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Ear, Nose, and Throat Diseases > Throat Conditions > Flashcards

Throat Conditions Flashcards

1
Q

Stridor: Definition

A

Noisy breathing

> > symptom not diagnosis
caused by partial obstruction of respiratory tract at or below the larynx

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2
Q

Stridor: Signs

A

High pitched
Whistle-like sounds
Most noticeable on inspiration

> > RED FLAG

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3
Q

Stridor: Children Differential Diagnosis

A

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

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4
Q

Stridor: Adult Differential Diagnosis

A

Trauma
Anaphylaxis
Laryngitis&raquo_space; inflammation of larynx
Epiglottitis
Laryngeal tumour

Iatrogenic&raquo_space; medical intervention is cause
» bronchoscopy, prolonged intubation, neck surger

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5
Q

Epiglottitis: Definition

A

Inflammation and swelling of the epiglottis

> > epiglottis is flap of cartilage that protects trachea (wind pipe)
potentially life threatening

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6
Q

Epiglottitis: Aetiology

A

Infection-
» most common: Haemophilus influenzae type b (Hib)
» Streptococcus pneumoniae
» Streptococcus A/B/C
» Staphylococcus aureus

Trauma-
» chemical or thermal burn
» foreign object

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7
Q

Epiglottitis: Risk Factors

A

Male
Unvaccinated&raquo_space; against Hib or others
Immunocompromised

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8
Q

Epiglottitis: Symptoms and Signs

A

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

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9
Q

Epiglottitis: Investigations

A

Clinical diagnosis
Laryngoscopy
Lateral neck x-ray&raquo_space; look for ‘thumbprint sign’

> > avoid stimulating activities
could cause complete obstruction of airways

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10
Q

Epiglottitis: Manegment

A

Airway emergency&raquo_space; call 999 if at GP
A&E&raquo_space; immediate airway management, bleep ENT, oxygen, IV antibiotics

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11
Q

Head and Neck Cancer: Definition

A

Cancer of paranasal sinuses and nasal cavity, oral cavity, salivary glands, larynx, pharynx

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12
Q

Head and Neck Cancer: Risk Factors

A

Smoking
Chewing tobacco
Alcohol
Human Papilova Virus (HPV 16)&raquo_space; base of tongue and tonsil
Diet&raquo_space; salt cured fish
Exposure to chemicals&raquo_space; formaldehyde
Pre-cancerous conditions&raquo_space; leukoplakia

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13
Q

Head and Neck Cancer: Symptoms and Signs

A

Dependent upon site of cancer

General symptoms
» localised pain
» localised swelling
&raquo_space; difficulty breathing
» bleeding (especially unilateral)
» changes to eating or speaking
» lymphadenopathy- swelling of lymph nodes

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14
Q

Head and Neck Cancer: Investigation

A

Dependent upon site

Ultrasound of neck
Nasoendoscopy
Laryngoscopy
MRI or CT scan head/sinuses/neck
Biopsy

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15
Q

Head and Neck Cancer: Management

A

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

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16
Q

Tonsillitis: Definition

A

Inflammation of the palatine tonsils

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17
Q

Tonsillitis: Epidemiology

A

Very common condition&raquo_space; most common in ages 5-15

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18
Q

Tonsillitis: Aetiology

A

Viral-
» influenza
» parainfluenza
» EBV
» HIV

Bacterial-
» group A streptococcus (GAS)
» Neisseria gonorrhoeae

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19
Q

Tonsillitis: Symptoms

A

Sore throat&raquo_space; acute/bacteria – progressive/viral
Odynophagia
Headache
Abdominal pain
Nausea and vomiting
Cough&raquo_space; viral
Rhinorrhoea&raquo_space; viral

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20
Q

Tonsillitis: Signs

A

Fever
Tonsillar exudate&raquo_space; clear or white/viral – white/yellow, foul odour/bacterial
Tonsillar hypertrophy&raquo_space; enlargement
Tonsillar erythema
Cervical lymphadenopathy&raquo_space; anterior/GAS – posterior/EBV

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21
Q

Tonsillitis: Investigation

A

Clinical diagnosis
» Centor criteria: fever >38c, tonsillar exudate, no cough, tender anterior cervical lymphadenopathy&raquo_space; score > 3 = GAS
» FeverPAIN: fever >38c, purulent tonsillar exudate, no cough, symptom onset <3 days, inflammed tonsils&raquo_space; score 4/5 = 62-65% GAS

Throat culture&raquo_space; definitive diagnosis
Serum HIV PCR&raquo_space; for HIV
Serum heterophile antibodies&raquo_space; glandular fever

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22
Q

Tonsillitis: Management

A

Supportive care-
» paracetamol
» fluids
» topical lidocaine&raquo_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

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23
Q

Tonsillitis: Complications

A

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

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24
Q

Quinsy: Definition

A

Peritonsillar abscess
» abscess between wall of tonsil and pharynx
» pontential of airway compromise

Abscess: build up of pus

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25
Q

Quinsy: Symptoms

A

Unilateral throat pain
Dysphagia&raquo_space; difficulty swallowing
Odynophagia&raquo_space; painful swallowing
Unilateral otalgia&raquo_space; ear pain
Drooling

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26
Q

Quinsy: Signs

A

Fever
Erythematous, oedematous tonsil with contralateral uvular deviation
Tonsillar exudate
Trismus&raquo_space; unable to open mouth
Muffled “hot potato” voice
Cervical lymphadenopathy

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27
Q

Quinsy: Investigation

A

Clinical
CT of neck&raquo_space; only if unclear

28
Q

Quinsy: Management

A

Medical emergency

Admit to hospital
Abscess drainage
IV antibiotics
IV fluids
Analgesia

29
Q

Glandular Fever: Definition

A

Viral infection caused by Epstein-Barr virus
» Infectious mononucleosis

30
Q

Glandular Fever: Epidemiology

A

90% of adults by 40 have had it
Most common in adolescents and young adults

31
Q

Glandular Fever: Aetiology

A

EBV infection
» transmitted through saliva, genital secretions, blood

32
Q

Glandular Fever: Symptoms

A

Sore throat
Malaise
Fatigue
Myalgias&raquo_space; muscle ache

33
Q

Glandular Fever: Signs

A

Fever
Tonsillar hypertrophy
Tonsillar exudate
Erythematous pharynx
Soft palate petechiae&raquo_space; small red dots caused by inflammed capillaries
Cervical lymphadenopathy&raquo_space; typically posterior
Splenomegaly&raquo_space; enlarged spleen
Hepatomegaly&raquo_space; enlarged liver
Maculopapular rash

34
Q

Glandular Fever: Investigations

A

Monospot test-
» checking for heterophile antibodies
» can be false negative within 2 weeks of symptom onset&raquo_space; repeat

Serum EBV antibodies test
FBC&raquo_space; checking for lymphocytes
LFTs&raquo_space; liver function test&raquo_space; elevated 2-3x upper limit of normal

35
Q

Glandular Fever: Management

A

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&raquo_space; risk of rupturing spleen

36
Q

Glandular Fever: Complications

A

Splenic rupture
Hepatitis&raquo_space; liver inflammation
Severe thrombocytopenia&raquo_space; low platelets
Haemolytic anaemia&raquo_space; red blood cells destroyed

37
Q

Aphthous Ulcer: Definition

A

Ulceration of the oral mucosa with grey base
» also called canker sore

38
Q

Aphthous Ulcer: Aetiology

A

Trauma
Emotional stress
Deficiencies of iron, zinc, vitamin B12, folate
Food sensitivities
HIV infections
Crohn’s disease&raquo_space; inflammatory bowel disease
Celiac disease

39
Q

Aphthous Ulcer: Investigations

A

Clinical diagnosis
If recurrent consider testing for systemic disease

40
Q

Aphthous Ulcer: Management

A

Supportive management-
» saline mouth wash
» topical corticosteroids
» milk of magnesia applied topically

If ulceration >21 days&raquo_space; ENT referral

41
Q

Oral Candidiasis: Definition

A

Oral fungus infection

42
Q

Oral Candidiasis: Aetiology

A

Oral overgrowth of the normal GI flora yeast-like fungus Candida species
» most commonly Candida albicans

43
Q

Oral Candidiasis: Risk Factors

A

Extremes of ages
Immunosuppression
Medication use
Broad-spectrum antibiotics&raquo_space; disrupt natural flora balance
Oral/inhaled steroids
Diabetes
Poor dental hygiene
Smoking
Nutritional deficiency

44
Q

Oral Candidiasis: Symptoms

A

Local burning
Soreness or itching
Odynophagia&raquo_space; painful swallowing
Chest pain&raquo_space; if yeast in oesophagus

45
Q

Oral Candidiasis: Signs

A

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

46
Q

Oral Candidiasis: Investigations

A

Clinical diagnosis
If recurrent consider testing for systemic disease
» HIV, diabetes mellitus, deficiencies of iron/b12

47
Q

Oral Candidiasis: Management

A

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

48
Q

Oral Leukoplakia: Definition

A

White plaque of oral mucosa
1% premalignant lesion

49
Q

Oral Leukoplakia: Risk Factors

A

Tobacco
Alcohol
Immunosuppression
Chronic candidiasis

50
Q

Oral Leukoplakia: Symptoms

A

Asymptomatic

51
Q

Oral Leukoplakia: Signs

A

Bright white, sharply defined patches on the oral mucosa
Slightly raised above surrounding mucosa
Cannot be scraped away

52
Q

Oral Leukoplakia: Investigations

A

Biopsy needed for confirmation

53
Q

Oral Leukoplakia: Management

A

Refer to ENT

54
Q

Oral Herpes: Definition

A

Cold sores

Caused by Herpes Simplex Virus (HSV)
» 90% oral herpes caused by HSV-1
» genital and orogential herpes caused by HSV-2

55
Q

Oral Herpes: Aetiology

A

Transmitted via direct contact of skin or mucous membranes with infected secretions

> > primary viral infection
becomes latent in dorsal ganglia
reactivation of herpes virus

56
Q

Oral Herpes: Symptoms

A

Early symptoms of primary infection-
» pain, burning, tingling, pruritus (itchy), paraesthesia
» blisters
» fever, malaise, sore throat

57
Q

Oral Herpes: Signs

A

Fever
Cervical lymphadenopathy
Clustered erythematous vesicles of mouth, nose or chin
Ulcers eventually crust over and heal

58
Q

Oral Herpes: Investigations

A

Clinical diagnosis
Swab for HSV PCR

59
Q

Oral Herpes: Management

A

Topical antiviral OTC
Oral antiviral&raquo_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

60
Q

Sialadenitis: Definition

A

Infection of major salivary glands
» by retrograde transmission of bacteria from oral cavity via salivary duct

61
Q

Sialadenitis: Symptoms and Signs

A

Enlarged painful salivary gland
Purulent drainage from duct orifice
Red or painful duct
Fever
Decreased salivary secretion

62
Q

Sialadenitis: Management

A

Heat/cold compresses with massage
Aggressive hydration
Lemon drops or citrus juice to promote salivary flow
Analgesia medication&raquo_space; painkillers

63
Q

Salivary Calculus: Defintion

A

Sialolithiasis: salivary stone
» development of stones inside salivary glands

> > Sialo: salivary glands
lith: stone

64
Q

Salivary Calculus: Symptoms and Signs

A

Pain and swelling associated with eating

65
Q

Salivary Calculus: Management

A

Lemon drops or citrus juice promotes salivary flow
» eventually should push stone out through ducts

Ear, Nose, and Throat Diseases (3 decks)

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