Throat

Question 1

Name 5 symptoms of tonsillitis

Answer 1

sore throat, pain on swallowing, change in voice, trismus, drooling, fever, ear ache, anorexia, bilaterally inflamed tonsils, lymphadenopathy (jugulodigastric)

Question 2

What tests would you do for tonsilltis?

Answer 2

EBV serology
heterophile antibody
LFTs

Question 3

What would you use to treat tonsillitis?

Answer 3

HYDRATION
methotrexate
Pen V
analgesia, antipyrexia

Question 4

What is the criteria for giving antibiotics in tonsillitis?

Answer 4

FeverPAIN

• fever in past 24 hours
• purulent fever
• absence of cough
• severe tonsil inflammation
• new onset < 3 days

Question 5

What are some differentials of tonsillitis?

Answer 5

Quinsy/peritonsillar abscess
glandular fever
malignancy
scarlet fever

Question 6

Why do you not give amoxicillin for tonsillitis?

Answer 6

Glandular fever is a differential of tonsillitis and amoxicillin + glandular fever = huge rash

Question 7

What would difference in swallowing symptoms indicate?

Answer 7

fluids not solids = stricture

solids not fluids = motility disorder

Question 8

What is Barret’s oesophagus?

Answer 8

When oesophageal squamous mucosa is converted to columnar glandula mucosa
- RF for oesophageal adenocarcinoma

Question 9

What are some risk factors for oesophageal cancer?

Answer 9

obesity, smoking, alcohol, GORD, achlasia, family hx, increasing age, male

Question 10

What are some symptoms of oesophageal cancer?

Answer 10

dysphagia, vomiting, GI bleed, anaemia, weight loss, dyspepsia, reflux, sometimes lump in abdomen or lymph nodes (advanced)

Question 11

What are some differentials of goitre?

Answer 11

thyroid malignancy

Question 12

What would thyroid function tests indicate if thyroid problems are present?

Answer 12

TSH
hyperthyroid - low TSH
hypothyroid - high TSH
(TSH feeds into thyroid which produces T4 and T3)

Question 13

How long would lymphadenopathy from self-limiting infection typically last?

Answer 13

< 3 weeks

Question 14

What should you do with TSH in thyroid malignancy?

Answer 14

Keep low to reduce risk of recurrence - give lots of thyroxine

Question 15

What is the most common type of thyroid malignancy?

Answer 15

differentiated, papillary cancer

Question 16

What are causes of hypothyroidism and 3 symptoms?

Answer 16

primary disease of thyroid or idoine deficiency
- tired, weight gain, cold intolerance, poor memory, depression, goitre, puffy eyes, dry hair, constipation, overweight, carpal tunnel

Question 17

How do you treat hypothyroidism?

Answer 17

levothyroxine - T4

Question 18

What is the most serious complication of hypothyroidism?

Answer 18

Myxoedema coma
30-50%
Signs - ECG changes, hyponatraemia, hypoglycamia

Question 19

What are Hashimoto’s disease?

Answer 19

Autoimmune hypothyroidism with TPO antibodies

- CD8 cell mediated

Question 20

What are 3 symptoms of hyperthyroidism? What is the treatment?

Answer 20

heat intolerance, diarrhoea, weight loss, insomnia, thin hair

• antithyroid drugs e.g. carbimazole
• radioactive iodine
• Surgery

Question 21

What is the main complication of hyperthyroidism?

Answer 21

thyrotoxic storm - fever, delerium, dehydration, tachycardia, abdo pain - 20% mortality
- treat with propranolol and treat cause

Question 22

What are some causes of lymphadenopathy?

Answer 22

infective - infective mononucleosis, CMV, HIV malignant - lymphoma, metastatis

Question 23

What are some causes of facial pain?

Answer 23

sinusitus, atypical facial pain, trigeminal neuralgia, temporo - mandibular joint dysfunction, dental causes, eye related causes, temporal arteritis, ENT malignancy

Question 24

What is herpes labialis? How would you treat it?

Answer 24

cold sores

self-limiting, avoid contact

Question 25

What are some risk factors for oral candida?

Answer 25

being a baby, wearing dentures, antibiotics, antibacterial mouthwash, steroids, dry mouth, diabetes, anaemia, lack of iron folate or B12, poor immune system, frailty, smokers

Question 26

How would you treat oral candida?

Answer 26

miconazole mouth gel
Nystatin drops
fluconazole (tablets)

Question 27

What is gingivitis?

Answer 27

Proliferation of anaerobic bacteria in bacterial plaque = chronic peridontitis and gradual destruction of supporting teeth tissue resulting in loss of teeth

Question 28

What is ramsey hunt syndrome?

Answer 28

herpes zoster becomes reactivated in VIIth cranial nerve (facial nerve) = vertigo, hearing loss, tinnitus, facial drop, rash

TREAT with antivirals and steroids

Question 29

What are some differntials of a sore throat?

Answer 29

tonsolitis, pharyngitis, epiglottitis/laryngitis, glandular fever, neoplasm, quinsy, immunocompromised

Question 30

What is the organism in diptheria?

Answer 30

C. diptheriae (gram + bacillus)

Question 31

What are some symptoms of diptheria?

Answer 31

tonsillar and pharyngeal inflammation, regional lymphadenopathy, husky voice, dyspnoea, cyanosis, neuro

Question 32

How would you treat diptheria?

Answer 32

isolation and bed rest
antitoxin therapy
immunisation in childhood

Question 33

What virus causes glandular fever? What is another name for it?

Answer 33

epstein-barr virus

infectious mononucleosis

Question 34

How do you treat glandular fever?

Answer 34

conservative including analgesia
steroids
avoid contact sport for 6-8 weeks to avoid splenic rupture, avoid alcohol

Question 35

What are some symptoms of glandular fever?

Answer 35

prolonged malaise, sore throat with sheet of pus, fine macular rash, bilateral upper lid oedema, lymphadenopathy

Question 36

Which antibiotics do you give for throat infections and sinusitis?

Answer 36

phenoxymethylpenicillin / erythromycin