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4th year passmedicine by topic > Throat Disease > Flashcards

Throat Disease Flashcards

1
Q

Sore throat encompasses

A

pharyngitis, tonsillitis, laryngitis

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2
Q

throat swabs and rapid antigen tests are diagnostic in sore throat

A

false

throat swabs and rapid antigen tests should not be carried out routinely in patients with a sore throat

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3
Q

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

A

true

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4
Q

Mx sore throat antibiotics are not routinely indicated

A

true

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5
Q

Sore throat NICE indications for antibiotics

A

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

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6
Q

The Centor criteria are: score 1 point for each (maximum score of 4)

A

presence of tonsillar exudate

tender anterior cervical lymphadenopathy or lymphadenitis

history of fever

absence of cough

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7
Q

Centor score & Likelihood of isolating Streptococci

0 or 1 or 2

A

3 to 17%

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8
Q

Centor score & Likelihood of isolating Streptococci

3 or 4

A

32 to 56%

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9
Q

The FeverPAIN criteria are: score 1 point for each (maximum score of 5)

A 
Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza
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10
Q

If abs indicated in sore throat then prescribe?

A

either phenoxymethylpenicillin or erythromycin

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11
Q

Acute tonsillitis - Characterised by

A

pharyngitis, fever, malaise and lymphadenopathy.

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12
Q

Acute tonsillitis - Over half of all cases are bacterial with

A

Streptococcus pyogenes

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13
Q

bacterial tonsillitis is usually managed conservatively

A

false

Treatment with penicillin type antibiotics is indicated for bacterial tonsillitis

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14
Q

Bacterial tonsillitis may result in local abscess formation (quinsy)

A

true

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15
Q

Complications of tonsillitis include:

A

otitis media
quinsy - peritonsillar abscess
rheumatic fever and glomerulonephritis very rarely

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16
Q

The indications for tonsillectomy are controversial. NICE recommend that surgery should be considered only if the person meets ALL of the following criteria

A

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

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17
Q

Singleton indications for tonsillectomy?

A

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

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18
Q

Complications of tonsillectomy - primary (< 24 hours)

A

haemorrhage in 2-3% (most commonly due to inadequate haemostasis), pain

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19
Q

Complications of tonsillectomy - secondary (24 hours to 10 days)

A

haemorrhage (most commonly due to infection), pain

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20
Q

Peritonsillar abscess (quinsy) uvula deviates towards/away from affected side?

A

deviation of the uvula to the unaffected side

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21
Q

Peritonsillar abscess (quinsy) sx?

A

severe throat pain, which lateralises to one side

deviation of the uvula to the unaffected side

trismus (difficulty opening the mouth)

reduced neck mobility

22
Q

peritonsillar abscess referral?

A

Patients need urgent review by an ENT specialist.

23
Q

peritonsillar abscess mx

A

needle aspiration or incision & drainage + intravenous antibiotics
tonsillectomy should be considered to prevent recurrence

24
Q

The pain may increase for up to ?following a tonsillectomy.

A

6 days

25
Q

All post-tonsillectomy haemorrhages should be assessed by ENT.

A

true

26
Q

Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by

A

immediate return to theatre.

27
Q

Post tonsillectomy secondary haemorrhage occurs when?

A

between 5 and 10 days after surgery

28
Q

Post tonsillectomy secondary haemorrhage is often associated with?

A

wound infection

29
Q

Post tonsillectomy secondary haemorrhage mx?

A

admission and antibiotics

Severe bleeding may require surgery

30
Q

Causes of hoarseness include:

A 
voice overuse
smoking
viral illness
hypothyroidism
gastro-oesophageal reflux
laryngeal cancer
lung cancer
31
Q

When investigating patients with hoarseness a chest x-ray should be considered to?

A

exclude apical lung lesions.

32
Q

A suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over with:

A

persistent unexplained hoarseness or

An unexplained lump in the neck.

33
Q

Head and neck cancer sx

A

neck lump
hoarseness
persistent sore throat
persistent mouth ulcer

34
Q

Oral cancer

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either:

A

unexplained ulceration in the oral cavity lasting for more than 3 weeks or

a persistent and unexplained lump in the neck.

35
Q

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

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.

36
Q

Thyroid cancer
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump.

A

True

37
Q

Laryngopharyngeal reflux (LPR) is

A

is a condition caused by gastro-oesophageal reflux resulting in inflammatory changes to the larynx/hypopharynx mucosa

38
Q

Laryngopharyngeal reflux (LPR) s a common diagnosis and thought to account for around 10% of ear, nose and throat referrals.

A

True

39
Q

Typical lump in Laryngopharyngeal reflux ?

A

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

40
Q

Laryngopharyngeal reflux examination?

A

the external examination of the neck should be normal, with no masses
the posterior pharynx may appear erythematous

41
Q

Diagnosis of Laryngopharyngeal reflux is made by?

A

in the absence of red flags a clinical diagnosis of LPR can be made without further investigations

42
Q

Laryngopharyngeal reflux mx

A

lifestyle measures
possible triggers include fatty foods, caffeine, chocolate and alcohol
proton pump inhibitor
sodium alginate liquids (e.g. Gaviscon)

43
Q

most common cause of neck swellings

A

Reactive lymphadenopathy

44
Q

How does Lymphoma feel?

A

Rubbery, painless

45
Q

Thyroid swelling moves upwards on swallowing

A

true

46
Q

Thyroglossal cyst is more common in

A

< 20 years old

47
Q

Thyroglossal cyst feels ?

A

Usually midline, between the isthmus of the thyroid and the hyoid bone

Moves upwards with protrusion of the tongue

48
Q

Cystic hygroma is what?

A

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

49
Q

Branchial cyst develops due to?

A

failure of obliteration of the second branchial cleft in embryonic development

Usually present in early adulthood

50
Q

Branchial cyst feels like?

A

oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx

51
Q

Cervical rib more common in

A

Adult females

52
Q

Carotid aneurysm feels like?

A

Pulsatile lateral neck mass which doesn’t move on swallowing

4th year passmedicine by topic (96 decks)

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