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ENT > Throat > Flashcards

Throat Flashcards

1
Q

Tonsillectomy is an operation that is usually performed with?

A

-Adenoidectomy

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2
Q

What are the indications for a tonsillectomy?

A
  • recurrent acute tonsillitis(3 or 4 attacks per year)
  • chronic tonsillitis(chronic sore throat in adults)
  • snoring and sleep apneoa
  • peritonsillar abscess(quinsy)
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3
Q

What are the contraindications to tonsillectomy?

A
  • bleeding disorders
  • recent pharyngeal infection
  • weight less than 15 kg or obese
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4
Q

What are adenoids?

A

Adenoids are a collection of lymphoid tissue in the postnasal space

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5
Q

At what age do the adenoids hypertrophy?

A

The grow rapidly at the age of 6 and then become significantly smaller by 12 years

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6
Q

What are the symptoms of adenoids?

A
  • Anosmia
  • nasal obstruction
  • malaise
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7
Q

What are two otological conditions associated with eustachian tube blockage in children?

A
  • acute otitis media

- otitis media with effusion

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8
Q

What are the 4 symptoms of adenoid hypertrophy?

A
  • nasal obstruction
  • hyponasal speech(sounds like a cold)
  • OME, acute otitis media
  • snoring and sleep apneoa
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9
Q

What is secondary haemorrhage?

A
  • usually occurs 5-10 days post adenoidectomy

- treated with antibiotics and bed rest

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10
Q

What is the function of the larynx?

A
  • protects the tracheobronchial tree

- voice production

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11
Q

Name the 3 salivary glands?

A
  1. parotid glands
  2. submandibular glands
  3. sublingual glands
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12
Q

What type of secretion do the parotids produce?

A

serous

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13
Q

What typeof fluid do the submandibular glands produce?

A

seromucionous

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14
Q

Why do lymph nodes enlarge?

A
  1. primary disease of the nodes

2. secondary to pathology in the head/neck

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15
Q

What is the function of the saliva?

A
  • lubrication of food
  • mastication and deglutition(swallowing)
  • assists articulation
  • oral hygiene
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16
Q

What nerve are the laryngeal nerves supplied by?

A

recurrent laryngeal nerve

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17
Q

What is the cricothyroid supplied by?

A

superior laryngeal nerve

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18
Q

Where does sensation to the glottis/subglottis come from?

A

-recurrent laryngeal nerve

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19
Q

What innervates the supraglottis?

A

The superior laryngeal nerve

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20
Q

What innervates the tongue muscles?

A

hypoglossal nerve

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21
Q

Taste to the anterior two thirds of the tongue is via the?

A

chordi tympani nerve

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22
Q

What are the main signs and symptoms of oral disease?

A
  • pain
  • masses
  • ulceration
  • haemorrhage
  • halitosis
  • discolouration
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23
Q

Are tongue masses always considered neoplastic/non-neoplastic?

A

Neoplastic

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24
Q

What is special about median rhomboid glossitis?

A

It presents as a red lesion on the tongue and is benign

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25
Q

What is a ranula?

A

It is a cystic lesion in the floor of the mouth(which is caused by blockage of the sublingual salivary gland)

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26
Q

Define aphonia?

A

It is the absence of a voice or if it is merely a whisper

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27
Q

What is dysphonia?

A

Dysphonia is the alteration in the quality of voice

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28
Q

What are the causes of dysphonia?

A
  1. inflammatory laryngeal lesions
  2. neoplastic lesions
  3. neurologivcal lesions
  4. systemic causes
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29
Q

What is the primary cause of acute laryngitis?

And after how long must we refer to an ENT specialist?

A

An upper respiratory tract infection and sometimes shouting(vocal abuse)
-after 3 weeks of dysphonia

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30
Q

What causes unilateral inflammatory polyps on the larynx?

A

–inhalation of fumes, chemicals, tobacco

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31
Q

How do we treat unilateral inflammatory polyps on the larynx?

A

By removing the polyps on the larynx

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32
Q

What are the risk factors for chronic laryngitis?

A
  • smoking tobacco
  • alcohol
  • laryngopharyngeal reflux
  • abuse of vocal cords
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33
Q

What does the larynx look like on chronic laryngitis?

A
  • leukoplakia(white patches)

- hypertrophic epithelium

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34
Q

What causes laryngopharyngeal reflux?

A

When Gastro-oesophageal reflux is above the lower oesophageal sphincter and it allows acids, pepsin, and bile salts which can be damaging to the larynx

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35
Q

What are the 3 examples of central neurological lesions of the larynx?

A
  • pseudobulbar palsy
  • multiple sclerosis
  • cerebral pasly
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36
Q

What are the 3 examples of peripheral neurological lesions of the larynx?

A
  • motor neurone disease
  • myasthenia gravis
  • vagus nerve lesions and recurrent laryngeal nerve lesions
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37
Q

Why is the left recurrent laryngeal nerve involved in pathology?

A

Because the left is longer-it goes from the cranium via the base of the skull, neck, thorax, and into the larynx whereas the right goes into the right

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38
Q

What is the most common cause of vocal nerve palsy?

A

malignancy in the neck or the chest

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39
Q

What is spasmodic dysphonia? And what is it caused by?

A

-It is primarily neurogenic can be caused by family conflict, bereavement car accidents etc.
It can be treated with botulinum toxin injection into the vocal cords

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40
Q

What are the systemic causes that cause dysphonia?

A
  1. hypothyroidism- causes chronic oedema of the vocal cords
  2. angioneurotic oedema- type 1 allergic response causing laryngeal oedema
  3. rheumatoid arthritis can cause vocal cord immobility
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41
Q

What is the management of patients with systemic causes of dysphonia?

A

medialisation

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42
Q

Why are children more prone to upper airway obstruction?

A

Because they have narrower airways and they have softer cartilage that collapses

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43
Q

What is stridor?

A

It is noisy breathing that results from narrowing of the airway at or below the larynx

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44
Q

Narrowing of the __ would cause inspiratory stridor:

A

-The supraglottis

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45
Q

Narrowing of the ___ would cause biphasic stridor:

A

-The glottis or the cervical trachea

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46
Q

Narrowing of the ___ would cause expiratory stridor:

A

-bronchial narrowing

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47
Q

What is stertor?

A

Noisy breathing due to narrowing above the larynx, for example adenotonsillar hypertrophy

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48
Q

What is another name for laryngotracheobronchitis?

A

Croup

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49
Q

What is the cause of laryngotracheobronchial bronchitis?

At what age does it usually occur?

A

para-influenza

From 6 months to 3 years

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50
Q

What are the clinical signs of laryngotracheobronchitis?

A
  • pyrexia
  • painful barking cough
  • gross mucosal oedema in the lower respiratory tract
  • inspiratory stridor which can develop into biphasic stridor
  • sometimes complete airway obstruction
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51
Q

What is the management of croup?

A
  • oxygen administration
  • humidifier and warm air to loosen the thick mucus
  • nebulised or systemic steroids may be helpful
  • intubation for progressive and severe cases(for only 2-5 days)
  • tracheostomy is the last resort
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52
Q

What organism causes suraglottitis/epiglotitis?

A

Group B Haemophilus influenza and is characterised by intense swelling in the supraglottis

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53
Q

What age group does supraglottitis/epiglotitis occur in and what is the clinical presentation?

A
  • pyrexia
  • stridor
  • open mouth breathing and raised chin
  • dribbling
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54
Q

Why is epiglottitis an emergency?

A

Because the time between stridor and total obstruction can be very short

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55
Q

What is the management of epiglottitis?

A
  • adrenaline/epinephrine nebulisers
  • intubation by anaethetist and tracheostomy by ENT specialist
  • intravenous 3rd generation cephalosporins are also NB
56
Q

What is the common congenital tumour causing stridor?

A
  • Subglottic haemangioma

- It is self-limiting as it regresses after 1 year

57
Q

What is laryngomalacia?

A

It is the weakening of the supra-glottic framework which collapses on inspiration particularly during exertion and crying.
It mostly occurs in boys and presents with the omega sign of the epiglottis

58
Q

When does laryngomalacia resolve?

A

It resolves around the age of 2 yrs and surgery is needed if the child fails to thrive

59
Q

What are 7 signs of severe respiratory failure caused by airway obstruction?

A
  1. cyanosis
  2. nasal flaring
  3. tachycardia
  4. tachypnoea
  5. use of accessory muscles of respiration
  6. chest wall recession
  7. tracheal plugging
60
Q

What is subglottic stenosis and what is it caused by?

A
  • stenosis of the subglottis and is caused by prolonged intubation especially in premature babies. It can also be congenital
  • It presents with stridor on exertion and a respiratory infection
61
Q

What is the management of subglottic stenosis?

A
  • tracheostomy
  • laser excision
  • laryngeal reconstructive surgery
62
Q

What isthe cause of foreign body inhalation in 1)adults and 2)children?

A

1) alcohol or a psychiatric problem

2) most commonly happens

63
Q

What are the common symptoms of foreign body obstruction?

A

-sudden coughing, wheezing or stridor in a previously well child
-chest infection from it lodging in a small airway
But sometimes patients are symptomless for a long time

64
Q

How do you dislodge a foreign body from a 1)child

2)adult?

A

You need to lift the child with their legs up and smack them on their back
2) For adults you need to do the Heimlich maneovre

65
Q

What is a retropharyngeal abscess and how does it occur?

A

It is now rare but occurs as a swelling and inflammation in the retropharyngeal space secondary to oropharyngeal infection

66
Q

What is the presentation of a child with a retropharyngeal abscess and how do we treat it?

A
  • Hyperextended neck which is held rigid
  • urgent parenteral antibiotics are used and surgical drainage is done to avoid spontaneous rupture and inhalation of pus
67
Q

What is respiratory papillomata caused by?

A

It is caused by Human papilloma virus

68
Q

What is the treatment for respiratory papillomata?

A
  • carbon dioxide laser
  • sharp dissection under microscope
  • medical treatment like inteferons may be used as well
69
Q

What does acute laryngitis present with and what is the management?

A
  • it presents with hoarseness and throat discomfort and inflammation of the vocal cords
  • management is voice rest, steam inhalation and avoidance of smoke and spirits
70
Q

What is Ludwig’s angina and how does it what are the risk factors?

A

It is rapid swelling cellulitis of the sublingual and submaxillary spaces(particularly of the floor of the mouth)
Risk factors include: smoking, poor hygiene, alcohol, dental infection

71
Q

What is the clinical picture of Ludwig’s angina??

A
  • fever
  • pallor
  • dysphagia(difficulty swallowing)
  • drooling
  • odynophagia(pain when swallowing)
72
Q

What is the management of Ludwig’s angina?

A
  • incision drainage
  • antibiotics
  • incision and tracheostomy if necessary
73
Q

What is the clinical presentation of infective conditions associated with sore throats?

A
  • painful throat
  • cervical lymphadenopathy
  • fever
74
Q

Candidal infection usually occurs in patients that are immuno-compromised caused by?

A
  • AIDS
  • Chemo
  • radiotherapy
  • diabetes
75
Q

What is a peritonsillar abscess and what causes it?

A

-a condition where pus forms between the tonsil capsule and the the constrictor muscle

76
Q

What are the symptoms/signs of a pt with peritonsillar abscess?

A
  • hot potato voice
  • inability to swallow causing dribbling
  • trismus(difficulty opening the jaw)
  • severe unilateral sore throat
  • uvula pushed to the opposite side of the midline
77
Q

What is the management of peritonsillar absess?

A
  • incision and drainage

- AB(Penicillin as the organism is haemolytic streptococcus. If the patient is allergic then give erythromycin)

78
Q

If patients have a chronic sore throat, what must we think about?

A

-malignancy of the oral cavity or pharynx

79
Q

What are the causes of acute sore throats in children?

A
  • acute pharyngitis

- tonsillititis

80
Q

When would we consider doing a tonsillectomy in Quinsy?

A

Type 1. 20% of quinsies recur and 80% do not recur in this group
Type 2. 80% of the quinsies recur and 20% do not and so you need to do a tonsillectomy in these patients

81
Q

If phayngitis is caused by a viral process, does it need AB?

A

NO

82
Q

What is the clinical picture of a child with acue tonsillitis?

A
  • systemically unwell
  • dysphagia
  • pyrexia
  • halitosis
  • cervical lymphadenopathy
83
Q

Whta is the management of a child with acute tonsililitis?

A
  1. Bed rest
  2. Antibiotics-penicillin(parenterally if necessary)
  3. analgesia(paracetamol to treat the pyrexia)
  4. Adequate fluids
84
Q

What gives a similar picture of acute tonsilitis in a child?

A

Diphtheria tonsil is usually covered in a membrane)

85
Q

What are the causes of a chronic sore throat?

A
  1. chronic tonsilitis
  2. post-nasal drip
  3. smoking
  4. alcohol
  5. Acid reflux
  6. chronic laryngitis(non-infective)
86
Q

What is another name for infectious mononucleosis?

Who does it usually occur in?

A
  • Glandular fever

- It presents in teenagers because of the transmission of saliva

87
Q

What is the clinical picture of a teenager with infectious mononucleosis?

A
  1. cervical lymphadenopathy
  2. hepatosplenomegaly
  3. dysphagia
  4. haemorrhagic petechiae on the hard palate
  5. membranous exudates on large tonsils
88
Q

How do we diagnose infectious mononucleosis?

A

-positive monospot or paul bunnell test

89
Q

What is Eagle syndrome?

A

It is stylohyoid ligament calcification that presents with unilateral constant pain and responds to NSAIDS and sometimes surgery

90
Q

What is dysphagia?

A

Difficulty swallowing

  • swallowing occurs in 3 phases: oral, pharyngeal and oesophageal phase
  • swallowing takes 8-10 seconds
91
Q

What disorders make swallowing liquids more difficult than food?

A

-neurological disorders

92
Q

How do we examine the throat for causes of dysphagia?

A

-use a mirror or a flexible rhinolaryngoscope which makes it possible to look at the hypopharynx and view the vocal cord paralysis and possible pooling of saliva

93
Q

What investigations would you do in Dysphagia?

A
  1. lateral X-ray

2. barium swallow to view the hypopharynx, oesophagus and stomach

94
Q

What are the causes of acute dysphagia?

A
  1. Tonsillitis
  2. Apthous ulceration
  3. swallowed foreign bodies
  4. ingestion of caustic liquids
  5. tracheostomy
95
Q

What are the causes of chronic dysphagia?

A
  1. neuromuscular disorders-myasthenia gravis, multiple sclerosis, stroke , parkinsons disease
  2. intrinsic causes- neoplasm, achalasia, pharyngeal pouch, strictures
  3. extrinsic causes-aortic aneurysm, thyroid enlargement
  4. systemic causes-scleroderma
  5. psychosomatic- globus pharyngeus
  6. Age- 2% will present with it after 65 years
96
Q

Where in the respiratory system does a neoplasm of the intrinsic muscles occur?

A
  • The post cricoid area
  • oesophagus
  • piriform fossa
97
Q

What is the management of a neoplasm in the pharyngo-oesohagus?

A
  • radiotherapy

- salvage surgery

98
Q

What is a pharyngeal pouch?

A

Also known as Zenkers diverticulum
It is a hernia that occurs in the weakened spot (Killians dehiscence) between the upper thyropharyngeas and the lower cricopharyngesus of the inferior constrictor muscle

99
Q

What are the complications of having a phyrangeal pouch and how do you treat it?

A

-food collecting in the pouch
- pneumonitis if overspill happens
You treat it with surgery or cricopharyngeal myotomy

100
Q

What should we be worried about in oesophageal strictures?

A
  1. You must biopsy it in case of malignancy
101
Q

Because most oesophageal strictures are as a result of GERD, what is your management?

A
  1. medical treatment with reflux meds
102
Q

Achalasia of the oesophagus is?

A

-failure of the cardia to relax when swallowing
-This causes abnormal stricture in the defective site and proximal dilatation of the oesophagus
This pt needs a cardiomyotomy to relieve the cardia

103
Q

In which patients does pharyngeal globus usually occur in?

A
  • middle aged women who complain of anxiety

- it could also be acid reflux causing the lump in the throat’

104
Q

What medications contribute to dysphagia?

A
  1. antihistamines
  2. antihypertensives
  3. antidepressants
  4. anticholinergics
105
Q

What is Plummer-Vinson syndrome and why is it NB regarding dysphagia??

A
  • It’s is precancerous NBNB
  • presents with a syndrome of : glossitis, cheilosis, fatigue, Iron defieciency anaemia, and also has post-cricoid oesophageal webs, and achlorhydia(decreased hydrochloric acid in stomach)
  • It is associated with Rheumatoid Arthritis and Sjorgens
106
Q

What are 5 examples of autoimmune causes of dysphagia?

A
  1. SLE
  2. Rheumatoid Arthritis
  3. Sjorgens syndrome
  4. Dermatomyositis
107
Q

In regards to swelling of the salivary glands, how do you classify the pain?

A
  1. intermittent
  2. constant
  3. progressive
108
Q

What can cause swelling of the parotid gland?

A
  • neoplasm (90% being benign pleomorphic adenoma)
  • Sjorgens syndrome
  • sarcoidosis
  • systemic diseases
  • drugs
109
Q

What should we worry about if a patients presents with pain, paratomegaly and facial nerve paresis?

A

malignancy

110
Q

Describe Sjorgens Syndrome

A 
It is a syndrome that occurs mostly in women 
It is associated with
-xerostomia(dry mouth)
-keratoconjunctivitis sicca(dry eyes)
-RA
And it is an autoimmune disease
111
Q

What kind of paratomegaly does sarcoidodis present with?

A

-diffuse

112
Q

What are the causes of parotid swelling that present with swelling and pain?

A
  • mumps(usually bilateral)
  • bacterial parotitis(usually unilateral)
  • neoplasia
  • parotid calculi
113
Q

How do patients with mumps present?

A

-pyrexia
-tender bilateral parotid swelling
-trismus
Complication: orchitis and SNHL

114
Q

How do patients with bacterial parotitis present?

A
  • Usually older and debilitated

- unilateral tender parotid with pus in the parotid duct orifice sometimes

115
Q

Any swelling in the submandibular gland that only presents with swelling and no pain should be considered as?

A

malignant

116
Q

Why is the most common cause of submandibular swelling secondary to infection in the oral cavity?

A

Because they are so close to the lymph nodes that are situated in the submandibular region

117
Q

What are submandibular calculi?

A

They are calculi that exist in the submandibular duct and are more palpable when eating in the floor of the mouth

118
Q

If the parotid gland and the submandibular gland have localised swelling always look for:

A

A neoplasm

119
Q

What is snoring caused by?

A

Vibration of the pharyngeal wall, the tongue and the soft palate

120
Q

What is the definition of sleep apnoea in adults?

A

-30 episodes of cessation of breathing for a duration of about 10 seconds over a 7 hour period of sleep

121
Q

What 3 things cause secondary sleep apnea?

A
  1. central sleep apnea-due to a defect in the respiratory drive in the brainstem
  2. Obstructive sleep apnea(OSA)- Presents with chest movements and shifting of air- the site of obstruction may nasal,pharyngeal or laryngotracheal
  3. Mixed type
122
Q

What are the complications of having sleep apnea?

A
  1. Cardiac problems: pulmonary hypertension, cor pulmonale, right sided heart failure, cardiac dysrhythmias
  2. CNS- fatigue, loss of concentration and memory
  3. children: failure to thrive, SIDS
123
Q

What are the different investigations you do in a aptient with obstructive sleep apnea?

A
  1. CT and Xray to look at the post-nasal spaces
  2. Rhinolaryngoscopy(flexible scope that can have a view of what’s going on back there)
  3. Sleep studies
  4. STOP-BANG scoring system comprised of 8 questions
124
Q

What is the management of sleep apnea?

A
  1. CPAP
  2. reducing alcohol consumptions and losing weight
  3. surgery-adenotonsillectomy and laser assisted palotoplasty
125
Q

Foreign bodies in the thraot are usually:

A
  1. Inhaled

2. Swallowed

126
Q

In which group of people does inhaled foreign bodies occur in and what is the percentage?

A

Usually children under the age of 4 and it is 75%

127
Q

WHAT IS WORSE BETWEEN ORGANIC MATERIAL(VEGETABLES, PEANUTS, SEEDS AND POPCORN AND NON-ORGANIC A MATERIAL LIKE COINS AND BUTTONS?

A

-Organic materials is worse because it causes a mucosal reaction

128
Q

Why is laryngeal impaction an emergency?

A

-Because it can lead to total respiratory obstruction

129
Q

What is the clinical picture of a patient with inhalational foreign body?

A
  1. choking
  2. wheezing
  3. coughing
130
Q

What difference will it have if the foreign body is lodged in the trachea vs the bronchi?

A

In the trachea it will be bilateral wheezing

Bronchi is unilateral

131
Q

What are the things that people swallow?

A
  • fish bones
  • meat bones
  • coins if children
132
Q

What are the narrowest parts that get food lodged there?

A

oropharynx- the tonsils, posterior tongue, vallecular

-pharyngo- oesophagus- the piriform fossa and the post cricoid

133
Q

What are the clinical features of someone with swallowed foreign body?

A
  • acute dysphagia
  • difficulty swallowing even saliva
  • tachycardia and dyspneo
  • otalgia, neck tenderness, and fever point to it being a ruptured oesophagus
134
Q

What would neck tenderness point towards?

A

It would pint towards pharyno-oesophagus rupture

135
Q

How can you visualise the foreign body?

A

By using a tongue depressor and a laryngeal mirror

136
Q

What is the Management of a foreign body?

A
  • Removal using anglled forceps
  • local anaesthesia would be nice
  • If a food bolus is stuck in the oesophagus then you ca leave it for 6-12 hours and then give sedativesto help move it down
137
Q

What is important about the management of an oesophageal rupture?

A
  • It is important because 50% of them cause mortality within the first 24 hours if not treated
  • Patient must be nil by mouth, get a intravenous line in, parenterally fed and given broad spectrum antibiotics
  • contrast swallow may help us visualise the lesion
  • surgical intervention may be NB

ENT (8 decks)

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