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ENT SOH > Throat conditions > Flashcards

Throat conditions Flashcards

1
Q

Stridor - examination

A

Attempts to examine the throat should be avoided

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2
Q

Sore throat - cause

A 
Viral infection (most common)
Bacterial infection
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3
Q

Viral sore throat - management

A

Self limiting

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4
Q

Bacterial sore throat - causative organism

A

Strep pyogenes (group A strep)

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5
Q

Bacterial sore throat - clinical presentation

A

Acute follicular tonsillitis

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6
Q

Bacterial sore throat - Management

A

Penicillin

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7
Q

Bacterial sore throat - late complications

A

Rheumatic fever

Glomerulonephritis

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8
Q

Diphtheria - who gets it

A

Rarely seen in UK due to vaccine

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9
Q

Diphtheria - clinical features

A

Severe sore throat

Grey-white membrane across the pharynx

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10
Q

Diphtheria - management

A

Antitoxin

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11
Q

Oral thrush - causative organism

A

Candida albicans

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12
Q

Oral thrush - who gets it

A

People who recently had antibiotics

Immunosuppressed

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13
Q

Oral thrush - clinical features

A

White patches on red, raw mucous membranes

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14
Q

Oral thrush - management

A

Nystatin

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15
Q

Infectious Mononucleosis - definition

A

Glandular fever

Think of mono as in (union)

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16
Q

Infectious Mononucleosis - cause

A

Epstein Barr Virus (EBV)

  • virus of the herpes family
  • transmitted by kissing
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17
Q

Infectious Mononucleosis - who gets it?

A

Young adults

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18
Q

Infectious Mononucleosis - Clinical features

A 
Gradual onset over a few days 
Sore throat 
Enlarged tonsils 
- white exudate often coats tonsils 
Fever
Enlarged cervical lymph nodes 
Malaise 
Lethargy 
Jaundice 
Rash 
Hepatosplenomegaly 
Palatal petechiae (pin point bruising) 
Oedematous uvula
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19
Q

Infectious Mononucleosis - when to suspect

A

If suspected tonsillitis persists despite antibiotic treatment

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20
Q

Infectious Mononucleosis - investigations

A 
Bloods 
- atypical lymphocytes 
- atypical mononuclear cells 
- low CRP (this is surprising)
EBV virus IgM 
Paul Bunnell test 
Monospot test 
Hetrophile antibody +ve
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21
Q

Infectious Mononucleosis - management

A

Bed rest
Paracetamol
Severe cases: corticosteroids (i.e. if upper airway obstruction)
Antibiotics
- try not to give as can get generalised macular rash from amoxicillin

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22
Q

Infectious Mononucleosis - complications

A

Anaemia
Thrombocytopenia
Splenic rupture
Upper airway obstruction

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23
Q

Laryngeal polyps - definition

A

There is a reactive change in the laryngeal mucosa

This results in unilateral and pedunculated polyp

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24
Q

Laryngeal polyps - cause

A

Vocal abuse
Infection
Smoking

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25
Q

Contact ulcer - definition

A

Inflammatory response to trauma or abuse of vocal cords

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26
Q

Contact ulcer - causes

A

Chronic throat
Voice abuse
GORD

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27
Q

Squamous papilloma - definition

A

Type 6 and 11
Causes benign disease
Warts

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28
Q

Squamous papilloma - who gets it

A

Children under 5

Adults age 20-40

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29
Q

Squamous papilloma - pathology

A

Finger like projections

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30
Q

Paraganglioma - definition

A

Tumour arising in clusters of neuroendocrine cells

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31
Q

Paraganglioma - types

A

Chromaffin positive

Chromaffin negative

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32
Q

Paraganglioma - where are chromaffin positive usually?

A

Below the diaphragm

- sympathetic nervous system can secrete catecholamines (adrenaline)

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33
Q

Paraganglioma - where are chromaffin negative usually?

A

Above the diaphragm

- don’t produce adrenaline

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34
Q

Paraganglioma - associated conditions

A

MEN 2

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35
Q

Tonsilitis - definition

A

Inflammation of the tonsils

36
Q

Tonsilitis - 2 main causes

A 
Viral infection (most common)
Bacterial infection
37
Q

Tonsilitis - viral causes

A

EBV
Rhinovirus
Adenovirus
Influenza

38
Q

Tonsilitis - bacterial causes

A

Strep pyogenes (GABHS)
Staph aureus
Strep pneumoniae

39
Q

Tonsilitis - clinical features (viral)

A

Malaise
Sore throat
Temperature
Lasts 3-4 days

40
Q

Tonsilitis - clinical features (bacterial)

A 
Systemic upset 
Fever 
Odynophagia 
Hallitosis
May mimic earache (referred pain)
41
Q

Tonsilitis - examination

A

Lymphadenopathy

42
Q

Tonsilitis - investigations

A

Throat swab is not recommended

- core species do not always correlate with commensal surface bacteria

43
Q

Tonsilitis - which set of criteria differentiates bacterial from viral tonsillitis?

A

Centor criteria

44
Q

Tonsilitis - centor criteria

A 
1 point for each of the following: 
History of fever 
Tonsillar exudates (white/yellow)
Tender anterior cervical adenopathy 
Absence of cough
45
Q

Tonsilitis - centor criteria 0-1 points

A

No antibiotics

Likely to be viral infection

46
Q

Tonsilitis - centor criteria 2 or 3 points

A

Should receive antibiotic if symptoms progress

47
Q

Tonsilitis - centor criteria 4 or 5 points

A

Treat empirically with an antibiotic as there is high risk of bacterial infection

48
Q

Tonsilitis - management viral

A

Supportive treatment

49
Q

Tonsilitis - management bacterial

A

Antibiotics
- penicillin 500mg QDS for 10 days
- clarithromycin if penicillin allergic
Surgery

50
Q

Tonsilitis - when is surgery indicated

A

7 or more well documented clinically significant adequately treated sore throats in the preceding year

51
Q

Tonsilitis - complications

A

Peritonsilar abscess

Unilateral tonsil enlargement

52
Q

Peritonsilar abscess - definition

A

Complication of acute bacterial tonsillitis
Bacteria between the muscle and tonsil produce pus
The pus expands and drags the tonsil away from its attachments

53
Q

Peritonsilar abscess - clinical features

A

Hx of preceding tonsillitis then
unilateral throat pain
odynophagia
lock jaw (trismus)

54
Q

Peritonsilar abscess - examination

A

Uvula pushed to one side

Medial displacement of tonsil and uvula

55
Q

Peritonsilar abscess - management

A

Aspiration
- drainage of abscess gives instant relief
Antibiotics

56
Q

Recurrent respiratory papillomatosis - definition

A

Warty growth in the upper airway which can cause obstruction

57
Q

Recurrent respiratory papillomatosis - cause

A

HPV

  • type 16 or 18 = malignant risk
  • type 6 or 11 = benign
58
Q

Recurrent respiratory papillomatosis - clinical features

A

Stridor
Dyspnoea
Hoarseness

59
Q

Subglottic stenosis - definition

A

Narrowing of subglottis which causes airway obstruction

60
Q

Subglottic stenosis - cause

A

Small vessel vasculitis

61
Q

Throat cancer - clinical features

A 
Persistent sore throat (3/4 weeks)
Odynophagia
Dysphagia 
Stridor
Hoarseness / voice change 
Neck mass
62
Q

Glottic tumours - where do they usually present?

A

Most present on the vocal cords and stay there (doesn’t metastasise)

63
Q

Squamous cell carcinoma - types

A

HPV related

Smoking and alcohol related

64
Q

Squamous cell carcinoma - HPV related

A

HPV makes E6 and E7 proteins which disrupt p53 and RB pathways repectively leading to cellular immortality

65
Q

HPV Squamous cell carcinoma - who gets it?

A

Young people who are relatively fit and healthy

66
Q

HPV squamous cell carcinoma - clinical features

A

Lump in the neck region

67
Q

HPV squamous cell carcinoma - management

A

Chemotherapy and radiotherapy

- patietns tend to do really well with this

68
Q

What is the most common site for a salivary gland tumour?

A

Parotid gland

69
Q

Tumours in the parotid gland are usually more malignant than tumours of submandibular/sublingual glands. True or false?

A

False

- tumours in smaller glands are more likely to be malignant

70
Q

Salivary gland tumour - clinical features

A

Young person with a painful mass

71
Q

Pleomorphic adenoma - definition

A

Most common benign salivary tumour

Mainly in parotid glands

72
Q

Pleomorphic adenoma - who gets it

A

Females

Old

73
Q

Warthins tumour - definition

A

Mainly occurs in parotid glands

74
Q

Warthins tumour - risk factors

A

Smoking

75
Q

Warthins tumour - pathology

A

Bilateral

Multicentric

76
Q

Most common malignant salivary gland tumour worldwide?

A

Mucoepidermoid carcinoma

77
Q

Globus pharyngeus - clinical features

A

Patient complains on a lump in the midline of the throat when swallowing saliva
This lump disappears when ingesting foods or liquids

78
Q

Globus pharyngeus - there is no abnormality on examination or investigations. True or false?

A

True

79
Q

Laryngomalacia - definition

A

Soft larynx

Larynx collapses during breathing

80
Q

Laryngomalacia - who gets it

A

Young infants

81
Q

Laryngomalacia - clinical features

A

Chronic stridor

Noisy breathing

82
Q

Commonest cause of bacterial tonsillitis?

A

beta haemolytic strep

strep pyogenes

83
Q

What is quinsy?

A

Peri-tonsillar abscess

84
Q

OSA is an indication for tonsillectomy? True or false

A

True

85
Q

Quinsy in a pt with recurrent tonsillitis is an indication for tonsillectomy? true or false?

A

True

86
Q

Laryngeal nodules are always bilateral and commoner in females ?

A

True

87
Q

Which questionnaire is used to discriminate snoring from OSA ?

A

Epworth

ENT SOH (9 decks)

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