Throat Conditions Flashcards
Stridor: Definition
Noisy breathing
> > symptom not diagnosis
caused by partial obstruction of respiratory tract at or below the larynx
Stridor: Signs
High pitched
Whistle-like sounds
Most noticeable on inspiration
> > RED FLAG
Stridor: Children Differential Diagnosis
Croup-
» laryngotracheobronchitis
» viral infection
» barking cough
» low fever
» most common in 6months - 2yrs
Inhaled foreign body
Anaphylaxis-
» severe allergic reaction
Epiglotitis-
» inflammation of epiglottis
» caused by bacteria H. influenza type B
Congenital-
» laryngomalacia- larynx doesn’t fully form
Stridor: Adult Differential Diagnosis
Trauma
Anaphylaxis
Laryngitis»_space; inflammation of larynx
Epiglottitis
Laryngeal tumour
Iatrogenic»_space; medical intervention is cause
» bronchoscopy, prolonged intubation, neck surger
Epiglottitis: Definition
Inflammation and swelling of the epiglottis
> > epiglottis is flap of cartilage that protects trachea (wind pipe)
potentially life threatening
Epiglottitis: Aetiology
Infection-
» most common: Haemophilus influenzae type b (Hib)
» Streptococcus pneumoniae
» Streptococcus A/B/C
» Staphylococcus aureus
Trauma-
» chemical or thermal burn
» foreign object
Epiglottitis: Risk Factors
Male
Unvaccinated»_space; against Hib or others
Immunocompromised
Epiglottitis: Symptoms and Signs
Children-
» acute, fever, sore throat, stridor, odynophagia (painful swallowing), drooling, anxious and restless
Adults-
» progressive, fever, sore throat, muffled/hoarse voice, stridor, dyspnoea (shortness of breath), drooling
Epiglottitis: Investigations
Clinical diagnosis
Laryngoscopy
Lateral neck x-ray»_space; look for ‘thumbprint sign’
> > avoid stimulating activities
could cause complete obstruction of airways
Epiglottitis: Manegment
Airway emergency»_space; call 999 if at GP
A&E»_space; immediate airway management, bleep ENT, oxygen, IV antibiotics
Head and Neck Cancer: Definition
Cancer of paranasal sinuses and nasal cavity, oral cavity, salivary glands, larynx, pharynx
Head and Neck Cancer: Risk Factors
Smoking
Chewing tobacco
Alcohol
Human Papilova Virus (HPV 16)»_space; base of tongue and tonsil
Diet»_space; salt cured fish
Exposure to chemicals»_space; formaldehyde
Pre-cancerous conditions»_space; leukoplakia
Head and Neck Cancer: Symptoms and Signs
Dependent upon site of cancer
General symptoms
» localised pain
» localised swelling
»_space; difficulty breathing
» bleeding (especially unilateral)
» changes to eating or speaking
» lymphadenopathy- swelling of lymph nodes
Head and Neck Cancer: Investigation
Dependent upon site
Ultrasound of neck
Nasoendoscopy
Laryngoscopy
MRI or CT scan head/sinuses/neck
Biopsy
Head and Neck Cancer: Management
Referral for laryngeal cancer-
» patient is over 45
» hoarseness
» neck mass
Referral for oral cancer-
» oral ulcer for more than 3 weeks
» persistent neck mass
Surgery
Chemotherapy
Radiotherapy
Immunotherapy
Tonsillitis: Definition
Inflammation of the palatine tonsils
Tonsillitis: Epidemiology
Very common condition»_space; most common in ages 5-15
Tonsillitis: Aetiology
Viral-
» influenza
» parainfluenza
» EBV
» HIV
Bacterial-
» group A streptococcus (GAS)
» Neisseria gonorrhoeae
Tonsillitis: Symptoms
Sore throat»_space; acute/bacteria – progressive/viral
Odynophagia
Headache
Abdominal pain
Nausea and vomiting
Cough»_space; viral
Rhinorrhoea»_space; viral
Tonsillitis: Signs
Fever
Tonsillar exudate»_space; clear or white/viral – white/yellow, foul odour/bacterial
Tonsillar hypertrophy»_space; enlargement
Tonsillar erythema
Cervical lymphadenopathy»_space; anterior/GAS – posterior/EBV
Tonsillitis: Investigation
Clinical diagnosis
» Centor criteria: fever >38c, tonsillar exudate, no cough, tender anterior cervical lymphadenopathy»_space; score > 3 = GAS
» FeverPAIN: fever >38c, purulent tonsillar exudate, no cough, symptom onset <3 days, inflammed tonsils»_space; score 4/5 = 62-65% GAS
Throat culture»_space; definitive diagnosis
Serum HIV PCR»_space; for HIV
Serum heterophile antibodies»_space; glandular fever
Tonsillitis: Management
Supportive care-
» paracetamol
» fluids
» topical lidocaine»_space; topical pain relief
» throat lozenges
Antibiotics-
» only if Centor and feverPAIN criteria reached
» 1st line: phenoxymethylpenicillin
» 2nd line: clarithromycin
» Erythromycin for pregnant
REFER TO NICE GUIDELINES
Tonsillitis: Complications
Group A Streptococcus complications-
Scarlet fever-
» scarlatina rash
» strawberry tongue
» deep erythema
Rheumatic fever-
» autoimmune response to unresolved GAS infection
» affects joints, heart, brain, skin
Quinsy: Definition
Peritonsillar abscess
» abscess between wall of tonsil and pharynx
» pontential of airway compromise
Abscess: build up of pus
Quinsy: Symptoms
Unilateral throat pain
Dysphagia»_space; difficulty swallowing
Odynophagia»_space; painful swallowing
Unilateral otalgia»_space; ear pain
Drooling
Quinsy: Signs
Fever
Erythematous, oedematous tonsil with contralateral uvular deviation
Tonsillar exudate
Trismus»_space; unable to open mouth
Muffled “hot potato” voice
Cervical lymphadenopathy
Quinsy: Investigation
Clinical
CT of neck»_space; only if unclear
Quinsy: Management
Medical emergency
Admit to hospital
Abscess drainage
IV antibiotics
IV fluids
Analgesia
Glandular Fever: Definition
Viral infection caused by Epstein-Barr virus
» Infectious mononucleosis
Glandular Fever: Epidemiology
90% of adults by 40 have had it
Most common in adolescents and young adults
Glandular Fever: Aetiology
EBV infection
» transmitted through saliva, genital secretions, blood
Glandular Fever: Symptoms
Sore throat
Malaise
Fatigue
Myalgias»_space; muscle ache
Glandular Fever: Signs
Fever
Tonsillar hypertrophy
Tonsillar exudate
Erythematous pharynx
Soft palate petechiae»_space; small red dots caused by inflammed capillaries
Cervical lymphadenopathy»_space; typically posterior
Splenomegaly»_space; enlarged spleen
Hepatomegaly»_space; enlarged liver
Maculopapular rash
Glandular Fever: Investigations
Monospot test-
» checking for heterophile antibodies
» can be false negative within 2 weeks of symptom onset»_space; repeat
Serum EBV antibodies test
FBC»_space; checking for lymphocytes
LFTs»_space; liver function test»_space; elevated 2-3x upper limit of normal
Glandular Fever: Management
Viral infection = supportive care-
» symptoms can last 2-4 weeks
» fatigue can last longer
» avoid kissing, sharing fluids, drinks, utensils
» avoid contact sports and heavy lifting»_space; risk of rupturing spleen
Glandular Fever: Complications
Splenic rupture
Hepatitis»_space; liver inflammation
Severe thrombocytopenia»_space; low platelets
Haemolytic anaemia»_space; red blood cells destroyed
Aphthous Ulcer: Definition
Ulceration of the oral mucosa with grey base
» also called canker sore
Aphthous Ulcer: Aetiology
Trauma
Emotional stress
Deficiencies of iron, zinc, vitamin B12, folate
Food sensitivities
HIV infections
Crohn’s disease»_space; inflammatory bowel disease
Celiac disease
Aphthous Ulcer: Investigations
Clinical diagnosis
If recurrent consider testing for systemic disease
Aphthous Ulcer: Management
Supportive management-
» saline mouth wash
» topical corticosteroids
» milk of magnesia applied topically
If ulceration >21 days»_space; ENT referral
Oral Candidiasis: Definition
Oral fungus infection
Oral Candidiasis: Aetiology
Oral overgrowth of the normal GI flora yeast-like fungus Candida species
» most commonly Candida albicans
Oral Candidiasis: Risk Factors
Extremes of ages
Immunosuppression
Medication use
Broad-spectrum antibiotics»_space; disrupt natural flora balance
Oral/inhaled steroids
Diabetes
Poor dental hygiene
Smoking
Nutritional deficiency
Oral Candidiasis: Symptoms
Local burning
Soreness or itching
Odynophagia»_space; painful swallowing
Chest pain»_space; if yeast in oesophagus
Oral Candidiasis: Signs
Different types of Candida
» each present differently
Oral thrush-
» patches of curd-like yellow/white plaques on tongue, palate or pharynx
» easily scraped off, revealing erythematous base
Acute erythematous/atrophic-
» erythematous palate or dorsal tongue
Angular cheilitis-
» erythema
» fissuring on edges of mouth
Oral Candidiasis: Investigations
Clinical diagnosis
If recurrent consider testing for systemic disease
» HIV, diabetes mellitus, deficiencies of iron/b12
Oral Candidiasis: Management
Treat underlying cause
Advice patients taking inhaled steroids to rinse mouth after use
Mild or localised-
» use topical anti-fungal treatment
» Eg. Miconazole gel
Severe, extensive, or with HIV-
» oral anti-fungal treatment
» Eg. Oral fluconazole
Oral Leukoplakia: Definition
White plaque of oral mucosa
1% premalignant lesion
Oral Leukoplakia: Risk Factors
Tobacco
Alcohol
Immunosuppression
Chronic candidiasis
Oral Leukoplakia: Symptoms
Asymptomatic
Oral Leukoplakia: Signs
Bright white, sharply defined patches on the oral mucosa
Slightly raised above surrounding mucosa
Cannot be scraped away
Oral Leukoplakia: Investigations
Biopsy needed for confirmation
Oral Leukoplakia: Management
Refer to ENT
Oral Herpes: Definition
Cold sores
Caused by Herpes Simplex Virus (HSV)
» 90% oral herpes caused by HSV-1
» genital and orogential herpes caused by HSV-2
Oral Herpes: Aetiology
Transmitted via direct contact of skin or mucous membranes with infected secretions
> > primary viral infection
becomes latent in dorsal ganglia
reactivation of herpes virus
Oral Herpes: Symptoms
Early symptoms of primary infection-
» pain, burning, tingling, pruritus (itchy), paraesthesia
» blisters
» fever, malaise, sore throat
Oral Herpes: Signs
Fever
Cervical lymphadenopathy
Clustered erythematous vesicles of mouth, nose or chin
Ulcers eventually crust over and heal
Oral Herpes: Investigations
Clinical diagnosis
Swab for HSV PCR
Oral Herpes: Management
Topical antiviral OTC
Oral antiviral»_space; for primary infection, sever, recurrent, immunocompromised
Minimise transmission risk-
» avoid kissing or oral sex until healed
» don’t share items that come in contact with lesions
» avoid touching lesions
» wash hands with soap and water
Sialadenitis: Definition
Infection of major salivary glands
» by retrograde transmission of bacteria from oral cavity via salivary duct
Sialadenitis: Symptoms and Signs
Enlarged painful salivary gland
Purulent drainage from duct orifice
Red or painful duct
Fever
Decreased salivary secretion
Sialadenitis: Management
Heat/cold compresses with massage
Aggressive hydration
Lemon drops or citrus juice to promote salivary flow
Analgesia medication»_space; painkillers
Salivary Calculus: Defintion
Sialolithiasis: salivary stone
» development of stones inside salivary glands
> > Sialo: salivary glands
lith: stone
Salivary Calculus: Symptoms and Signs
Pain and swelling associated with eating
Salivary Calculus: Management
Lemon drops or citrus juice promotes salivary flow
» eventually should push stone out through ducts
