Question 2

What are the congenital causes of neck lumps in children?

Answer 2

1. Branchial cyst
2. Thyroglossal cyst
3. Dermoid cyst
4. Vascular malformation

Question 3

What are the features of a branchial cyst?

Answer 3

benign
aspiration - acellular fluid with cholesterol crystals
may have a fistula - prone to infection
ANTERIOR to the sternocleidomastoid muscle and between the SCM and pharynx
Unilateral - typically on the left
smooth, soft, fluctuant, non-tender
no transillumination

Question 4

What is the treatment for branchial cysts

Answer 4

Conservative management
Surgical excision
Antibiotics for acute infection

Question 5

What is the treatment for branchial cysts

Answer 5

Conservative management
Surgical excision
Antibiotics for acute infection

Question 6

What is the treatment of a primary haemorrhage following a tonsillectomy?

Answer 6

Primary haemorrhage = usually within 6-8 hrs

ANY blood is usually enough to warrant a return to theatre

Emergency - return to theatre (can apply adrenaline-soaked gauze initially to control bleeding)

Question 7

What is the management of a secondary haemorrhage following a tonsillectomy?

Answer 7

Secondary haemorrhage = usually 5-10 days post operation (occurs in 1-2% of tonsillectomy)

Usually caused by a wound infection - admission and antibiotics are the treatment

ALL must be assessed by ENT

Severe - may warrant a return to theatre

Question 8

When do thyroidectomy complications usually occur?

Answer 8

Would healthy but swelling (first 2 days) - Haematoma

Wound red and swelling (>3 days after) - Abscess/infection

Wound healthy and no swelling - Laryngeal Nerve injury

Question 9

What is the emergency management of haematoma after thyroidectomy?

Answer 9

Cut the surgical clips - with bedside wire cutters
Insert a drain

Question 10

What is a cystic hygroma?

Answer 10

A fluid filled sac (cyst) that results from a malformation in the lymphatic system.

Question 11

What are common features of a cystic hygroma?

Answer 11

Classicaly found on the left side
90% present before 2 years of age

Question 12

What is the treatment for quinsy?

Answer 12

IV antibiotics + Surgical drainage

Consider tonsillectomy in 6 weeks

Question 13

What are the two scoring systems used to determine antibiotic prescribing in tonsillitis?

Answer 13

CENTOR criteria

FeverPain Criteria

Question 14

What is the CENTOR criteria?

Answer 14

Tonsillar Exudate
Recorded Fever >38
Tender lymphadenopathy
Absence of cough

Question 15

What is the fever pain score?

Answer 15

Fever >38
Purulence
Attend rapidly (3 days or less)
severely inflamed tonsils
No cough or coryza

Question 16

What antibiotics are prescribed for tonsillitis?

Answer 16

7-10 days phenoxymethylpenicillin.

OR

7-10 days Clarithromycin.