Throat

Question 1

List some red flag symptoms

Answer 1

• Dysphagia: could be due to lack of coordination in any stages of swallowing (neuro or muscle damage), or obstruction at any point go the swallowing mechanism (benign or malignant).
• Odynophagia: more common in acute, painful conditions (tonsilitis, pharyngitis, epiglottits, supraglottits). If insidious esp with otalgia think malignancy.
• Hoarseness/voice change: inflammatory (eg URTI, granuloma), traumatic, VC aplsy, lesion on the cords (malignan or papilloma), can be psychogenic esp in aphonia
• Airway obstruction: usually present with stertor or stridor. Can be acute (infection/trauma/FB) or chornic (VC palsy, tumour, extrinsic compression)

Question 2

What’s the difference between stridor and stertor

Answer 2

Stertor is an upper airway noise while stridor is a glottic/subglottich/tracheal noise.

Question 3

What are the stages of swallowing

Answer 3

1. Oral (few seconds)
   Food chewed and miced with saliva to form bolus
   Bolus moved to back of mouth by tongue
2. Pharyngeal (<1 sec)
   Initiation is voluntary, completion onvoluntary
   Elevation of larynx, closure epiglottits, wave-like pharyngeal muscle
3. Oesophageal (3-5 sec)
   Relaxation of VOS
   Propulsion of bolus down oesophagus
   Relaxation of LOS

Question 4

Common causative pathogens tonsillitis

Answer 4

Bacterial (30%): group A streps eg strep pyogenes, haemophilus influenzaem strep pneumoniae

Viral: influenza, parainfluenza, adenovirus

Question 5

Describe the centor criteria

Answer 5

1. History of fever
2. Tonsillar exudates
3. Tender anteroir cervical lymphadenopathy
4. No cough

0-1: no antibiotic
2: consider rapid Ag test + Rx if positive
>3: antibiotics

Question 6

Management tonsillitis

Answer 6

Generally just paracetamol and ibuprogen

Abx if bacterial - penicillin V or erythromycin

Question 7

Indications for tonsillectomy

Answer 7

Indications:

Sore throats due to tonsillitis

>7 attacks a year OR >5/2 years OR >3/3years

Symptoms for at least a year

Episodes are disabling + present normal functioning

Have to wait until 4 weeks without infection

Question 8

DDx tonsillitis

Answer 8

EBV (glandular fever)- has similar presentation

Agranulocytosis

Leukaemia

Diphtheria

Scarlet Fever

Question 9

Complications tonsillitis

Answer 9

QUINSY (Peri-tonsillar Abscess)

Scarlet fever

Otitis media

Obstructive Sleep Apnoea

Retropharyngeal abscess

Question 10

Presentation quinsy

Answer 10

Odynophagia (+ inability to swallow saliva)

‘Hot potato’ speech (talking as if hot potato in mouth)

Trismus (lock jaw) (pterygoids right next to tonsils)

Deviation of uvula to contralateral side

Question 11

Management quinsy

Answer 11

Incise/aspirate under LA

IV Antibiotics

Question 12

Describe presentation and management scarlet fever

Answer 12

Sore throat

Fever

Characteristic red rash - Chest, axillae or behind ears, strawberry red tongue

Management is with penicillin

Question 13

Congenital causes stridor

Answer 13

Laryngomalacia (most common cause in infancy, tends to resolve itself)

Web/stenosis

Vocal cord palsy

Question 14

Causes of acquired stridor

Answer 14

Croup (laryngotracheobronchitis)

Laryngiis

Epiglottitis/supraglottits

Foreign body

Trauma, vocal cord palsy

Allergy

Question 15

What is globus pharyngeus?

Answer 15

Painless sensation of a lump in the throat and may be described as a foreign boy sensation, a tightening or hcoicking failing. Typically central and suprasternal.

Question 16

Common symptoms throat

Answer 16

Airway obstruction

Hoarsness

Aspiration

Inability to clear secretions/cough

Dysphagia

Odynophagia

“Lump in throat”

Question 17

Indications adenoidectomy

Answer 17

Enlargement causing nasal airway obstruction, which can result in obstructive breathing, obstructive sleep apneasymptoms, and chronic mouth breathing (could result in palatal and dental abnormalities)