Throat Disease Flashcards
Sore throat encompasses
pharyngitis, tonsillitis, laryngitis
throat swabs and rapid antigen tests are diagnostic in sore throat
false
throat swabs and rapid antigen tests should not be carried out routinely in patients with a sore throat
Mx sore throat ingle dose of oral corticosteroid may reduce the severity and duration of pain, although this has not yet been incorporated into UK guidelines
true
Mx sore throat antibiotics are not routinely indicated
true
Sore throat NICE indications for antibiotics
features of marked systemic upset secondary to the acute sore throat
unilateral peritonsillitis
a history of rheumatic fever
an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
3 or more Centor criteria are present
The Centor criteria are: score 1 point for each (maximum score of 4)
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough
Centor score & Likelihood of isolating Streptococci
0 or 1 or 2
3 to 17%
Centor score & Likelihood of isolating Streptococci
3 or 4
32 to 56%
The FeverPAIN criteria are: score 1 point for each (maximum score of 5)
Fever over 38°C. Purulence (pharyngeal/tonsillar exudate). Attend rapidly (3 days or less) Severely Inflamed tonsils No cough or coryza
If abs indicated in sore throat then prescribe?
either phenoxymethylpenicillin or erythromycin
Acute tonsillitis - Characterised by
pharyngitis, fever, malaise and lymphadenopathy.
Acute tonsillitis - Over half of all cases are bacterial with
Streptococcus pyogenes
bacterial tonsillitis is usually managed conservatively
false
Treatment with penicillin type antibiotics is indicated for bacterial tonsillitis
Bacterial tonsillitis may result in local abscess formation (quinsy)
true
Complications of tonsillitis include:
otitis media
quinsy - peritonsillar abscess
rheumatic fever and glomerulonephritis very rarely
The indications for tonsillectomy are controversial. NICE recommend that surgery should be considered only if the person meets ALL of the following criteria
definitely have tonsillitis
the person has FIVE or more episodes of sore throat per year
symptoms have been occurring for at least a year
disabling episodes
Singleton indications for tonsillectomy?
recurrent febrile convulsions secondary to episodes of tonsillitis
obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
peritonsillar abscess (quinsy) if unresponsive to standard treatment
Complications of tonsillectomy - primary (< 24 hours)
haemorrhage in 2-3% (most commonly due to inadequate haemostasis), pain
Complications of tonsillectomy - secondary (24 hours to 10 days)
haemorrhage (most commonly due to infection), pain
Peritonsillar abscess (quinsy) uvula deviates towards/away from affected side?
deviation of the uvula to the unaffected side
Peritonsillar abscess (quinsy) sx?
severe throat pain, which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility
peritonsillar abscess referral?
Patients need urgent review by an ENT specialist.
peritonsillar abscess mx
needle aspiration or incision & drainage + intravenous antibiotics
tonsillectomy should be considered to prevent recurrence
The pain may increase for up to ?following a tonsillectomy.
6 days
All post-tonsillectomy haemorrhages should be assessed by ENT.
true
Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by
immediate return to theatre.
Post tonsillectomy secondary haemorrhage occurs when?
between 5 and 10 days after surgery
Post tonsillectomy secondary haemorrhage is often associated with?
wound infection
Post tonsillectomy secondary haemorrhage mx?
admission and antibiotics
Severe bleeding may require surgery
Causes of hoarseness include:
voice overuse smoking viral illness hypothyroidism gastro-oesophageal reflux laryngeal cancer lung cancer
When investigating patients with hoarseness a chest x-ray should be considered to?
exclude apical lung lesions.
A suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over with:
persistent unexplained hoarseness or
An unexplained lump in the neck.
Head and neck cancer sx
neck lump
hoarseness
persistent sore throat
persistent mouth ulcer
Oral cancer
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either:
unexplained ulceration in the oral cavity lasting for more than 3 weeks or
a persistent and unexplained lump in the neck.
Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:
a lump on the lip or in the oral cavity or
a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.
Thyroid cancer
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump.
True
Laryngopharyngeal reflux (LPR) is
is a condition caused by gastro-oesophageal reflux resulting in inflammatory changes to the larynx/hypopharynx mucosa
Laryngopharyngeal reflux (LPR) s a common diagnosis and thought to account for around 10% of ear, nose and throat referrals.
True
Typical lump in Laryngopharyngeal reflux ?
around 70% of patients have the sensation of a lump in the throat - ‘globus’
typically felt in the midline
typically worse when swallowing saliva rather than eating or drinking
Laryngopharyngeal reflux examination?
the external examination of the neck should be normal, with no masses
the posterior pharynx may appear erythematous
Diagnosis of Laryngopharyngeal reflux is made by?
in the absence of red flags a clinical diagnosis of LPR can be made without further investigations
Laryngopharyngeal reflux mx
lifestyle measures
possible triggers include fatty foods, caffeine, chocolate and alcohol
proton pump inhibitor
sodium alginate liquids (e.g. Gaviscon)
most common cause of neck swellings
Reactive lymphadenopathy
How does Lymphoma feel?
Rubbery, painless
Thyroid swelling moves upwards on swallowing
true
Thyroglossal cyst is more common in
< 20 years old
Thyroglossal cyst feels ?
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
Cystic hygroma is what?
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
Branchial cyst develops due to?
failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
Branchial cyst feels like?
oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Cervical rib more common in
Adult females
Carotid aneurysm feels like?
Pulsatile lateral neck mass which doesn’t move on swallowing
