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Y4 Neuro and special senses > Throat > Flashcards

Throat Flashcards

1
Q

What is obstructive sleep apnoea ?

A

Cased by the collapse of the pharyngeal airway.
Characterised by episodes of apnoea during sleep where the person stops breathing periodically for up to a few minutes.

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2
Q

What are some risk factors of obstructive sleep apnoea ?

A

Middle age
Male
Obesity
Alcohol
Smoking

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3
Q

What are some features of obstructive sleep apnoea ?

A

Episodes of apnoea during sleep
Snoring
Morning headache
Waking up unrefreshed from sleep
Daytime sleepiness
Concentration problems

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4
Q

What scale is used to assess symptoms of sleepiness associated with obstructive sleep apnoea ?

A

Epworth sleepiness scale

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5
Q

What is the management of obstructive sleep apnoea ?

A

Correct reversible risk factors
CPAP
Surgery

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6
Q

What tests can be performed for obstructive sleep apnoea ?

A

Sleep studies

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7
Q

What is assessed for in sleep studies ?

A

O2 sats
HR
RR
Breathing

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8
Q

What is the most common procedure for obstructive sleep apnoea if surgery is indicated ?

A

Uvulopalatopharyngoplasty

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9
Q

What is tonsillitis ?

A

Inflammation of the tonsils

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10
Q

What is the most common cause of tonsillitis ?

A

Viral infection

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11
Q

What is the most common bacterial cause of tonsillitis ?

A

Group A streptococcus ( strep pyogenes )

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12
Q

What is waldeyer’s tonsillar ring ?

A

A ring of lymphoid tissue in the pharynx

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13
Q

What tonsils are in waldeyer’s tonsillar ring ?

A

Adenoids
Tubal
Palatine
Lingual

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14
Q

Which tonsils get affected most commonly in tonsillitis ?

A

Palatine

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15
Q

What is a typical presentation of tonsillitis ?

A

Sore throat
Fever above 38 degrees
Pain on swallowing

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16
Q

What is seen on examination in tonsillitis ?

A

Red, inflamed and enlarged tonsils with or without exudates.
Anterior cervical lymphadenopathy

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17
Q

What are some criteria to distinguish between viral and bacterial tonsillitis ?

A

Centor criteria
FeverPAIN score

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18
Q

What are some features of tonsillitis that would make you consider admission ?

A

Immunocompromised
Systemically unwell
Dehydration
Stridor
Respiratory distress
Peritonsillar abscess

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19
Q

When would you consider antibiotics for tonsillitis ?

A

Centor equal or over 3
FeverPAIN equal or over 4

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20
Q

What is the choice of antibiotic in tonsillitis ?

A

Penicillin V for 10 days
Clarithromycin ( penicillin allergy )

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21
Q

What are some complications of tonsillitis ?

A

Peritonsillar abscess ( quinsy )
Otitis media
Scarlet fever
Rheumatic fever
Post-strep Glomerulonephritis
Post strep reactive arthritis

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22
Q

What is quinsy ?

A

Peritonsillar abscess
It arises when there is a bacterial infection with trapped pus forming an abscess in the region of the tonsils

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23
Q

What is quinsy a complication of ?

A

Untreated or partially treated tonsillitis

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24
Q

How does quinsy present ?

A

Sore throat
Painful swallowing
Fever
Neck pain
Trismus
Change in voice
Swelling and erythema

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25
Q

What is Trismus ?

A

Refers to when the patient is unable to open their mouth

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26
Q

What is the most common organism to cause quinsy ?

A

Streptococcus pyogenes ( group A strep )

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27
Q

What is the management of quinsy ?

A

Needle aspiration or surgical incision and drainage
Abx ( broad spectrum ) before and after surgery

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28
Q

What is a tonsillectomy ?

A

The name for the surgical removal of the tonsils

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29
Q

What are the indications of a tonsillectomy ?

A

Recurrent tonsillitis
Recurrent tonsillar abscesses
Enlarged tonsils causing difficulty breathing, swallowing or snoring

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30
Q

What are some complications of a tonsillectomy ?

A

Sore throat
Damage to teeth
Infection
Post-tonsillectomy bleeding

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31
Q

Why can post-tonsillectomy bleeding be life-threatening ?

A

Aspiration of blood

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32
Q

What is the management of post-tonsillectomy bleeding ?

A

IV access
FBC, clotting, group and save, crossmatch
Analgesia
NBM if surgery is required

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33
Q

What are some options for stopping less severe bleeds in post-tonsillectomy bleeding ?

A

Hydrogen peroxide
Adrenalin

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34
Q

What are the borders of the anterior triangle ?

A

Superior - mandible
Medial - midline of the neck
Lateral - sternocleidomastoid

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35
Q

What forms the borders of the posterior triangle ?

A

Inferior - clavicle
Posterior - trapezius
anteromedial - sternocleidomastoid

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36
Q

What are some differentials for neck lumps ?

A

Skin abscesses
Lymphadenopathy
Lipoma
Goitre
Haematoma
Thyroglossal cysts
Branchial cysts

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37
Q

What are some differentials for neck lumps in children ?

A

Cystic hygromas
Dermoid cyst
Haemangiomas
Venous malformation

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38
Q

What are some features for a 2 week wait referral for neck lumps ?

A

Unexplained neck lump in someone aged above 45
A persistent unexplained neck lump

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39
Q

What are some investigations to perform in someone with a neck lump ?

A

FBC and blood film
HIV
Mono spot or EBV
Thyroid function test
LDH ( Hodgkin’s )
USS
CT or MRI
Biopsy

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40
Q

What are some types of biopsy ?

A

Fine needle aspiration cytology
Core biopsy
Incision biopsy
Removal of lump

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41
Q

How can lymphadenopathy be grouped ?

A

Reactive ( URTI )
Infective ( TB, HIV )
Inflammatory conditions ( SLE, sarcoidosis )
Malignancy ( lymphoma,leukaemia, metastasis )

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42
Q

What causes infectious mononucleosis ?

A

Infection with EBV

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43
Q

How does infectious mononucleosis present ?

A

Fever
Sore throat
Fatigue
Lymphadenopathy

44
Q

What is the first line investigation for infectious mononucleosis ?

A

Mono spot test

45
Q

What is the management of infectious mononucleosis ?

A

Supportive
Avoid alcohol
Avoid contact sports

46
Q

Why should a patient with infectious mononucleosis avoid contact sports ?

A

Risk of splenic rupture

47
Q

What is a goitre ?

A

Generalised swelling of the thyroid gland

48
Q

What can cause a goitre ?

A

Grave’s disease
Toxic multinodular goitre
Hashimoto’s thyroiditis
Iodine deficiency
Lithium

49
Q

What can cause an individual thyroid lump ?

A

Benign hyperplastic nodules
Thyroid cysts
Thyroid adenoma
Thyroid cancer
Parathyroid tumour

50
Q

What can cause salivary gland enlargement ?

A

Stones blocking the drainage of the glands through the ducts
Infection
Tumours

51
Q

What is the carotid body ?

A

A structure located just above the carotid bifurcation.
It contains glomus cells which are chemoreceptors that detect the blood’s oxygen, CO2 and pH.

52
Q

What is a carotid body tumour ?

A

Excessive growth of the glomus cells
Benign

53
Q

How does a carotid body tumour present ?

A

Slow growing lump
Upper anterior triangle
Painless
Pulsatile
Bruit
Horner’s syndrome

54
Q

What is a characteristic finding on imaging for carotid body tumours ?

A

Splaying of the internal and external carotid arteries.

55
Q

Describe the pathway of the thyroid in foetal development ?

A

The thyroid gland starts at the base of the tongue.
It gradually travels down the neck to the final position in front of the trachea beneath the larynx.

56
Q

How do Thyroglossal cysts develop ?

A

The movement of the thyroid in foetal development leaves behind the Thyroglossal duct which should disappear.
When this persists it can give rise to a fluid filled cyst.

57
Q

How can Thyroglossal cysts present ?

A

Midline
Mobile
Non-tender
Soft
Fluctuant
Move up and down with movement of the tongue

58
Q

How can a diagnosis of Thyroglossal cysts be confirmed ?

A

USS
CT

59
Q

What is the main complication of a Thyroglossal cyst ?

A

Infection of the cyst causing a hot, tender and painful lump

60
Q

What is the management of Thyroglossal cyst ?

A

Surgically removed
It can reoccur if the entire duct isn’t removed

61
Q

What is a branchial cyst ?

A

A congenital abnormality that arises when the second branchial cleft fails to form properly during foetal development. This leaves a space surrounded by epithelial tissue in the lateral aspect of the neck.

62
Q

How do branchial cysts present ?

A

Round, soft, cystic swelling
In the anterior triangle of the neck

63
Q

What is the management of a Branchial cyst ?

A

Conservative
Surgical excision - where recurrent infections are occurring

64
Q

Where do head and neck cancers usually arise from ?

A

Squamous cell carcinoma arising from the squamous cells of the mucosa.

65
Q

Where are the potential areas of head and neck cancers ?

A

Nasal cavity
Paranasal sinuses
Mouth
Salivary glands
Pharynx
Larynx

66
Q

What are some risk factors for head and neck cancers ?

A

Smoking
Chewing tobacco
Alcohol
HPV - strain 16
EBV

67
Q

What are some red flags for head and neck cancers ?

A

Lump in the mouth or on the lip
Unexplained ulceration in the mouth lasting more than 3 weeks
Persistent neck lump
Unexplained hoarseness of voice
Unexplained thyroid lump

68
Q

What is Ludwig’s angina?

A

A type of progressive cellulitis that invades the floor of the mouth and soft tissues of the neck.

69
Q

What is the most common cause of Ludwig’s angina ?

A

Odontogenic infections which spread into the submandibular space.

70
Q

What are some features of Ludwig’s angina ?

A

Neck swelling
Dysphagia
Fever

71
Q

Why is Ludwig’s angina a life threatening emergency ?

A

Airway obstruction can occur rapidly

72
Q

What is the management of Ludwig’s angina ?

A

Airway management
IV antibiotics

73
Q

What is glossitis ?

A

Inflammation of the tongue

74
Q

What are some features of glossitis ?

A

Red
Sore
Swollen
Atrophy of the tongue papillae

75
Q

What are some causes of glossitis ?

A

Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury or irritant exposure

76
Q

What is angioedema ?

A

Fluid accumulating in the tissues resulting in swelling

77
Q

What are the 3 main causes of angioedema ?

A

Allergic reactions
ACEi
C1 esterase inhibitor deficiency

78
Q

What is oral candidiasis ?

A

Oral thrush
The overgrowth of candida, a type of fungus, in the mouth. This results in white spots or patches that coat the surface of the tongue and palate.

79
Q

What are some common factors that predispose someone to developing oral candidiasis ?

A

Inhaled corticosteriods
Antibiotics
DM
Immunodeficiency
Smoking

80
Q

What are some treatment options for oral candidiasis ?

A

Miconazole gel
Nystatin suspension
Fluconazole tablets ( severe or recurrent )

81
Q

What is a geographic tongue ?

A

An inflammatory condition where patches of the tongue’s surface lose the epithelium and papillae.

82
Q

What is geographic tongue related to ?

A

Stress or mental illness
Psoriasis
Atopy
DM

83
Q

What is the management of geographic tongue ?

A

Usually doesn’t require treatment
Symptom management with topical steroids and antihistamines

84
Q

What are 2 key causes of strawberry tongue ?

A

Scarlet fever
Kawasaki disease

85
Q

What is a black hairy tongue ?

A

Results from decreased shedding of keratin from the tongues surface.
The papillae elongate and take on the appearance of hairs.

86
Q

What gives the dark pigmentation in black hairy tongue ?

A

Bacteria and food

87
Q

What can cause black hairy tongue ?

A

Dehydration
Dry mouth
Poor oral hygiene
Smoking

88
Q

What is the management of black hairy tongue ?

A

Adequate hydration
Gentle brushing of the tongue
Stop smoking

89
Q

What is leukoplakia ?

A

It is characterised by white patches in the mouth, often on the tongue or insides of the cheek.

90
Q

What does leukoplakia increase the risk of ?

A

Squamous cell carcinoma of the mouth

91
Q

What are some features of leukoplakia ?

A

Asymptomatic
Irregular and slightly raised
Fixed in place ( cant be scraped off )

92
Q

What is the management of leukoplakia ?

A

Stopping smoking
Reducing alcohol intake
Close monitoring
Laser removal

93
Q

What is lichen planus ?

A

An autoimmune condition that causes localised chronic inflammation of the skin.

94
Q

What are some features of lichen planus ?

A

Shiny, purplish skin
Flat topped
White lines - wickham’s striae

95
Q

What are the 3 patterns of lichen planus in the mouth ?

A

Reticular pattern
Erosive lesions
Plaques

96
Q

What is the management of lichen planus ?

A

Good oral hygiene
Stop smoking
Topical steroids

97
Q

What is gingivitis ?

A

Inflammation of the gums

98
Q

How does gingivitis present ?

A

Swollen gums
Bleeding after brushing
Painful gums
Bad breath ( halitosis )

99
Q

What are some risk factors of gingivitis ?

A

Plaque build up ( inadequate brushing )
Smoking
DM
Malnutrition
Stress

100
Q

What is hardened plaque called ?

A

Tartar

101
Q

What is the treatment of gingivitis ?

A

Good oral hygiene
Stop smoking
Chlorhexidine
Antibiotics
Dental surgery

102
Q

What is gingival hyperplasia ?

A

Refers to abnormal growth of the gums

103
Q

What are some possible causes of gingivial hyperplasia ?

A

Gingivitis
Pregnancy
Vitamin C deficiency
AML

104
Q

What is an aphthous ulcer ?

A

Well-circumscribed punched out white spots in the mouth.

105
Q

What can trigger aphthous ulcers ?

A

Emotional or physical stress
Trauma
Particular foods

106
Q

What underlying conditions can aphthous ulcers be indicative of ?

A

IBD - UC or Crohn’s
Coeliac
Behcet
Vitamin deficiency
HIV

107
Q

What can help manage symptoms of an aphthous ulcer ?

A

Choline salicylate ( bonjela )
Benzydamine
Lidocaine

Y4 Neuro and special senses (6 decks)

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