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CP2 - ENT > Throat- swallowing --> salivary glands > Flashcards

Throat- swallowing --> salivary glands Flashcards

1
Q

4 stages of swallowing

A

Oral preparatory phase
Oral phase
Pharyngeal (invol, CNIX)
Oesophageal phase

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2
Q

Oral preparatory phase of swallowing

A

Grinding of control

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3
Q

Oral phase of swallowing

A

Tongue pushes food bolus towards oropharynx

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4
Q

Pharyngeal phase of swallowing

A

Soft palate elevates + closes nasopharynx

Pharyngeal constrictor mm contracts from top to bottom, squeezing bolus inferiorly

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5
Q

Oesophageal phase of swallowing

A

Bolus enters upper oesphageal sphincter
Cricopharyngeus relaxes
Peristalsis - food towards LOS

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6
Q

Dysphagia pattern in malignant lesions

A

S –> L over w/m

+ W loss

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7
Q

Dysphagia pattern in achalasia/pharyngeal pouch

A

Slow over years

+ regurg of undigested food

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8
Q

Causes of aspiration (4)

A

Altered sensation to pharynx centrally
‘’ ‘’ pharynx peripherally (post radiotherapy)
Delays initiation of swallow + food slips in
Neuro/neoplasia –> faults in larynx

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9
Q

What is acute dysphagia usually caused by?

A

Foreign bodies

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10
Q

If Dysphagia has been occuring for >3 weeks - what investigations should be done?

A

TNO/FNE

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11
Q

What Ix is good for pharyngeal pouches

A

Contrast studies

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12
Q

What Ix is good for anatomy + coordination of phases of swallowing

A

Videofluroscopy

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13
Q

What is Prebysphagia

A

Decreased ability to swallow with age

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14
Q

Cause of prebysphagia

A

Decreased mm mass and strength

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15
Q

PS Prebysphagia (2)

A

Chronic dysphagia + malnutrition

Aspiration

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16
Q

Tx Presbysphagia (2)

A

Change consistency of food

Swallowing therapy

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17
Q

Globus pharyngeus

A

Sensation of lump/tightness in throat w/ no organic cause

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18
Q

Causes globus pharyngeus (2)

A

Inflamm larynx/hypopharynx

Psychogenic/depression

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19
Q

What is a pharyngeal pouch?

A

Natural area of weakness in hypopharynx

Posteromedial herniation betw thyropharyngeus + cricopharyngeus

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20
Q

How is a pharyngeal pouch distinguishable on examination?

A

Large midline lump that gurgles on palpation

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21
Q

Who gets pharyngeal pouches?

A

Elderly men

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22
Q

Sx pharyngeal pouch (5)

A 
Progressive dysphagia 
W loss 
Regurg of undigested food 
Hallitosis 
Dysphagia 
Cough
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23
Q

Tx pharnyngeal pouch

A

Endoscopic stapling

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24
Q

Swallowing therapy interventions (2)

A

Head/body posture

Control of bolus flow

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25
Q

Supraglottis

A

Above vocal chords

Including epiglottis + false VC

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26
Q

Inn supraglottis

A

Superior laryngeal nn

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27
Q

Glottis

A

True VC

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28
Q

Subglottis

A

From VC to trachea

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29
Q

Inn subglottis

A

Recurrent larygneal nn

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30
Q

Changes in vocal cords: Incr mass –>

A

Decr pitch of voice

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31
Q

Changes in vocal cords: Poor closure –>

A

Weak voice

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32
Q

Changes in vocal cords: Incr stiffness

A

Rough voice

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33
Q

Changes in vocal cords: Lesions on free edge

A

Irregular voice + breaking

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34
Q

How are the vocal cords examined?

A

FNE

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35
Q

How long does acute laryngitis last?

A

2 w

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36
Q

Tx acute laryngitis (4)

A

Fl
Analgesia
Anti-inflamm Dx
Avoid using voice

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37
Q

RF Chronic Laryngitis

A

Smoking
Alcohol
Excessive use of voice

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38
Q

Mx Chronic Laryngitis (2)

A

SALT

Avoid RF

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39
Q

What can chronic laryngitis progress into?

A

Carcinoma

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40
Q

Causes of VC palsy (2)

A

Recurrent laryngeal nn
Trauma
Mediastinal mass/thyroid malig

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41
Q

Cause of vocal cord nodules

A

Recurrent trauma to edge VC

B/c XS voice production

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42
Q

Mx vocal cord nodules (2)

A

SALT

Rest voice

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43
Q

What is mm tension dysphonia?

A

Inco-ordination of laryngeal mm

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44
Q

Ix for all changes in voice

A

CXR/FNE

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45
Q

Red flags for voice (SCALD)

A 
S- Smoker/stridor 
C - Consistent/cough blood 
A - Acute onset not related to URTI
L - Loss of W
D - Dyspnoea + dysphagia
46
Q

The 3 groups of Voice Treatment

A

Voice therapy
Medical therapy
Surgical therapy

47
Q

Voice therapy (4)

A

Vocal hygiene
Lubrication
Hydration
Advice on caffiene/alcohol

48
Q

Medical therapy voice (3)

A

ABx
Anti-reflux meds
Botox for spasmodic dysphonia

49
Q

Surgical therapy for voice

A

Endolaryngeal surgery w/ laser

50
Q

Which major salivary gland are most of the tumours in?

A

Parotid

51
Q

Is Parotid mucous or serous

A

Serous

52
Q

Name of Parotid duct

A

Stenson’s duct

53
Q

Where does Stenson’s duct enter the mouth?

A

Level of 2nd upper molar

54
Q

Which major salivary gland are most of the stones formed?

A

Submandibular gland

55
Q

Is Submandibular gland mucous or serous?

A

Both

56
Q

Name of Submandibular duct

A

Whartons

57
Q

Where does Whartons duct enter the mouth

A

Either size of frenulum

58
Q

Where is the sublingual gland?

A

Lines the floor of the mouth

59
Q

Is the sublingual gland mucous or serous?

A

Mucous

60
Q

Salivary stimuli (5)

A 
Smell 
Taste 
Psychic stimuli 
Chewing/mastication 
Parasymp Dx - pilocarpine
61
Q

Xerostomia

A

Dry mouth

62
Q

Common causes of Xerostomia (6)

A 
Depression 
Anxiety 
Drugs with antimuscarinic activity
Drugs with sympathomimetic activity 
Sjorgren's syndrome 
Radiothearpy H+N region
63
Q

Drugs with antimuscarinic properties that can cause xerostomia (7)

A 
Atropine 
Ipratropium 
TCAs
MOAIs
Phenothiazines 
Anti-parkinson drugs 
AntiH
64
Q

Drugs with sympathomimetic activity that can cause xerostomia (3)

A

Cold cures/decongestants
Bronchodilators
Appetite suppressants

65
Q

What is the most common cause of bilateral parotid enlargement?

A

Mumps

66
Q

Other causes of parotitis (apart from mumps) (4)

A

HIV
Bacterial - staphy
Fungal
Sarcoid

67
Q

Sialadenitis

A

Acute infection of partoid/SM gland

68
Q

Sx Sialadenitis (6)

A 
Pain 
Pyrexua
Swollen glands 
Pus @ opening parotid ducts --> bad taste 
SM - swollen floor of mouth
Less saliva
69
Q

Who gets Sialadenitis?

A

Old patients w/ poor dental hygiene

70
Q

Tx Sialadenitis (3)

A

High dose ABx
Rehydration
Oral care

71
Q

Sialoithiasis

A

Formation of stones in salivary glands

72
Q

Which gland does Sialolithiasis tend to occur?

A

SM glands

73
Q

S+S Sialolithiasis (4)

A

Colicky pain
Postprandial swelling
Gland swollen
Gland tender

74
Q

Tx Sialolithiasis (2)

A

Fl

Sialogues

75
Q

1’ Sjorgens syndrome

A

Dry eyes + dry mouth

76
Q

2’ Sjorgens syndrome

A

Dry eyes + Dry mouth

CT disease

77
Q

3 + 4 Sjorgens

A 
3 = Benign lymphoepithelial lesion 
4 = Aggressive lymphocytic behaviour confined to parotid glands
78
Q

Sx Sjorgens (4)

A

Dry eyes
Keratoconjunctivitis
Chronic hepatitis
Vasculitis

79
Q

Why does Sjorgen’s syndrome occur?

A

Loss of suppressor T cell activity

80
Q

Ix Sjorgens syndrome (3)

A

HLA/AI/DR3
Specific antigens - SSB/SSA
Labial biopsy = diagnostic

81
Q

Risks of having Sjorgens syndrome

A

1/6 –> Non-Hodgkins B cell lymphoma

82
Q

Tx Sjorgens (2)

A

Steroids

Artificial tears, saliva, lubricants

83
Q

Where are the majority of benign salivary gland tumours found?

A

Parotid gland

84
Q

Which salivary glands has the highest % of being malignant?

A

Minor salivary glands

85
Q

RF Benign salivary gland tumours

A

Previous radiation

86
Q

What is the most common type of benign salivary gland tumour?

A

Pleomorphic adenoma

87
Q

Where do you tend to find pleomorphic adenomas?

A

Parotid gland

88
Q

Can pleomorphic adenomas become malignant?

A

Yes, over many years (only 10%)

89
Q

Ix Pleomorphic adenoma

A

FNAC/CT

90
Q

Tx Pleomorphic adenoma

A

Surgical excision

91
Q

Where are Warthins tumours found

A

Partoid tails bilaterally

92
Q

Who gets Warthin’s tumours

A

Old men

93
Q

Tx Warthins tumours

A

Surgical excision

94
Q

How do malignancies in the salivaries glands present? (3)

A

Rapid growing
Painful
Involving other structures e.g. facial palsies

95
Q

Features of high grade muco-epidermoid tumours

A

Painful
Fully invasive
Rapid growth

96
Q

Mets for mucoepidermoid tumours (4)

A

Lungs
Brain
Bone
Local lymph

97
Q

Which gland is the majorty of muco-epidermoid tumours in?

A

Parotid

98
Q

Tx low grade muco-epidermoid tumour

A

Local resection

99
Q

Tx - high grade muco-epidermoid tumour

A

Radical neck dissection + radiotherapy

100
Q

Prognosis Muco-epidermoid tumours

A

30% recurrence :(

101
Q

Where are 99% of Acini cell tumours?

A

Parotid gland

102
Q

Tx Acini cell tumours

A

Resection

Preserve CN 7

103
Q

What is the most common salivary gland malignancy?

A

Adenoid cyst carcinoma

104
Q

How does Adenoid cyst carcinoma spread?

A

Gradually

Invading extensively w/ infiltration along nn

105
Q

Tx Adenoid cyst carcinoma

A

Radical excision

Radiotherapy

106
Q

Prognosis Adenoid cyst carcinoma

A

15%

107
Q

What is the most common type of lymphoma in salivary glands?

A

Non-Hodgkin’s lymphoma

108
Q

PS lymphoma in salivary glands (3)

A

Firm mass
Rapidly enlarging
Occasional LN met s

109
Q

How would you diagnose a lymphoma/

A

Biopsy

110
Q

Tx - Malignant salivary gland tumours

A

Partial superficial parotidectomy

Submandibular gland excision

CP2 - ENT (13 decks)

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