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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

24
Q

what is the most common carcinoma of the larynx

A

squamous cell carcinoma

25
where do laryngeal cancers originate
epiglottis vocal cords (false or true) area below the vocal cords extending below the glottis (sub glottis)
26
presentation of laryngeal cancer
``` hoarseness dysphagia odynophagia cervical lymphadenopathy supraglottic or glottic mass redness, ulceration, necrosis or bleeding ```
27
risk factors for laryngeal cancer
``` 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
investigations for laryngeal cancer
CT FNA flexible fibre-optic laryngoscopy laryngeal biopsy
29
treatment of laryngeal carcinoma
surgery +/- chemo and radio
30
what is the most common cause of stridorr in infants
laryngomalacia
31
presentation of laryngomalacia
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
treatment of laryngomalacia
mild - observe and GORD treatment compromised airway or disrupted feeding - surgery
33
what is laryngitis and how does it present
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
most common cause of infective laryngitis
viral - post URTI - Rhinovirus
35
what bacteria can cause laryngitis
mortadella haemophilia influenza strep pneumonia staph aureus
36
what bacterial most commonly causes epiglottis
haemophilia influenza type B
37
how do you diagnose laryngitis
laryngoscopy
38
treatment of laryngitis
viral - vocal cord hygiene - mucolytics - cough suppression bacterial - antibiotics (penicillin) - vocal hygiene - mucolytic/cough suppression usually viral and self limiting
39
symptoms of viral tonsillitis
``` cold like symptoms malaise sore throat temperature unable to undertake near normal activity possible lymphadenopathy lasts 3-4 days ```
40
symptoms of bacterial tonsillitis
``` more systemic, pyrexial presentation systemic upset fever odynophagia (painful swallow) halitosis unable to work/school lymphadenopathy lasts 1 week - required antibiotics to settle ```
41
which bacteria most commonly cause bacterial tonsillitis
strep progenies (group A haemolytic strep) - most common
42
criteria for tonsillectomy
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
what is a peritonsillar abcess
complication of acute tonsillitis | bacteria between muscle and tonsil - produce pus
44
presentation of peritonsillar access
unilateral throat pain and odynophagia (previously bilateral but unilateral following treatment for tonsillitis) truisms (difficulty opening mouth) 3- 7 says of preceding tonsillitis
45
diagnosis of peritonsillar access
medial displacement of tonsil and uvula concavity of palates lost- pushed down medially
46
treatment of peritonsillar access
aspiration | antibiotics
47
what are the two phases of primary infection with epstein-barr virus
primary infection in early childhood - rarely causes glandular fever primary infection in those >10 - causes glandular fever
48
presentation of glandular fever
``` fever enlarged lymph nodes sore throat, pharyngitis, tonsillitis malaise lethargy ``` gross tonsillar enlargement with membranous exudate marked cervical lymphadenopathy palatal petechial haemorrhages hepatosplenomegaly
49
how do you diagnose glandular fever
``` serology for EBV atypical lymphocytes in peripheral blood neutrophils and CRP low +monospot or Paul-bunnell test low CRP <100 ```
50
treatment of glandular fever
rest paracetamol avoid sports corticosteroids if complicated do NOT prescribe penicillin - cross reaction, causes macular rash
51
complications of glandular fever
anaemia, thrombocytopaenia splenic rupture increased risk of lymphoma - especially in immunosuppressed
52
presentation of diphtheria
severe sore throat with a grey-white membrane across the pharynx
53
bacteria that causes diphtheria
Corynebacterium Diphtheriae
54
investigations for diphtheria
bacterial culture - shows irregular staining pleomorphic bacilli on microscopy
55
management of diphtheria
isolation anti-toxin supportive measures penicillin/erythromycin

4th Year (25 decks)

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