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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
What is Trismus ?
Refers to when the patient is unable to open their mouth
26
What is the most common organism to cause quinsy ?
Streptococcus pyogenes ( group A strep )
27
What is the management of quinsy ?
Needle aspiration or surgical incision and drainage Abx ( broad spectrum ) before and after surgery
28
What is a tonsillectomy ?
The name for the surgical removal of the tonsils
29
What are the indications of a tonsillectomy ?
Recurrent tonsillitis Recurrent tonsillar abscesses Enlarged tonsils causing difficulty breathing, swallowing or snoring
30
What are some complications of a tonsillectomy ?
Sore throat Damage to teeth Infection Post-tonsillectomy bleeding
31
Why can post-tonsillectomy bleeding be life-threatening ?
Aspiration of blood
32
What is the management of post-tonsillectomy bleeding ?
IV access FBC, clotting, group and save, crossmatch Analgesia NBM if surgery is required
33
What are some options for stopping less severe bleeds in post-tonsillectomy bleeding ?
Hydrogen peroxide Adrenalin
34
What are the borders of the anterior triangle ?
Superior - mandible Medial - midline of the neck Lateral - sternocleidomastoid
35
What forms the borders of the posterior triangle ?
Inferior - clavicle Posterior - trapezius anteromedial - sternocleidomastoid
36
What are some differentials for neck lumps ?
Skin abscesses Lymphadenopathy Lipoma Goitre Haematoma Thyroglossal cysts Branchial cysts
37
What are some differentials for neck lumps in children ?
Cystic hygromas Dermoid cyst Haemangiomas Venous malformation
38
What are some features for a 2 week wait referral for neck lumps ?
Unexplained neck lump in someone aged above 45 A persistent unexplained neck lump
39
What are some investigations to perform in someone with a neck lump ?
FBC and blood film HIV Mono spot or EBV Thyroid function test LDH ( Hodgkin’s ) USS CT or MRI Biopsy
40
What are some types of biopsy ?
Fine needle aspiration cytology Core biopsy Incision biopsy Removal of lump
41
How can lymphadenopathy be grouped ?
Reactive ( URTI ) Infective ( TB, HIV ) Inflammatory conditions ( SLE, sarcoidosis ) Malignancy ( lymphoma,leukaemia, metastasis )
42
What causes infectious mononucleosis ?
Infection with EBV
43
How does infectious mononucleosis present ?
Fever Sore throat Fatigue Lymphadenopathy
44
What is the first line investigation for infectious mononucleosis ?
Mono spot test
45
What is the management of infectious mononucleosis ?
Supportive Avoid alcohol Avoid contact sports
46
Why should a patient with infectious mononucleosis avoid contact sports ?
Risk of splenic rupture
47
What is a goitre ?
Generalised swelling of the thyroid gland
48
What can cause a goitre ?
Grave’s disease Toxic multinodular goitre Hashimoto’s thyroiditis Iodine deficiency Lithium
49
What can cause an individual thyroid lump ?
Benign hyperplastic nodules Thyroid cysts Thyroid adenoma Thyroid cancer Parathyroid tumour
50
What can cause salivary gland enlargement ?
Stones blocking the drainage of the glands through the ducts Infection Tumours
51
What is the carotid body ?
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
What is a carotid body tumour ?
Excessive growth of the glomus cells Benign
53
How does a carotid body tumour present ?
Slow growing lump Upper anterior triangle Painless Pulsatile Bruit Horner’s syndrome
54
What is a characteristic finding on imaging for carotid body tumours ?
Splaying of the internal and external carotid arteries.
55
Describe the pathway of the thyroid in foetal development ?
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
How do Thyroglossal cysts develop ?
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
How can Thyroglossal cysts present ?
Midline Mobile Non-tender Soft Fluctuant Move up and down with movement of the tongue
58
How can a diagnosis of Thyroglossal cysts be confirmed ?
USS CT
59
What is the main complication of a Thyroglossal cyst ?
Infection of the cyst causing a hot, tender and painful lump
60
What is the management of Thyroglossal cyst ?
Surgically removed It can reoccur if the entire duct isn’t removed
61
What is a branchial cyst ?
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
How do branchial cysts present ?
Round, soft, cystic swelling In the anterior triangle of the neck
63
What is the management of a Branchial cyst ?
Conservative Surgical excision - where recurrent infections are occurring
64
Where do head and neck cancers usually arise from ?
Squamous cell carcinoma arising from the squamous cells of the mucosa.
65
Where are the potential areas of head and neck cancers ?
Nasal cavity Paranasal sinuses Mouth Salivary glands Pharynx Larynx
66
What are some risk factors for head and neck cancers ?
Smoking Chewing tobacco Alcohol HPV - strain 16 EBV
67
What are some red flags for head and neck cancers ?
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
What is Ludwig’s angina?
A type of progressive cellulitis that invades the floor of the mouth and soft tissues of the neck.
69
What is the most common cause of Ludwig’s angina ?
Odontogenic infections which spread into the submandibular space.
70
What are some features of Ludwig’s angina ?
Neck swelling Dysphagia Fever
71
Why is Ludwig’s angina a life threatening emergency ?
Airway obstruction can occur rapidly
72
What is the management of Ludwig’s angina ?
Airway management IV antibiotics
73
What is glossitis ?
Inflammation of the tongue
74
What are some features of glossitis ?
Red Sore Swollen Atrophy of the tongue papillae
75
What are some causes of glossitis ?
Iron deficiency anaemia B12 deficiency Folate deficiency Coeliac disease Injury or irritant exposure
76
What is angioedema ?
Fluid accumulating in the tissues resulting in swelling
77
What are the 3 main causes of angioedema ?
Allergic reactions ACEi C1 esterase inhibitor deficiency
78
What is oral candidiasis ?
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
What are some common factors that predispose someone to developing oral candidiasis ?
Inhaled corticosteriods Antibiotics DM Immunodeficiency Smoking
80
What are some treatment options for oral candidiasis ?
Miconazole gel Nystatin suspension Fluconazole tablets ( severe or recurrent )
81
What is a geographic tongue ?
An inflammatory condition where patches of the tongue’s surface lose the epithelium and papillae.
82
What is geographic tongue related to ?
Stress or mental illness Psoriasis Atopy DM
83
What is the management of geographic tongue ?
Usually doesn’t require treatment Symptom management with topical steroids and antihistamines
84
What are 2 key causes of strawberry tongue ?
Scarlet fever Kawasaki disease
85
What is a black hairy tongue ?
Results from decreased shedding of keratin from the tongues surface. The papillae elongate and take on the appearance of hairs.
86
What gives the dark pigmentation in black hairy tongue ?
Bacteria and food
87
What can cause black hairy tongue ?
Dehydration Dry mouth Poor oral hygiene Smoking
88
What is the management of black hairy tongue ?
Adequate hydration Gentle brushing of the tongue Stop smoking
89
What is leukoplakia ?
It is characterised by white patches in the mouth, often on the tongue or insides of the cheek.
90
What does leukoplakia increase the risk of ?
Squamous cell carcinoma of the mouth
91
What are some features of leukoplakia ?
Asymptomatic Irregular and slightly raised Fixed in place ( cant be scraped off )
92
What is the management of leukoplakia ?
Stopping smoking Reducing alcohol intake Close monitoring Laser removal
93
What is lichen planus ?
An autoimmune condition that causes localised chronic inflammation of the skin.
94
What are some features of lichen planus ?
Shiny, purplish skin Flat topped White lines - wickham’s striae
95
What are the 3 patterns of lichen planus in the mouth ?
Reticular pattern Erosive lesions Plaques
96
What is the management of lichen planus ?
Good oral hygiene Stop smoking Topical steroids
97
What is gingivitis ?
Inflammation of the gums
98
How does gingivitis present ?
Swollen gums Bleeding after brushing Painful gums Bad breath ( halitosis )
99
What are some risk factors of gingivitis ?
Plaque build up ( inadequate brushing ) Smoking DM Malnutrition Stress
100
What is hardened plaque called ?
Tartar
101
What is the treatment of gingivitis ?
Good oral hygiene Stop smoking Chlorhexidine Antibiotics Dental surgery
102
What is gingival hyperplasia ?
Refers to abnormal growth of the gums
103
What are some possible causes of gingivial hyperplasia ?
Gingivitis Pregnancy Vitamin C deficiency AML
104
What is an aphthous ulcer ?
Well-circumscribed punched out white spots in the mouth.
105
What can trigger aphthous ulcers ?
Emotional or physical stress Trauma Particular foods
106
What underlying conditions can aphthous ulcers be indicative of ?
IBD - UC or Crohn’s Coeliac Behcet Vitamin deficiency HIV
107
What can help manage symptoms of an aphthous ulcer ?
Choline salicylate ( bonjela ) Benzydamine Lidocaine

Y4 Neuro and special senses (6 decks)

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