Throat Flashcards
3 divisions of pharynx
Naso
Oro
Hypo
What are the boundaries of the oropharynx?
hard palate
valeculla (junction between base of tongue and epiglottis.
What are 2 key structures within the nasopharynx?
Eustacian tubes
Adenoids
What type of tissue are adenoids comprised of?
Lymphatic
What is the collection of tissue that make up the adenoids also known as?
Waldeyers’s ring
What groups of lymphoid tissue make up Waldeyer’s ring?
Adenoid
Tubal tonsils
Palatine tonsils
Lingual tonsils
At what age range do adenoids reach their maximum size?
5-7
How much adenoid tissue do adults have?
Little or none
What are the 4 key symptoms of adenoid hypertrophy?
Secretory otitis media (glue ear)
Nasal obstruction (rhinorrhoea)
Mouth breathing
Snoring/obstructive sleep apnoea
Difference between hypo and hyper nasal speech?
Hypo - no air comes out of nose
Hyper - too much air escapes during speech
2 indications for adenectomy
Airway obstruction caused by enlarged adenoids
Otitis media with effusion (glue ear) - recurrent and often as adjunct to grommet insertion
3 contraindications for adenectomy
bleeding disorders
palate deformity
recent URTI
What 2 findings must be investigated further to exclude nasopharyngeal cancer?
Unilateral glue ear
Nasopharyngeal masses in adults
How long does atypical attack of tonsilitis last?
3-7 days
What 4 organisms usually cause tonsillitis?
Viruses
Haemophilus Influenzae
Pneumococcus
Haemolytic Streptococcus
6 clinical features of tonsillitis?
Sore throat Odynophagia Fever Malaise Enlarged cervical lymph nodes Enlarged red tonsils
What is usually the first choice if antibiotic, if indicated, for tonsillitis?
Penicillin V
What antibiotics should be avoided in glandular fever and why?
Amoxicillin and ampicillin
Pt may develop florid rash
If you suspect glandular fever how can you test for this and what results will you get?
Differential blood count - raised monocytes
glandular fever screen - this may be negative so always check monocytes
If acute tonsillitis spreads locally, what 3 conditions can this result in?
Quinsy
Retropharyngeal abscess
Para pharyngeal abscess
3 rare outcomes of acute tonsillitis?
Rheumatic fever
Glomerulonephritis
Septicaemia
4 indications for tonsillitis?
Bleeding
Oropharyngeal obstruction (obstructive sleep apnoea)
Suspected malignancy
Recurrent tonsillitis
What type of cells are tosils lined with?
Squamous epithelium
What type of cancer usually affects the tonsils?
SSC
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.
What is the term to describe difficulty swallowing?
Dysphagia
What is the term referring to a sensation of a lump in the throat?
Globus
What is the term to describe pain on swallowing?
Odynophagia
Where do things that get stuck on swallowing usually get stuck in the oesophagus?
At the level of the cricopharynx
How can foreign bodies be removed from the oesophagus?
Rigid oesophagoscopy - general anaesthetic
OGD - sedation
What is globus pharyngeus?
Sensation of a lump in the throat
What is the likely background to globus pharyngeus?
Anxeity
Cancer phobia
work/familty stress
recent illness
Management of globus pharyngeus?
Referal to ENT clinic, for thorough examination, endoscopy and reassurance
What physical condition may contribute to globus pharyngeus?
gastroesophageal reflux
Managment of dysphagia?
Urgent referral
Barium swallow
(OGD)
(Rigid oesophagoscopy)
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
What are the three broad categories of dysphagia?
Extraluminal obstruction
Intraluminal/neuro cause
Intraluminal obstruction
3 extraluminal causes of dysphagia?
Neck mass
Mediastinal mass
Abnormal blood vessels - double aortic arch
4 intraluminal/neuro causes of dysphagia?
MS
Motor neurone disease
Stroke
Motility disorders
3 causes of interluminal obstruction?
Stricture
Cancer
Foreign body
Contributory factors for obstructive sleep apnoea
Male
Obese
Alcohol
Smoking
Other than those who are obese, when is obstructive sleep apnoea likely to affect women?
Post menopause
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
8 potential causes of a lump in the neck?
Thyroid/para thyroid malignancy Lymphadenopathy Colloid cyst Pharyngeal pouch Goitre vascular structure thyroglossal cyst
Where in the mouth does saliva enter from the parotid gland?
Opposite second molar via the parotid duct.
Where in the mouth does saliva enter from the submandibular glands?
Under the tongue either side of the frenulum via submandibular duct
How will salivary gland pathology often present?
Enlargement of one or more glands
How would you feel for a submandibular stone?
Bimanual palpation. One finger in mouth, one hand under mandible
In addition to palpation what other examination is crucial when assessing the parotid gland
Examination of facial nerve VII
What is inflammation of the salivary glands known as?
Sialadenitis
What is the most common cause of sialadaninitis?
Obstruction
What infection commonly causes swelling of the parotid glands?
Mumps
What is the treatment for viral sialadenitis?
Symptom relief - analgesia, anti inflammatory and hydration
In what population group is bacterial sialadenitis usually seen?
Elderly
What tow factors are usually present when bacterial sialedenitis is observed?
Dehydration
Poor oral hygiene
How does bacterial sialadenitis manifest?
Diffuse, unilateral, acute onset.
pt may also be pyrexial
What what will be the features of examination and palpation in bacterial sialadenitis?
Tender, swollen parotid gland.
thick mucopurulent secretions from parotid duct.
Treatment for bacterial sialadenitis?
Oral care
re-hydration
antibiotics if cellulitis or abscess present
Where are salivary stones most prevalent?
Sub-mandibular duct
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
how are salivary stones treated?
Analgesia
Heat and massage.
Surgery may be necessary in recurrent cases
What is a ranula?
A salivary retention cyst
In what salivary gland are ranula found
sublingual - smaller
How do ranula present?
persistent swelling under the tongue (possibly also under chin and submental area)
What causes a ranula?
Obstruction of the small sublingual ducts causes the glands to become swollen and cystic.
What salivary gland is most commonly affected by neoplasm?
parotid
What is the most common tumour to affect the salivary glands?
benign pleomorphic adenoma
Tumours of which salivary glands are more likely to be malignant?
Sub-mandibular
Sub-lingual
Best management for ranula?
Surgical removal
Follow history and examination, best management for discrete salivary masses?
Ultrasound guided FNA
poss MRI/CT
Most treated surgically with radiotherapy adjunct
What is the significance of facial pain or weakness associated parotid gland neoplasia?
Indicative of likely malignancy
Where do foreign objects/food commonly become lodged in children and elderly people?
cricopharynx
What is the thyroid attached to and how does this relate to examination?
trachea, thryroid masses will move with larynx when patient swallows
What type of neck lumps will move when the patient swallows AND when they stick their tongue out?
Thryroglossal duct cyst
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
What is the treatment of a branchial cyst?
Surgical removal
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.
What structure are vascular neck nodes normally related to and how common are these?
Carotid artery
Rare
How would a vascular mass differ from a non-vascular mass clinically?
Pulsatile
Where do true vascular masses develop and what are they called?
At the bifurcation of the common carotid
Carotid body tumors
What 2 things are often mistaken for vascular masses?
Lymph node overlying artery
Carotid bulb may be enlarged but normal
How are vascular masses investigated/managed?
ultrasound/MRI
Surgical excision
For infective enlargement of lymph nodes what is an important viral infection to consider?
HIV
What is the treatment for reactive lymph nodes secondary to viral infection?
Supportive
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
What clinical signs are associated with lymphoma other than lymphandenopathy?
Hepatomegaly
Splenagomagaly
What risk factors are associated with the development of SCC within the aero-digestive tract?
Tobacco
Alcohol
HPV
How do does the risk of getting cancer relate to alcohol and tobacco?
The risk is multiplicative rather than additive
What is the morst common site for SCC to develop?
Oral cavity
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
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
Likely causes of chronic laryngitis?
Smoking
Alcohol
Shouting - teachers and actors
Where is a cricothyroidotomy performed?
between the thyroid and crichoid cartilage
3 indications for tracheostomy
Bypass airway obstruction
permit respiratory toilet and suction
assist with artificial ventilation
What are the 3 main types of thyroid malignancy?
Papillary carcinoma
Follicular carcinoma
Anaplastic carcinoma
In what conditions does generalised enlargement of the thyroid occur?
Hashimoto’s
Graves’
What is nodular enlargement of the thyroid characterised by?
multiple nodules of varying size over the whole gland - multinodular goitre
What needs to be considered with solitary thyroid nodules?
Malignancy
Aside from malignancy what could solitary nodules on thyroid be?
Colloid cyst
benign adenoma
4 investigations for thyroid lumps?
TSH, T3 and T4
Thyroid auto antibodies
Ultrasound
FNA cytology with ultrasound guidance
