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4th Year > Throat > Flashcards

Throat Flashcards

1
Q

Centor criteria for tonsillitis

A

history of fever
cervical lymphadenopathy
no cough
tonsillar exudate

0-2 no antibiotic
2-3 points - receive antibiotic if symptoms progress
4-5 points treat empirically with antibiotics

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2
Q

what is globs pharyngus

A

the feeling of a lump in the throat

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3
Q

what nerves innervate the tongue - and which parts

A

Anterior 2/3 taste - chords tympani
anterior 2/3 sensation - linguinal (branches off CNV3)

posterior 1/3 taste - glossopharyngeal
posterior 1/3 sensation - glossopharyngeal

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4
Q

innervation of the parotid gland

A

CNIX - parasympathetic

CNVII - sympathetic

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5
Q

what are the salivary glands

A

parotid
submandibular
sublingual

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6
Q

which salivary glands presents with the most pathology

A

parotid

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7
Q

how does a salivary gland stone present and how is it treated (sialolithiasis)

A

pain in gland which comes and goes - is worse when eating
stone can sometimes be seen at opening to gland

most common in submandibular gland

intense continuous pain - stone blocking the full gland

needs pushed out manually or surgery to remove - therapeutic sialendoscopy

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8
Q

what is laryngomalacia

A

congenital softening of the tissues of the larynx

causes noisy breathing in infants - stidor

worse when crying or lying flat

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9
Q

what are laryngeal polyps

A

nodules that appear on vocal cords after acute injury

usually self limiting

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10
Q

causes of laryngeal polyps

A

vocal cord abuse
infection
smoking
hypothyroidism

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11
Q

what are laryngeal nodules

A

main cause is prolonged vocal cord abuse

usually bilateral

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12
Q

what is the most common benign salivary gland tumour and who gets it

A

pleomorphic adenoma

seen in females >60

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13
Q

what is the second most common benign salivary gland tumour and who gets it

A

Warthin’s tumour

men>50

associated with smoking

often bilateral in parotid gland

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14
Q

what are the most common malignant salivary gland tumours (world and UK) and how do they present

A

World - mucoepidermoid carcinoma (cancer of lining of salivary glands)

UK - adenoid cystic carcinoma

swelling near jaw, mouth or neck
facial nerve palsy
pain
difficulty swallowing

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15
Q

what is the most common tumour of the palate

A

adenoid cystic carcinoma

usually people >40s

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16
Q

what is a thyroglossal cyst and how does it present

A

developmental remnant occurring at any point along the thyroglossal tract (thyroid originated in the oropharynx then traveled down to anterior neck)

neck lump that is attached to base of tongue so moves when the patient sticks there tongue out

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17
Q

what is a branchial cyst and how does it present

A

developmental remnant due to failure of the cervical sinus to disappear (from 2nd branchial arch)

in anterior triangle of neck
presents in young adults
lined with squamous epithelium and contains cholesterol crystals

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18
Q

diagnostic investigation for branchial cyst

A

aspiration shows cholesterol crystals

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19
Q

what is an epidermoid (sebaceous) cyst

A

cutaneous lump containing unpleasant, which, thick, foul smelling liquid

usually leave alone but can excise if symptomatic

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20
Q

what are the differentials for a pulsatile neck lump

A

carotid body tumour - firm with no bruit

carotid aneurysm - fluctuant and associated with bruit

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21
Q

how do you diagnose a carotid body tumour and how is it treated

A

angiography or doppler ultrasound

excision by vascular surgeon

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22
Q

where do you cut through for an emergency airway

A

cricothyroid membrane

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23
Q

what are salivary gland stones usually made of

A

calcium

24
Q

what is the most common carcinoma of the larynx

A

squamous cell carcinoma

25
Q

where do laryngeal cancers originate

A

epiglottis
vocal cords (false or true)
area below the vocal cords extending below the glottis (sub glottis)

26
Q

presentation of laryngeal cancer

A 
hoarseness 
dysphagia 
odynophagia 
cervical lymphadenopathy 
supraglottic or glottic mass 
redness, ulceration, necrosis or bleeding
27
Q

risk factors for laryngeal cancer

A 
tobacco use >40 pack years 
alcohol use >8 units per day 
Achlorhydria 
hx of radiotherapy 
FH of laryngeal cancer 
black ethnicity 
male sex 
vocal cord dysplasia
28
Q

investigations for laryngeal cancer

A

CT
FNA
flexible fibre-optic laryngoscopy
laryngeal biopsy

29
Q

treatment of laryngeal carcinoma

A

surgery +/- chemo and radio

30
Q

what is the most common cause of stridorr in infants

A

laryngomalacia

31
Q

presentation of laryngomalacia

A

risk factors present (GORD, near abnormalities, male gender, genetic)
stridor
onset within 2 weeks of birth
features of airway obstruction
resolution of symptoms by 2 years of age
normal cry
feeding difficulties

32
Q

treatment of laryngomalacia

A

mild - observe and GORD treatment

compromised airway or disrupted feeding - surgery

33
Q

what is laryngitis and how does it present

A

inflammation of the larynx (can be viral, bacterial, or due to vocal cord strain or reflux)

hoarseness
dysphagia 
sore throat 
cough 
hyperaemia of the oropharynx 
hx of heavy vocal cord use of GORD 
fever 
enlarged tonsils 
cervical lymphadenopathy 
dyspnoea
34
Q

most common cause of infective laryngitis

A

viral - post URTI - Rhinovirus

35
Q

what bacteria can cause laryngitis

A

mortadella
haemophilia influenza
strep pneumonia
staph aureus

36
Q

what bacterial most commonly causes epiglottis

A

haemophilia influenza type B

37
Q

how do you diagnose laryngitis

A

laryngoscopy

38
Q

treatment of laryngitis

A

viral

  • vocal cord hygiene
  • mucolytics
  • cough suppression

bacterial

  • antibiotics (penicillin)
  • vocal hygiene
  • mucolytic/cough suppression

usually viral and self limiting

39
Q

symptoms of viral tonsillitis

A 
cold like symptoms 
malaise 
sore throat 
temperature 
unable to undertake near normal activity 
possible lymphadenopathy 
lasts 3-4 days
40
Q

symptoms of bacterial tonsillitis

A 
more systemic, pyrexial presentation 
systemic upset 
fever 
odynophagia (painful swallow) 
halitosis 
unable to work/school 
lymphadenopathy 
lasts 1 week - required antibiotics to settle
41
Q

which bacteria most commonly cause bacterial tonsillitis

A

strep progenies (group A haemolytic strep) - most common

42
Q

criteria for tonsillectomy

A

recurrent sore throats which can be proven to be acute tonsillitis
episodes are disabling and prevent normal functioning
7 or more well documented and adequately treated sore throats in the last year OR
5 or more in the preceding two years OR
3 or more in year of the preceding 3 years

43
Q

what is a peritonsillar abcess

A

complication of acute tonsillitis

bacteria between muscle and tonsil - produce pus

44
Q

presentation of peritonsillar access

A

unilateral throat pain and odynophagia
(previously bilateral but unilateral following treatment for tonsillitis)
truisms (difficulty opening mouth)

3- 7 says of preceding tonsillitis

45
Q

diagnosis of peritonsillar access

A

medial displacement of tonsil and uvula

concavity of palates lost- pushed down medially

46
Q

treatment of peritonsillar access

A

aspiration

antibiotics

47
Q

what are the two phases of primary infection with epstein-barr virus

A

primary infection in early childhood - rarely causes glandular fever

primary infection in those >10 - causes glandular fever

48
Q

presentation of glandular fever

A 
fever 
enlarged lymph nodes 
sore throat, pharyngitis, tonsillitis 
malaise 
lethargy

gross tonsillar enlargement with membranous exudate
marked cervical lymphadenopathy
palatal petechial haemorrhages
hepatosplenomegaly

49
Q

how do you diagnose glandular fever

A 
serology for EBV 
atypical lymphocytes in peripheral blood 
neutrophils and CRP low 
\+monospot or Paul-bunnell test 
low CRP <100
50
Q

treatment of glandular fever

A

rest
paracetamol
avoid sports
corticosteroids if complicated

do NOT prescribe penicillin - cross reaction, causes macular rash

51
Q

complications of glandular fever

A

anaemia, thrombocytopaenia
splenic rupture
increased risk of lymphoma - especially in immunosuppressed

52
Q

presentation of diphtheria

A

severe sore throat with a grey-white membrane across the pharynx

53
Q

bacteria that causes diphtheria

A

Corynebacterium Diphtheriae

54
Q

investigations for diphtheria

A

bacterial culture - shows irregular staining pleomorphic bacilli on microscopy

55
Q

management of diphtheria

A

isolation
anti-toxin
supportive measures
penicillin/erythromycin

4th Year (25 decks)

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