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Year 4 - 5. Neurology & Special Senses > Throat (ENT) > Flashcards

Throat (ENT) Flashcards

1
Q

Outline the nerve supply of the tongue

A

Anterior 2/3:
- Facial nerve (taste)
- Mandibular branch trigeminal nerve (sensation)

Posterior 1/3:
- Glossopharyngeal (both)

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2
Q

State some functions of the larynx

A
  • Ventilation (allow air passage)
  • Speaking / sound production
  • Cough
  • Airway protection (epiglottis)
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3
Q

Outline the 3 main cartilage structures in the larynx

A
  • Epiglottis
  • Arytenoid cartilages
  • Cricoid cartilage
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4
Q

State the cell type that lines the larynx and cell type that lines the true vocal cords

A

Larynx:
- Pseudostratified ciliated columnar epithelium

True vocal cords:
- Stratified squamous (lots of air abrasion)

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5
Q

Outline the route of the L&R recurrent laryngeal nerves

A

Left recurrent laryngeal nerve goes under the arch of the aorta (goes down further)

Right recurrent laryngeal nerve goes under the right subclavian artery

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6
Q

List 6 laryngeal conditions

A
  1. Laryngitis
  2. Laryngeal nodules
  3. Laryngeal cancer
  4. Epiglottitis
  5. Croup
  6. Laryngeal oedema e.g. anaphylaxis
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7
Q

Tonsillitis - state the following:
- Pathophysiology
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Inflammation of tonsils
- Most commonly viral cause (most common bacterial cause is group A strep)

Presentation:
- Fever
- Sore throat
- Painful swallow
- Poor oral intake
- Headache
- Inflamed and enlarged tonsils +/- exudate
- May have cervical lymphadenopathy
Can present with non-specific symptoms, particularly in younger children

Investigations:
- ENT examination (throat and ears)
- Use centor / feverPAIN criteria
*Throat swabs / antigen tests not routinely performed
*Blood tests reserved for immunodeficiency patients

Management:
If viral suspected…may take up to 1 week to resolve
- Analgesia
- Safety netting advice (return if the pain has not settled after 3 days or the fever rises above 38.3ºC) = start antibiotics, or consider alternative diagnosis
- Consider delayed prescriptions
If bacterial suspected…
- Penicillin V for 10 days (Clarithromycin if penicillin allergy)

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8
Q

What specific antibiotic should be avoided in tonsillitis and why

A

Avoid Amoxicillin

Causes a maculopapular rash in EBV cause of tonsillitis

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9
Q

State the most common age groups affected by tonsillitis

A

Children aged 5-10

Another peak between ages 15 and 20

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10
Q

Outline the centor criteria for tonsillitis

A

Centor Criteria:
- Used to estimate the probability that tonsillitis is due to a bacteria infection (therefore likelihood of benefit from antibiotics)

Centor:
- Cervical lymphadenopathy
- Exudates (tonsillar)
- No cough
- Temp over 38ºC

Score of 3 or 4…
- 40-60 % probability of bacterial tonsillitis
= Appropriate to offer antibiotics

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11
Q

Outline the fever-PAIN criteria for tonsillitis

A

Fever-PAIN Criteria:
- Used to estimate the probability that tonsillitis is due to a bacteria infection (therefore likelihood of benefit from antibiotics) = alternative to centor criteria

Criteria:
- Exudates (tonsillar)
- Temp over 38ºC
- Attends within 3 days
- Inflamed tonsils
- No cough

Score of 0-1:
- Safety net and no antibiotics
Score 2-3:
- Consider delayed antibiotic prescription
Score 4+:
- Appropriate to offer antibiotics

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12
Q

List some complications of tonsillitis

A
  • Peritonsillar abscess (quinsy)
  • Chronic tonsillitis
  • Otitis media (if spreads to inner ear)
  • Scarlet fever
  • Rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Post-streptococcal reactive arthritis
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13
Q

List some common viruses and bacteria responsible for tonsillitis

A

Viral:
- Rhinovirus
- Adenovirus
- Enterovirus
- EBV

Bacterial:
- Group A strep
- Strep pneumoniae
- Haemophilus influenzae
- E.Coli

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14
Q

List some causes of pain in the throat

A
  • URTI, influenza, COVID-19, EBV
  • Tonsillitis
  • Pharyngitis
  • Trauma e.g. recent intubation
  • Malignancy e.g. thyroid, oesophageal, apical lung cancer / oral mucositis
  • Allergic rhinitis with post-nasal drip
  • GORD
  • Certain medications e.g. cytotoxic drugs, Carbimazole, Clozapine
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15
Q

List some causes of dysphagia (difficulty swallowing)

A

Physical:
- Congenital malformation
- Tumour in GI tract e.g. oesophageal cancer
- Oesophageal strictures
- Pharyngeal pouch

Neurological:
- Head injuries
- MS
- Myasthenia gravis
- CNS tumors
- ALS (amyotrophic lateral sclerosis)
- Supranuclear palsy

Other:
- Sjögren syndrome (via xerostomia)
- Limited cutaneous systemic sclerosis
- Medications e.g. antipsychotics, bisphosphonates

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16
Q

List some differentials for neck swellings (midline, off centre and lymphadenopathy)

A

Midline:
- Thyroid mass e.g. goitre or malignant (WON’T move on tongue protrusion)
- Thyroglossal cyst duct (will move on tongue protrusion)

Off centre:
- Branchial cyst
- Salivary gland pathology e.g. inflammation or stones
- Haematoma (post-surgical)

Lymphadenopathy:
- Reactive (secondary to infection) e.g. EBV
- Malignancy e.g. local H&N cancer, lymphoma, leukaemia
- Rheumatological conditions e.g. SLE

17
Q

List some differentials for hoarse voice

A

Involvement of recurrent laryngeal nerves

  • Laryngeal nodules
  • Laryngitis
  • Supraglottitis and epiglottitis
  • Invasive malignancy e.g. laryngeal cancer, thyroid cancer, apical lung cancer
  • Post-surgical
  • Thoracic aortic aneurysm
  • Neurological e.g. MS, stroke
18
Q

Retropharyngeal abscess - state the following:
- Presentation
- Investigations
- Management

A

Presentation:
Common in children after a recent URTI
- Rigid neck
- Dysphagia
- Odynophagia (pain on swallowing)
- Systemically unwell +/- airway compromise

Investigations:
- CT neck

Management:
- ABCDE approach with priority of maintaining the airway
- IV antibiotics
- Surgery with incision and drainage

19
Q

Ludwig’s angina - state the following:
- Pathophysiology
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Infection of space between floor of mouth and mylohyoid
- Commonly associated with dental infections

Presentation:
- Painful mouth
- Drooling
- Protruding tongue
- Swelling of floor of mouth
- Airway compromise

Investigations:
- CT neck
- Orthopantomograph (OPG)

Management:
- ABCDE approach with priority of maintaining the airway
- IV antibiotics
- Surgery with incision and drainage

20
Q

Epiglottitis - state the following:
- Pathophysiology
- Presentation (including any red flags)
- Investigations
- Management

A

Pathophysiology:
- Acute inflammation and swelling of epiglottis
- Usually caused by infection, specifically Haemophilus influenza B (also streptococcus pneumoniae)

Presentation:
4 D’s!
- Drooling
- Dyspnoea (difficult breathe)
- Dysphagia (painful / difficult swallow)
- Dysphonia (muffled “hot potato” voice)
- Tripod position
- High fever

Investigations:
No examinations!
- Lateral x-ray shows thumbprint sign or can exclude foreign body

Management:
- Keep child as comfortable as possible, no examinations
- Immediate escalation to senior paediatrician and anaesthetist
- Most recover okay, but prepare for intubation or tracheostomy
- Once secure airway, IV antibiotics and Dexamethasone

21
Q

Outline the investigation of choice for almost all neck lumps

A

Fine needle aspiration (FNA)

Unless it is a pulsatile mass!

22
Q

Obstructive sleep apnoea - suggest some investigations and management steps

A
  • Weight and height (calculate BMI)
  • Thyroid function tests (hypothyroidism)
  • Chest x-ray (lung disease)
  • ECG (right sided ventricular failure)
  • Sleep studies

Management:
- Weight loss advice
- CPAP
- Mandibular positioning devices
- Adenotonsillectomy in children

23
Q

Outline differentials for a thyroid mass (knowing it’s thyroid tissue) and how they can be managed

A

Benign:
- Singular = colloid / cyst
- Multinodular = goitre
- Adenoma

Management: conversative, unless compressive symptoms then surgery

Malignant:
- Papillary adenocarcinoma (70%)
- Follicular carcinoma (20%)
- Medullary carcinoma
- Anaplastic carcinoma

Management: total thyroidectomy (unless anaplastic), plus radioiodine therapy for papillary and follicular

24
Q

List some potential complications following thyroid surgery

A

Post-operative haematoma / haemorrhage - may lead to airway obstruction
Damage to recurrent laryngeal nerve - may lead to airway obstruction if bilateral
Hypocalcaemia

25
Q

Acute sialadenitis - state the following:
- Pathophysiology
- Presentation
- Management

A

Pathophysiology:
- Acute infection of the salivary glands (most commonly the parotid gland)
- Bacterial or viral
- Chronic sialadenitis is rare

Presentation:
- Pain/tenderness over affected gland
- Swelling/oedema over affected gland
- Hardening of gland (induration)
- Local erythema

Management:
- Regular hydration
- Warm compresses
- Analgesia
- Sialogogues

26
Q

Sialolithiasis (salivary gland stones) - state the following:
- Pathophysiology
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Formation of stones in the salivary ducts
- Leads to obstruction, pain and swelling
- Most common in the submandibular gland

Presentation:
- Pain and swelling over affected gland (worse prior to/during meals)

Investigations:
- Sialogram
- Ultrasound

Management:
Conversative with regular hydration, warm compresses, analgesia, sialogogues
Endoscopy
Radiological removal
Surgery to remove stones or salivary gland

27
Q

Outline the main bacterial and viral causes of acute sialdenitis

A

Bacterial:
- Staph aureus

Viral:
- Mumps
- Coxsackievirus
- HIV
- Echovirus

Year 4 - 5. Neurology & Special Senses (7 decks)

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