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Neurology and Special Senses > Throat Conditions > Flashcards

Throat Conditions Flashcards

1
Q

What is a retropharyngeal abscess?

A

Neck infection involving abscess in the space between the pre-vertebral fascia and constrictor muscles

Most commonly seen in children

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2
Q

What causes retropharyngeal abscesses?

A

Complication of URTI from:

  • strep viridans
  • strep epidermis
  • staph aureus

Can also be trauma or foreign body

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3
Q

How do retropharyngeal abscesses present?

A

Spiking fever
Neck pain - especially on movement
Torticollis
Dysphagia and odynophagia –> drooling

!Airway compromise!

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4
Q

What is torticollis?

A

Abnormal, asymmetrical, twisted head position

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5
Q

What may be seen on examination with a retropharyngeal abscess?

A

Tonsillar swelling

Lymphadenopathy

Oropharyngeal swelling

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6
Q

What investigation may you carry out for a suspected retropharyngeal abscess and what would it show?

A

CT with contrast - ring enhancing lesion in retropharyngeal space

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7
Q

What are the risk factors associated with retropharyngeal abscess?

A

Diabetes
Dental Infection
FB ingestion
Trauma

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8
Q

What complications can arise from retropharyngeal abscesses?

A

Airway compromise
Mediastinitis
Pericarditis
CN9 + 12 palsy

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9
Q

How is a retropharyngeal abscess managed?

A

IV dexamethasone + nebulised adrenaline

IV Abx - ampicillin

Surgical drainage

Supportive therapy

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10
Q

What is Ludwig’s angina?

A

Cellulitis of the floor of the mouth

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11
Q

What causes Ludwig’s angina?

A

Follow dental infection in 90% of cases

Parapharyngeal abscess

Mandibular fracture

Cut/piercing in mouth

Submandibular salivary stones

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12
Q

How does Ludwig’s angina present?

A

Progress over hours
Drooling - dysphagia
Bilateral lower face swelling - mandible and neck
Elevation of the floor of the mouth
Posterior displacement of the tongue - can compromise airway
Painful neck area

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13
Q

How would you investigate Ludwig’s angina?

A

CT with contrast

+ dental x rays and chest imaging

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14
Q

How is Ludwig’s angina managed?

A

Airway management
Empirical IV Abx (Benpen + metronidazole)
Surgical incision and drainage

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15
Q

Give some differential diagnoses for neck lumps

A 
Reactive lymphadenopathy
Lymphoma
Thyroid swelling
Thyroglossal cyst
Pharyngeal pouch
Cystic hygroma
Branchial cyst
Cervical Rib
Carotid aneurysm
Sebaceous cyst
Lipoma
Salivary gland problems
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16
Q

If a patient presents with a history of general malaise but has a neck lump, what would be your primary differential?

A

Reactive lymphadenopathy

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17
Q

What history would indicate a neck lump is a lymphoma?

A

Rubbery painless lymphadenopathy

+- night sweats and splenomegaly

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18
Q

What feature of a neck lump would indicate it is a thyroid swelling?

A

Moves upwards on swallowing

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19
Q

What history would indicate a thyroglossal cyst?

A

Painful - if infected
Midline (between isthmus of thyroid and hyoid)
Move up with protrusion of tongue
Commonly <20yo

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20
Q

What history may indicate a neck lump is a pharyngeal pouch?

A

HALITOSIS

Usually older men
Represent herniation between thyropharyngeus and cricopharynxgeus
Gurgle on palpation
Usually not seen but if large then midline
Dysphagia, regurgitation, aspiration, chronic cough

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21
Q

How would a cystic hygroma appear?

A

Left side

Congenital lesion - most evident at birth, 90% before 2yo

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22
Q

What history indicates a branchial cyst?

A

Oval, mobile, cystic mass
Pain and redness
Between SCM and pharynx
Usually early adulthood

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23
Q

What is often noted about cervical rib?

A

More common in adult females

10% develop thoracic outlet syndrome

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24
Q

How may a carotid aneurysm appear?

A

Pulsatile lateral neck mass

Doesn’t move on swallowing

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25
Q

How does a sebaceous cyst appear?

A

Intradermal - quite superficial

Central punctum

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26
Q

What may make you think a neck lump is due to salivary gland issues?

A

Associated with eating
Fluctuant in size
May cross mandibular angle

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27
Q

What questions do you ask about for a neck lump?

A 
Fever
Malaise
Night Sweats?
Weight Loss?
Swallowing okay?
Voice change?
Smoker
Travel?
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28
Q

What investigations would you request for a neck lump?

A

FBC and ESR - generalised lymphadenopathy
Thyroid function tests
CXR - supraclavicular and >40yo
USS and fine needle aspiration if diagnosis unclear - NOT IF PULSATILE

29
Q

What is the most common head and neck cancer? What cancers do “head and neck” cancers include?

A

Squamous cell carcinoma

Oral cavity
Pharynx
Larynx

30
Q

What are the red flags for head and neck cancers?

A 
Neck lumps
Hoarse voice
Oral Ulcer > 3 weeks
Red/white oral patch
Lip lump
Stridor
Dysphagia or odynophagia >3 weeks
Unilateral throat discomfort >4 weeks
Tooth mobility
31
Q

What are the main risk factors for head and neck cancers/

A 
Smoking
Alcohol
Poor dentition
Poor diet - limited fruit, veg and fish
GORD
HPV16
32
Q

How are head and neck cancers investigated?

A

Fine needle aspiration cytology

33
Q

How are head and neck cancers staged?

A

TNM staging

34
Q

Whats the difference between a thyroid nodule and goitre?

A

Goitre - enlargement of the thyroid gland - can be multiple nodules

Lump

  • can be in a normal thyroid gland or a goitre.
  • can be cystic, colloid, hyperplastic, malignant or oedematous
35
Q

What TFT’s would you expect to see in a non-toxic goitre?

A

Normal

36
Q

What thyroid conditions can cause raised TFT’s?

A

Grave’s disease

Toxic multi nodular goitre

37
Q

What happens in toxic multi nodular goitres?

A

Autonomously functioning thyroid nodules secrete excess hormone

38
Q

What thyroid conditions can cause low TFT’s?

A

Hashimoto’s
De Quervain’s thyroiditis
Riedel’s thyroiditis

39
Q

What history would indicate de quervain’s thyroiditis?

A

Painful goitre
Raised ESR
Following URTI

40
Q

What happens in acute suppurative thyroiditis?

A

Infection causing an abscess

41
Q

What history may indicate Riedel’s thyroiditis?

A

Painless goitre

Fibrous tissue replace thyroid parenchyma

42
Q

What are the red flags for thyroid lumps?

A 
Stridor - same day referral
In a child 
Voice changes
Rapid enlargement over weeks
Cervical lymphadenopathy
History of radiation exposure
43
Q

How would you investigate a thyroid lump?

A

Thyroid function tests
US guided fine needle aspiration
Hemithyroidectomy if in diagnostic doubt

44
Q

What are the types of thyroid neoplasms?

A 
Benign - adenoma (follicular cells)
Malignant:
- Papillary adenocarcinoma  (70%)
- Follicular carcinoma (20%)
- Medullary carcinoma (5%)
 - Anaplastic carcinoma (5%)
45
Q

What history is common in papillary adenocarcinoma of the thyroid?

A

Most common type of malignant thyroid neoplasm

Younger patients

History of neck irradiation

46
Q

What may indicate a thyroid cancer is a follicular carcinoma?

A

Metastasise to bones and lungs

47
Q

What is important to know about medullary carcinoma’s of the thyroid?

A

Neoplasm of C Cells - regulate calcitonin

Typically seen in MEN syndromes - screen other organs

Genetic component

48
Q

What is important to know about anaplastic thyroid carcinoma?

A

Typically older patients

Poor prognosis - weeks/months by time of diagnosis

49
Q

How are non neoplastic thyroid nodules managed?

A

Conservatively

Hemithyroidectomy if airway compression, patient preference or cosmetic reasons

Avoid thyroidectomy due to complications and lifelong thyroxine req.

50
Q

How are neoplastic thyroid nodules managed?

A

Adenoma - diagnostic hemithyroidectomy

Carcinoma - total thyroidectomy

51
Q

What complications are associated with thyroid surgery?

A

Post-operative haemorrhage
Airway obstruction - haemorrhage or vocal cord palsy
Vocal cord palsy
Hypocalcaemia

52
Q

What are the salivary glands?

A

Parotid
Sublingual
Submandibular

53
Q

Which salivary gland is normally affected by calculi?

A

Submandibular - 80%

54
Q

What makes up most salivary calculi?

A

Calcium phosphate or calcium carbonate

70% radioopaque

55
Q

How does sialiolithiasis usually present?

A

Colicky pain and post prandial swelling of the gland

56
Q

How is sialolithiasis diagnosed?

A

Sialography - demonstrate site of obstruction

57
Q

How is sialolithiasis managed?

A

Distal aspect of Wharton’s duct - remove orally

Other stones and chronic inflammation - gland excision

58
Q

What ducts are connected to each salivary gland?

A

Parotid - Stensons duct
Submandibular - Wharton’s duct
Sublingual - duct of Rivinus

59
Q

What is sialadenitis?

A

Infection of the salivary glands

Usually due to staph aureus tracking from oral cavity

60
Q

What risk factors are associated with sialadenitis?

A 
Decreased saliva or obstruction
Dehydration
Malnourishment
Radiotherapy
Drugs - antihistamines, beta blockers, diuretics
61
Q

How is sialadenitis managed?

A

Abx - fluclox and metronidazole
Warm compress - encourage flow
Hydration

62
Q

How does sialadnitis present?

A 
Reduced saliva
Bad taste in mouth - pus
Pain
Swelling 
Redness of skin
63
Q

What is Sjogrens syndrome?

A

Autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces

May be primary or secondary to rheumatoid arthritis/other connective tissue disorders

64
Q

Who is Sjogren’s more common in?

A

Females

65
Q

What does Sjogren’s increase risk of ?

A

Lymphoid malignancy - 40-60fold increase

66
Q

What are the main features of Sjogrens?

A 
Dry eyes
dry mouth
vaginal dryness
arthralgia
Raynaud's
Myalgia
Sensory polyneuropathy
Recurrent parotitis
Renal tubular acidosis - usually subclinical
67
Q

What antibodies are associated with Sjogrens

A

Rheumatoid Factor - nearly 100% of patients
ANA - 70%
Anti-Ro - 70% with primary sjogrens
Anti-La - 30% of primary sjogrens

68
Q

What other investigations are indicated for suspected Sjogrens?

A

Schirmers test - filter paper near conjunctival sac to measure tear formation

Histology - focal lymphocytic infiltration

Hypergammaglobulinaemia

69
Q

How is Sjogren’s managed?

A

Artificial saliva and tears

Pilocarpine - may stimulate saliva production

Neurology and Special Senses (28 decks)

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