Throat conditions Flashcards
Stridor - examination
Attempts to examine the throat should be avoided
Sore throat - cause
Viral infection (most common) Bacterial infection
Viral sore throat - management
Self limiting
Bacterial sore throat - causative organism
Strep pyogenes (group A strep)
Bacterial sore throat - clinical presentation
Acute follicular tonsillitis
Bacterial sore throat - Management
Penicillin
Bacterial sore throat - late complications
Rheumatic fever
Glomerulonephritis
Diphtheria - who gets it
Rarely seen in UK due to vaccine
Diphtheria - clinical features
Severe sore throat
Grey-white membrane across the pharynx
Diphtheria - management
Antitoxin
Oral thrush - causative organism
Candida albicans
Oral thrush - who gets it
People who recently had antibiotics
Immunosuppressed
Oral thrush - clinical features
White patches on red, raw mucous membranes
Oral thrush - management
Nystatin
Infectious Mononucleosis - definition
Glandular fever
Think of mono as in (union)
Infectious Mononucleosis - cause
Epstein Barr Virus (EBV)
- virus of the herpes family
- transmitted by kissing
Infectious Mononucleosis - who gets it?
Young adults
Infectious Mononucleosis - Clinical features
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
Infectious Mononucleosis - when to suspect
If suspected tonsillitis persists despite antibiotic treatment
Infectious Mononucleosis - investigations
Bloods - atypical lymphocytes - atypical mononuclear cells - low CRP (this is surprising) EBV virus IgM Paul Bunnell test Monospot test Hetrophile antibody +ve
Infectious Mononucleosis - management
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
Infectious Mononucleosis - complications
Anaemia
Thrombocytopenia
Splenic rupture
Upper airway obstruction
Laryngeal polyps - definition
There is a reactive change in the laryngeal mucosa
This results in unilateral and pedunculated polyp
Laryngeal polyps - cause
Vocal abuse
Infection
Smoking
Contact ulcer - definition
Inflammatory response to trauma or abuse of vocal cords
Contact ulcer - causes
Chronic throat
Voice abuse
GORD
Squamous papilloma - definition
Type 6 and 11
Causes benign disease
Warts
Squamous papilloma - who gets it
Children under 5
Adults age 20-40
Squamous papilloma - pathology
Finger like projections
Paraganglioma - definition
Tumour arising in clusters of neuroendocrine cells
Paraganglioma - types
Chromaffin positive
Chromaffin negative
Paraganglioma - where are chromaffin positive usually?
Below the diaphragm
- sympathetic nervous system can secrete catecholamines (adrenaline)
Paraganglioma - where are chromaffin negative usually?
Above the diaphragm
- don’t produce adrenaline
Paraganglioma - associated conditions
MEN 2
Tonsilitis - definition
Inflammation of the tonsils
Tonsilitis - 2 main causes
Viral infection (most common) Bacterial infection
Tonsilitis - viral causes
EBV
Rhinovirus
Adenovirus
Influenza
Tonsilitis - bacterial causes
Strep pyogenes (GABHS)
Staph aureus
Strep pneumoniae
Tonsilitis - clinical features (viral)
Malaise
Sore throat
Temperature
Lasts 3-4 days
Tonsilitis - clinical features (bacterial)
Systemic upset Fever Odynophagia Hallitosis May mimic earache (referred pain)
Tonsilitis - examination
Lymphadenopathy
Tonsilitis - investigations
Throat swab is not recommended
- core species do not always correlate with commensal surface bacteria
Tonsilitis - which set of criteria differentiates bacterial from viral tonsillitis?
Centor criteria
Tonsilitis - centor criteria
1 point for each of the following: History of fever Tonsillar exudates (white/yellow) Tender anterior cervical adenopathy Absence of cough
Tonsilitis - centor criteria 0-1 points
No antibiotics
Likely to be viral infection
Tonsilitis - centor criteria 2 or 3 points
Should receive antibiotic if symptoms progress
Tonsilitis - centor criteria 4 or 5 points
Treat empirically with an antibiotic as there is high risk of bacterial infection
Tonsilitis - management viral
Supportive treatment
Tonsilitis - management bacterial
Antibiotics
- penicillin 500mg QDS for 10 days
- clarithromycin if penicillin allergic
Surgery
Tonsilitis - when is surgery indicated
7 or more well documented clinically significant adequately treated sore throats in the preceding year
Tonsilitis - complications
Peritonsilar abscess
Unilateral tonsil enlargement
Peritonsilar abscess - definition
Complication of acute bacterial tonsillitis
Bacteria between the muscle and tonsil produce pus
The pus expands and drags the tonsil away from its attachments
Peritonsilar abscess - clinical features
Hx of preceding tonsillitis then
unilateral throat pain
odynophagia
lock jaw (trismus)
Peritonsilar abscess - examination
Uvula pushed to one side
Medial displacement of tonsil and uvula
Peritonsilar abscess - management
Aspiration
- drainage of abscess gives instant relief
Antibiotics
Recurrent respiratory papillomatosis - definition
Warty growth in the upper airway which can cause obstruction
Recurrent respiratory papillomatosis - cause
HPV
- type 16 or 18 = malignant risk
- type 6 or 11 = benign
Recurrent respiratory papillomatosis - clinical features
Stridor
Dyspnoea
Hoarseness
Subglottic stenosis - definition
Narrowing of subglottis which causes airway obstruction
Subglottic stenosis - cause
Small vessel vasculitis
Throat cancer - clinical features
Persistent sore throat (3/4 weeks) Odynophagia Dysphagia Stridor Hoarseness / voice change Neck mass
Glottic tumours - where do they usually present?
Most present on the vocal cords and stay there (doesn’t metastasise)
Squamous cell carcinoma - types
HPV related
Smoking and alcohol related
Squamous cell carcinoma - HPV related
HPV makes E6 and E7 proteins which disrupt p53 and RB pathways repectively leading to cellular immortality
HPV Squamous cell carcinoma - who gets it?
Young people who are relatively fit and healthy
HPV squamous cell carcinoma - clinical features
Lump in the neck region
HPV squamous cell carcinoma - management
Chemotherapy and radiotherapy
- patietns tend to do really well with this
What is the most common site for a salivary gland tumour?
Parotid gland
Tumours in the parotid gland are usually more malignant than tumours of submandibular/sublingual glands. True or false?
False
- tumours in smaller glands are more likely to be malignant
Salivary gland tumour - clinical features
Young person with a painful mass
Pleomorphic adenoma - definition
Most common benign salivary tumour
Mainly in parotid glands
Pleomorphic adenoma - who gets it
Females
Old
Warthins tumour - definition
Mainly occurs in parotid glands
Warthins tumour - risk factors
Smoking
Warthins tumour - pathology
Bilateral
Multicentric
Most common malignant salivary gland tumour worldwide?
Mucoepidermoid carcinoma
Globus pharyngeus - clinical features
Patient complains on a lump in the midline of the throat when swallowing saliva
This lump disappears when ingesting foods or liquids
Globus pharyngeus - there is no abnormality on examination or investigations. True or false?
True
Laryngomalacia - definition
Soft larynx
Larynx collapses during breathing
Laryngomalacia - who gets it
Young infants
Laryngomalacia - clinical features
Chronic stridor
Noisy breathing
Commonest cause of bacterial tonsillitis?
beta haemolytic strep
strep pyogenes
What is quinsy?
Peri-tonsillar abscess
OSA is an indication for tonsillectomy? True or false
True
Quinsy in a pt with recurrent tonsillitis is an indication for tonsillectomy? true or false?
True
Laryngeal nodules are always bilateral and commoner in females ?
True
Which questionnaire is used to discriminate snoring from OSA ?
Epworth
