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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
Q

What are the SIGN recommendations for tonsillectomy?

A

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.

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26
Q

What is the term to describe difficulty swallowing?

A

Dysphagia

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27
Q

What is the term referring to a sensation of a lump in the throat?

A

Globus

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28
Q

What is the term to describe pain on swallowing?

A

Odynophagia

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29
Q

Where do things that get stuck on swallowing usually get stuck in the oesophagus?

A

At the level of the cricopharynx

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30
Q

How can foreign bodies be removed from the oesophagus?

A

Rigid oesophagoscopy - general anaesthetic

OGD - sedation

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31
Q

What is globus pharyngeus?

A

Sensation of a lump in the throat

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32
Q

What is the likely background to globus pharyngeus?

A

Anxeity
Cancer phobia
work/familty stress
recent illness

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33
Q

Management of globus pharyngeus?

A

Referal to ENT clinic, for thorough examination, endoscopy and reassurance

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34
Q

What physical condition may contribute to globus pharyngeus?

A

gastroesophageal reflux

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35
Q

Managment of dysphagia?

A

Urgent referral
Barium swallow
(OGD)
(Rigid oesophagoscopy)

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36
Q

What is a pharyngeal pouch and who does it normally affect and where?

A

And area of mucosa herniates and forms a pouch that food can collect in.
Normally above the cricopharynx
Normally affects the elderly

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37
Q

What are the three broad categories of dysphagia?

A

Extraluminal obstruction
Intraluminal/neuro cause
Intraluminal obstruction

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38
Q

3 extraluminal causes of dysphagia?

A

Neck mass
Mediastinal mass
Abnormal blood vessels - double aortic arch

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39
Q

4 intraluminal/neuro causes of dysphagia?

A

MS
Motor neurone disease
Stroke
Motility disorders

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40
Q

3 causes of interluminal obstruction?

A

Stricture
Cancer
Foreign body

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41
Q

Contributory factors for obstructive sleep apnoea

A

Male
Obese
Alcohol
Smoking

42
Q

Other than those who are obese, when is obstructive sleep apnoea likely to affect women?

A

Post menopause

43
Q

How is obstructive sleep apnoea managed?

A 
Address underlying cause:
obesity 
smoking 
alcohol
nasal polyps/deviated septum

CPAP - may not be tolerated by can be very effective

44
Q

8 potential causes of a lump in the neck?

A 
Thyroid/para thyroid malignancy
Lymphadenopathy 
Colloid cyst
Pharyngeal pouch
Goitre
vascular structure 
thyroglossal cyst
45
Q

Where in the mouth does saliva enter from the parotid gland?

A

Opposite second molar via the parotid duct.

46
Q

Where in the mouth does saliva enter from the submandibular glands?

A

Under the tongue either side of the frenulum via submandibular duct

47
Q

How will salivary gland pathology often present?

A

Enlargement of one or more glands

48
Q

How would you feel for a submandibular stone?

A

Bimanual palpation. One finger in mouth, one hand under mandible

49
Q

In addition to palpation what other examination is crucial when assessing the parotid gland

A

Examination of facial nerve VII

50
Q

What is inflammation of the salivary glands known as?

A

Sialadenitis

51
Q

What is the most common cause of sialadaninitis?

A

Obstruction

52
Q

What infection commonly causes swelling of the parotid glands?

53
Q

What is the treatment for viral sialadenitis?

A

Symptom relief - analgesia, anti inflammatory and hydration

54
Q

In what population group is bacterial sialadenitis usually seen?

55
Q

What tow factors are usually present when bacterial sialedenitis is observed?

A

Dehydration

Poor oral hygiene

56
Q

How does bacterial sialadenitis manifest?

A

Diffuse, unilateral, acute onset.

pt may also be pyrexial

57
Q

What what will be the features of examination and palpation in bacterial sialadenitis?

A

Tender, swollen parotid gland.

thick mucopurulent secretions from parotid duct.

58
Q

Treatment for bacterial sialadenitis?

A

Oral care
re-hydration
antibiotics if cellulitis or abscess present

59
Q

Where are salivary stones most prevalent?

A

Sub-mandibular duct

60
Q

If a patient presents with recurrent swelling of a salivary gland on eating or drinking (especially tart stuff), what is the likely diagnosis?

A

Salivary duct stone

61
Q

how are salivary stones treated?

A

Analgesia
Heat and massage.
Surgery may be necessary in recurrent cases

62
Q

What is a ranula?

A

A salivary retention cyst

63
Q

In what salivary gland are ranula found

A

sublingual - smaller

64
Q

How do ranula present?

A

persistent swelling under the tongue (possibly also under chin and submental area)

65
Q

What causes a ranula?

A

Obstruction of the small sublingual ducts causes the glands to become swollen and cystic.

66
Q

What salivary gland is most commonly affected by neoplasm?

67
Q

What is the most common tumour to affect the salivary glands?

A

benign pleomorphic adenoma

68
Q

Tumours of which salivary glands are more likely to be malignant?

A

Sub-mandibular

Sub-lingual

69
Q

Best management for ranula?

A

Surgical removal

70
Q

Follow history and examination, best management for discrete salivary masses?

A

Ultrasound guided FNA
poss MRI/CT
Most treated surgically with radiotherapy adjunct

71
Q

What is the significance of facial pain or weakness associated parotid gland neoplasia?

A

Indicative of likely malignancy

72
Q

Where do foreign objects/food commonly become lodged in children and elderly people?

A

cricopharynx

73
Q

What is the thyroid attached to and how does this relate to examination?

A

trachea, thryroid masses will move with larynx when patient swallows

74
Q

What type of neck lumps will move when the patient swallows AND when they stick their tongue out?

A

Thryroglossal duct cyst

75
Q

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?

A

Branchial cyst

76
Q

What is the treatment of a branchial cyst?

A

Surgical removal

77
Q

In patients over 40 years of age how does the initial management of a branchial cyst differ from younger people?

A

View with suspicion as metastatic head and neck cancer can present with cystic neck nodes.

78
Q

What structure are vascular neck nodes normally related to and how common are these?

A

Carotid artery

Rare

79
Q

How would a vascular mass differ from a non-vascular mass clinically?

80
Q

Where do true vascular masses develop and what are they called?

A

At the bifurcation of the common carotid

Carotid body tumors

81
Q

What 2 things are often mistaken for vascular masses?

A

Lymph node overlying artery

Carotid bulb may be enlarged but normal

82
Q

How are vascular masses investigated/managed?

A

ultrasound/MRI

Surgical excision

83
Q

For infective enlargement of lymph nodes what is an important viral infection to consider?

84
Q

What is the treatment for reactive lymph nodes secondary to viral infection?

A

Supportive

85
Q

Malignant lymph nodes as a result of lymphoma are likely to be accompanied by type B symptoms, what are these?

A

Night sweats
Weight loss
General pruritis

86
Q

What clinical signs are associated with lymphoma other than lymphandenopathy?

A

Hepatomegaly

Splenagomagaly

87
Q

What risk factors are associated with the development of SCC within the aero-digestive tract?

A

Tobacco
Alcohol
HPV

88
Q

How do does the risk of getting cancer relate to alcohol and tobacco?

A

The risk is multiplicative rather than additive

89
Q

What is the morst common site for SCC to develop?

A

Oral cavity

90
Q

9 red flags for head and neck cancer

A 
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
Q

How long does acute lanryngitis last and what is the management?

A

2 weeks
Fluids, analgesia and anti inflammatory drugs
Voice rest - no shouting, whispering or straining

92
Q

Likely causes of chronic laryngitis?

A

Smoking
Alcohol
Shouting - teachers and actors

93
Q

Where is a cricothyroidotomy performed?

A

between the thyroid and crichoid cartilage

94
Q

3 indications for tracheostomy

A

Bypass airway obstruction
permit respiratory toilet and suction
assist with artificial ventilation

95
Q

What are the 3 main types of thyroid malignancy?

A

Papillary carcinoma
Follicular carcinoma
Anaplastic carcinoma

96
Q

In what conditions does generalised enlargement of the thyroid occur?

A

Hashimoto’s

Graves’

97
Q

What is nodular enlargement of the thyroid characterised by?

A

multiple nodules of varying size over the whole gland - multinodular goitre

98
Q

What needs to be considered with solitary thyroid nodules?

A

Malignancy

99
Q

Aside from malignancy what could solitary nodules on thyroid be?

A

Colloid cyst

benign adenoma

100
Q

4 investigations for thyroid lumps?

A

TSH, T3 and T4
Thyroid auto antibodies
Ultrasound
FNA cytology with ultrasound guidance

402 Ear, Nose & Throat (3 decks)

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