Throat Flashcards
Name 5 symptoms of tonsillitis
sore throat, pain on swallowing, change in voice, trismus, drooling, fever, ear ache, anorexia, bilaterally inflamed tonsils, lymphadenopathy (jugulodigastric)
What tests would you do for tonsilltis?
EBV serology
heterophile antibody
LFTs
What would you use to treat tonsillitis?
HYDRATION
methotrexate
Pen V
analgesia, antipyrexia
What is the criteria for giving antibiotics in tonsillitis?
FeverPAIN
- fever in past 24 hours
- purulent fever
- absence of cough
- severe tonsil inflammation
- new onset < 3 days
What are some differentials of tonsillitis?
Quinsy/peritonsillar abscess
glandular fever
malignancy
scarlet fever
Why do you not give amoxicillin for tonsillitis?
Glandular fever is a differential of tonsillitis and amoxicillin + glandular fever = huge rash
What would difference in swallowing symptoms indicate?
fluids not solids = stricture
solids not fluids = motility disorder
What is Barret’s oesophagus?
When oesophageal squamous mucosa is converted to columnar glandula mucosa
- RF for oesophageal adenocarcinoma
What are some risk factors for oesophageal cancer?
obesity, smoking, alcohol, GORD, achlasia, family hx, increasing age, male
What are some symptoms of oesophageal cancer?
dysphagia, vomiting, GI bleed, anaemia, weight loss, dyspepsia, reflux, sometimes lump in abdomen or lymph nodes (advanced)
What are some differentials of goitre?
thyroid malignancy
What would thyroid function tests indicate if thyroid problems are present?
TSH
hyperthyroid - low TSH
hypothyroid - high TSH
(TSH feeds into thyroid which produces T4 and T3)
How long would lymphadenopathy from self-limiting infection typically last?
< 3 weeks
What should you do with TSH in thyroid malignancy?
Keep low to reduce risk of recurrence - give lots of thyroxine
What is the most common type of thyroid malignancy?
differentiated, papillary cancer
What are causes of hypothyroidism and 3 symptoms?
primary disease of thyroid or idoine deficiency
- tired, weight gain, cold intolerance, poor memory, depression, goitre, puffy eyes, dry hair, constipation, overweight, carpal tunnel
How do you treat hypothyroidism?
levothyroxine - T4
What is the most serious complication of hypothyroidism?
Myxoedema coma
30-50%
Signs - ECG changes, hyponatraemia, hypoglycamia
What are Hashimoto’s disease?
Autoimmune hypothyroidism with TPO antibodies
- CD8 cell mediated
What are 3 symptoms of hyperthyroidism? What is the treatment?
heat intolerance, diarrhoea, weight loss, insomnia, thin hair
- antithyroid drugs e.g. carbimazole
- radioactive iodine
- Surgery
What is the main complication of hyperthyroidism?
thyrotoxic storm - fever, delerium, dehydration, tachycardia, abdo pain - 20% mortality
- treat with propranolol and treat cause
What are some causes of lymphadenopathy?
infective - infective mononucleosis, CMV, HIV malignant - lymphoma, metastatis
What are some causes of facial pain?
sinusitus, atypical facial pain, trigeminal neuralgia, temporo - mandibular joint dysfunction, dental causes, eye related causes, temporal arteritis, ENT malignancy
What is herpes labialis? How would you treat it?
cold sores
self-limiting, avoid contact
What are some risk factors for oral candida?
being a baby, wearing dentures, antibiotics, antibacterial mouthwash, steroids, dry mouth, diabetes, anaemia, lack of iron folate or B12, poor immune system, frailty, smokers
How would you treat oral candida?
miconazole mouth gel
Nystatin drops
fluconazole (tablets)
What is gingivitis?
Proliferation of anaerobic bacteria in bacterial plaque = chronic peridontitis and gradual destruction of supporting teeth tissue resulting in loss of teeth
What is ramsey hunt syndrome?
herpes zoster becomes reactivated in VIIth cranial nerve (facial nerve) = vertigo, hearing loss, tinnitus, facial drop, rash
TREAT with antivirals and steroids
What are some differntials of a sore throat?
tonsolitis, pharyngitis, epiglottitis/laryngitis, glandular fever, neoplasm, quinsy, immunocompromised
What is the organism in diptheria?
C. diptheriae (gram + bacillus)
What are some symptoms of diptheria?
tonsillar and pharyngeal inflammation, regional lymphadenopathy, husky voice, dyspnoea, cyanosis, neuro
How would you treat diptheria?
isolation and bed rest
antitoxin therapy
immunisation in childhood
What virus causes glandular fever? What is another name for it?
epstein-barr virus
infectious mononucleosis
How do you treat glandular fever?
conservative including analgesia
steroids
avoid contact sport for 6-8 weeks to avoid splenic rupture, avoid alcohol
What are some symptoms of glandular fever?
prolonged malaise, sore throat with sheet of pus, fine macular rash, bilateral upper lid oedema, lymphadenopathy
Which antibiotics do you give for throat infections and sinusitis?
phenoxymethylpenicillin / erythromycin
