Throat (and neck) Flashcards
What neck lumps do you get anteriorly? (infront of sternocleidomastoid)
And defining features
- Branchial cyst (congenital but unnoticed until inflamed URTI)
- Carotid body cyst (pulsatile)
- Thyroid nodule (thigh thyroxine)
- Laryngocele (HOARSENESS, trombone players, inflate with valsalva)
What neck lumps do you get posteriorly? (behind of sternocleidomastoid)
And defining features
- Cystic hygroma (transilluminate, noted at birth)
- Cervical ribs (hard lump, tingling arms)
- Virchows node (?GI cancer symptoms)
What neck lump do you commonly find at the back of neck?
Lipoma
What lumps can you get at the midline (and how can you tell them apart?)
Midline
- Dermoid cyst (Teratoma-nails/hair)-dont move-
- Thyrogloassal cyst (move on swallowing+tongue)
- Thyroid isthmus swelling (move on swallowing)
What is a branchial cyst?
- MOBILE cyst made in embryonic development
- Lateral aspect of neck
- Anterior to sternocledomastoid (URTI)
What is a cystic hygroma?
- Error in development of lymph sacs
- lump typically on left side of neck (posterior)
- Noted at birth
- transilluminates
What can people with a cervical rib develop?
Thoracic outlet syndrome (10%)
- pain in shoulders/neck
- tingling fingers
What is the most common cause of neck swelling?
Reactive lymphadenopathy
Symptoms of pharyngeal pouch?
dysphagia regurgitation HALLITOSIS aspiration chronic cough
Investigations for neck lumps?
USS and FNA (fine needle aspiration)
What are the two main causes of a sore throat?
Acute pharyngitis = inflammation of the oropharynx
Tonsillitis
Often in combination = tonsillopharyngitis
What is centor criteria?
What makes up the centor criteria and how is it scored?
CENTOR-look for bacterial features
C - Cough absent E - tonsillar Exudate N - Nodes T - Temperature OR - young (more likely) OR old (less likely)
3 or 4 of these suggest strep throat and would benefit from abx
All 4 absent, unlikely to be bacterial (80% negative predictive value)
What is the age modification of the centor criteria?
3-14yrs = 1 point 15-44yr= 0 points >45 = -1 point
(must be older than 3 years)
What is the management of a bacterial sore throat?
Penicillin V 500mg QDS for 10 days
What is the management of a bacterial sore throat if penicillin allergic?
Clarithromycin 250-500mg BD for 5 days
What is the management of a bacterial sore throat if pregnancy?
Erythromycin 250-500mg QDS for 5 days
What are some complications of tonsillitis?
Otitis media Sinusitis Quinsy Pharyngeal abscess Lemierre syndrome (infectious thrombophlebitis of the internal jugular vein)
What is Lemierre syndrome?
Acute septicaemia and jugular vein thrombosis secondary to infection with Fusobacterium species
Septic emboli to lungs, bone, muscle, kidney, liver
What clinical features of tonsillitis point towards viral?
Headache
Earache
Nasal congestion
Cough
What indicates a peritonsillar abscess may be forming as a complication of tonsillitis?
Trismus (lockjaw due to spasms of the jaw musculature)
Changes in voice quality
What causes most sore throats
Viruses
eg rhinovirus, coronavirus, parainfluenza virus
Bacteria
Group A strep- Strep pyogenes
What is a submandibular space infection that can present with mouth pain?
Ludwig angina
How does ludwig angina present
Mouth pain Fever Stiff neck Difficulty swallowing Trismus Airway obstruction may occur
How does EBV present?
-Fever
-Pharyngitis
-Enlarged erythematous tonsils with white and grey deposits
-Generalised lymphadenitis
+/- liver, spleen and skin involvement
What should a sore throat not be treated with? why?
Amoxicillin
Causes maculopapular rash if caused by EBV
Why are NSAIDs contraindicated for post tonsillectomy pain relief?
Increased risk of bleeding
What are options for tonsillectomy?
Subtotal tonsillectomy - tonsils partially removed while capsule remains
Total tonsillectomy
Recall tonsillectomy eligibility criteria
≥ 7 episodes in the past year, OR
≥ 5 episodes/year in the past 2 years, OR
≥ 3 episodes/year in the past 3 years
Strep PHyogenes can lead to what?
Streptococcus “PH”yogenes is the most common cause of bacterial pharyngitis
which can result in rheumatic “PHever”
and poststreptococcal glomerulonePHritis
Managment of epiglottis?
- Immediately admit and contact paediatrics (dont lie them down)
- take blood cultures and start IV CEFOTAXIME (or ceftriaxone)
- Will likely have to be intubated by experienced anaesthetist (HDU/PICU)
- ET tube can usually be removed after 24 hours when antibiotics have started to work. Abx continued for 3-5 days
What is globus pharyngeus?
Feeling of a lump in the throat where no true lump exists
Can lead to frequent clearing of throat
Noticed most when swallowing saliva
(diagnosis of exclusion)
List types of oral cavity cancers (3)
Oral mucosal cancer
Salivary gland cancer
Tonsillar cancer
*they are most often SCC
How do oral cavity cancers present?
Halitosis Pain eg earache Dysphagia Non healing ulcers Unusual bleeding in mouth Facial swelling Lymphadenopathy
How are oral cavity cancers investigated?
Biopsy and histopathology Panendoscopy (mouth, nose, voice box and oesophagus) HPV testing CXR Axial CT PET CT
What is the management of oral cavity cancers?
Surgical resection
- Maxillectomy
- Mandibulectomy
- Glossectomy
- Laryngectomy
- Radical neck dissection
Chemo (HPV have better responce)
Radio (HPV have better responce)
How does trigeminal neuralgia present?
-Unilateral facial pain
- Severe shooting / stabbing followed by burning ache
- Typically from mouth to angle of jaw
- Lasts several seconds but can last up to minutes, can occur up to 100 times a day
- At rest or triggered by movements eg chewing
- Facial spasms may occur
How is trigeminal neuralgia diagnosed?
Clinical diagnosis
MRI to exclude structural cause
What is the management of trigeminal neuralgia?
Carbamazepine
