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402 Ear, Nose & Throat > Throat > Flashcards

Throat Flashcards

1
Q

3 divisions of pharynx

A

Naso
Oro
Hypo

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2
Q

What are the boundaries of the oropharynx?

A

hard palate

valeculla (junction between base of tongue and epiglottis.

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3
Q

What are 2 key structures within the nasopharynx?

A

Eustacian tubes

Adenoids

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4
Q

What type of tissue are adenoids comprised of?

A

Lymphatic

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5
Q

What is the collection of tissue that make up the adenoids also known as?

A

Waldeyers’s ring

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6
Q

What groups of lymphoid tissue make up Waldeyer’s ring?

A

Adenoid
Tubal tonsils
Palatine tonsils
Lingual tonsils

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7
Q

At what age range do adenoids reach their maximum size?

A

5-7

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8
Q

How much adenoid tissue do adults have?

A

Little or none

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9
Q

What are the 4 key symptoms of adenoid hypertrophy?

A

Secretory otitis media (glue ear)
Nasal obstruction (rhinorrhoea)
Mouth breathing
Snoring/obstructive sleep apnoea

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10
Q

Difference between hypo and hyper nasal speech?

A

Hypo - no air comes out of nose

Hyper - too much air escapes during speech

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11
Q

2 indications for adenectomy

A

Airway obstruction caused by enlarged adenoids

Otitis media with effusion (glue ear) - recurrent and often as adjunct to grommet insertion

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12
Q

3 contraindications for adenectomy

A

bleeding disorders
palate deformity
recent URTI

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13
Q

What 2 findings must be investigated further to exclude nasopharyngeal cancer?

A

Unilateral glue ear

Nasopharyngeal masses in adults

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14
Q

How long does atypical attack of tonsilitis last?

A

3-7 days

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15
Q

What 4 organisms usually cause tonsillitis?

A

Viruses
Haemophilus Influenzae
Pneumococcus
Haemolytic Streptococcus

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16
Q

6 clinical features of tonsillitis?

A 
Sore throat
Odynophagia
Fever 
Malaise 
Enlarged cervical lymph nodes
Enlarged red tonsils
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17
Q

What is usually the first choice if antibiotic, if indicated, for tonsillitis?

A

Penicillin V

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18
Q

What antibiotics should be avoided in glandular fever and why?

A

Amoxicillin and ampicillin

Pt may develop florid rash

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19
Q

If you suspect glandular fever how can you test for this and what results will you get?

A

Differential blood count - raised monocytes

glandular fever screen - this may be negative so always check monocytes

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20
Q

If acute tonsillitis spreads locally, what 3 conditions can this result in?

A

Quinsy
Retropharyngeal abscess
Para pharyngeal abscess

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21
Q

3 rare outcomes of acute tonsillitis?

A

Rheumatic fever
Glomerulonephritis
Septicaemia

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22
Q

4 indications for tonsillitis?

A

Bleeding
Oropharyngeal obstruction (obstructive sleep apnoea)
Suspected malignancy
Recurrent tonsillitis

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23
Q

What type of cells are tosils lined with?

A

Squamous epithelium

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24
Q

What type of cancer usually affects the tonsils?

A

SSC

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25
What are the SIGN recommendations for tonsillectomy?
Sore throat due to acute tonsillitis Bad enough to require time off work or school 7 episodes in 1 year, 5 in 2 or 3 in 3.
26
What is the term to describe difficulty swallowing?
Dysphagia
27
What is the term referring to a sensation of a lump in the throat?
Globus
28
What is the term to describe pain on swallowing?
Odynophagia
29
Where do things that get stuck on swallowing usually get stuck in the oesophagus?
At the level of the cricopharynx
30
How can foreign bodies be removed from the oesophagus?
Rigid oesophagoscopy - general anaesthetic | OGD - sedation
31
What is globus pharyngeus?
Sensation of a lump in the throat
32
What is the likely background to globus pharyngeus?
Anxeity Cancer phobia work/familty stress recent illness
33
Management of globus pharyngeus?
Referal to ENT clinic, for thorough examination, endoscopy and reassurance
34
What physical condition may contribute to globus pharyngeus?
gastroesophageal reflux
35
Managment of dysphagia?
Urgent referral Barium swallow (OGD) (Rigid oesophagoscopy)
36
What is a pharyngeal pouch and who does it normally affect and where?
And area of mucosa herniates and forms a pouch that food can collect in. Normally above the cricopharynx Normally affects the elderly
37
What are the three broad categories of dysphagia?
Extraluminal obstruction Intraluminal/neuro cause Intraluminal obstruction
38
3 extraluminal causes of dysphagia?
Neck mass Mediastinal mass Abnormal blood vessels - double aortic arch
39
4 intraluminal/neuro causes of dysphagia?
MS Motor neurone disease Stroke Motility disorders
40
3 causes of interluminal obstruction?
Stricture Cancer Foreign body
41
Contributory factors for obstructive sleep apnoea
Male Obese Alcohol Smoking
42
Other than those who are obese, when is obstructive sleep apnoea likely to affect women?
Post menopause
43
How is obstructive sleep apnoea managed?
``` Address underlying cause: obesity smoking alcohol nasal polyps/deviated septum ``` CPAP - may not be tolerated by can be very effective
44
8 potential causes of a lump in the neck?
``` Thyroid/para thyroid malignancy Lymphadenopathy Colloid cyst Pharyngeal pouch Goitre vascular structure thyroglossal cyst ```
45
Where in the mouth does saliva enter from the parotid gland?
Opposite second molar via the parotid duct.
46
Where in the mouth does saliva enter from the submandibular glands?
Under the tongue either side of the frenulum via submandibular duct
47
How will salivary gland pathology often present?
Enlargement of one or more glands
48
How would you feel for a submandibular stone?
Bimanual palpation. One finger in mouth, one hand under mandible
49
In addition to palpation what other examination is crucial when assessing the parotid gland
Examination of facial nerve VII
50
What is inflammation of the salivary glands known as?
Sialadenitis
51
What is the most common cause of sialadaninitis?
Obstruction
52
What infection commonly causes swelling of the parotid glands?
Mumps
53
What is the treatment for viral sialadenitis?
Symptom relief - analgesia, anti inflammatory and hydration
54
In what population group is bacterial sialadenitis usually seen?
Elderly
55
What tow factors are usually present when bacterial sialedenitis is observed?
Dehydration | Poor oral hygiene
56
How does bacterial sialadenitis manifest?
Diffuse, unilateral, acute onset. | pt may also be pyrexial
57
What what will be the features of examination and palpation in bacterial sialadenitis?
Tender, swollen parotid gland. | thick mucopurulent secretions from parotid duct.
58
Treatment for bacterial sialadenitis?
Oral care re-hydration antibiotics if cellulitis or abscess present
59
Where are salivary stones most prevalent?
Sub-mandibular duct
60
If a patient presents with recurrent swelling of a salivary gland on eating or drinking (especially tart stuff), what is the likely diagnosis?
Salivary duct stone
61
how are salivary stones treated?
Analgesia Heat and massage. Surgery may be necessary in recurrent cases
62
What is a ranula?
A salivary retention cyst
63
In what salivary gland are ranula found
sublingual - smaller
64
How do ranula present?
persistent swelling under the tongue (possibly also under chin and submental area)
65
What causes a ranula?
Obstruction of the small sublingual ducts causes the glands to become swollen and cystic.
66
What salivary gland is most commonly affected by neoplasm?
parotid
67
What is the most common tumour to affect the salivary glands?
benign pleomorphic adenoma
68
Tumours of which salivary glands are more likely to be malignant?
Sub-mandibular | Sub-lingual
69
Best management for ranula?
Surgical removal
70
Follow history and examination, best management for discrete salivary masses?
Ultrasound guided FNA poss MRI/CT Most treated surgically with radiotherapy adjunct
71
What is the significance of facial pain or weakness associated parotid gland neoplasia?
Indicative of likely malignancy
72
Where do foreign objects/food commonly become lodged in children and elderly people?
cricopharynx
73
What is the thyroid attached to and how does this relate to examination?
trachea, thryroid masses will move with larynx when patient swallows
74
What type of neck lumps will move when the patient swallows AND when they stick their tongue out?
Thryroglossal duct cyst
75
In a young patient, with a lump in the anterior upper third of the sternocleidomastiod muscle, possible with acute swelling, what is the likely diagnosis?
Branchial cyst
76
What is the treatment of a branchial cyst?
Surgical removal
77
In patients over 40 years of age how does the initial management of a branchial cyst differ from younger people?
View with suspicion as metastatic head and neck cancer can present with cystic neck nodes.
78
What structure are vascular neck nodes normally related to and how common are these?
Carotid artery | Rare
79
How would a vascular mass differ from a non-vascular mass clinically?
Pulsatile
80
Where do true vascular masses develop and what are they called?
At the bifurcation of the common carotid | Carotid body tumors
81
What 2 things are often mistaken for vascular masses?
Lymph node overlying artery | Carotid bulb may be enlarged but normal
82
How are vascular masses investigated/managed?
ultrasound/MRI | Surgical excision
83
For infective enlargement of lymph nodes what is an important viral infection to consider?
HIV
84
What is the treatment for reactive lymph nodes secondary to viral infection?
Supportive
85
Malignant lymph nodes as a result of lymphoma are likely to be accompanied by type B symptoms, what are these?
Night sweats Weight loss General pruritis
86
What clinical signs are associated with lymphoma other than lymphandenopathy?
Hepatomegaly | Splenagomagaly
87
What risk factors are associated with the development of SCC within the aero-digestive tract?
Tobacco Alcohol HPV
88
How do does the risk of getting cancer relate to alcohol and tobacco?
The risk is multiplicative rather than additive
89
What is the morst common site for SCC to develop?
Oral cavity
90
9 red flags for head and neck cancer
``` Hoarseness (more than 3 weeks) Dysphagia Odynophagia Unexplained otalgia Neck lump Non healing (more than 3 weeks) White/red patches in mouth (more than 3 weeks) Stridor Face/cheek swelling ```
91
How long does acute lanryngitis last and what is the management?
2 weeks Fluids, analgesia and anti inflammatory drugs Voice rest - no shouting, whispering or straining
92
Likely causes of chronic laryngitis?
Smoking Alcohol Shouting - teachers and actors
93
Where is a cricothyroidotomy performed?
between the thyroid and crichoid cartilage
94
3 indications for tracheostomy
Bypass airway obstruction permit respiratory toilet and suction assist with artificial ventilation
95
What are the 3 main types of thyroid malignancy?
Papillary carcinoma Follicular carcinoma Anaplastic carcinoma
96
In what conditions does generalised enlargement of the thyroid occur?
Hashimoto's | Graves'
97
What is nodular enlargement of the thyroid characterised by?
multiple nodules of varying size over the whole gland - multinodular goitre
98
What needs to be considered with solitary thyroid nodules?
Malignancy
99
Aside from malignancy what could solitary nodules on thyroid be?
Colloid cyst | benign adenoma
100
4 investigations for thyroid lumps?
TSH, T3 and T4 Thyroid auto antibodies Ultrasound FNA cytology with ultrasound guidance

402 Ear, Nose & Throat (3 decks)

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