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5thyr > Throat (and neck) > Flashcards

Throat (and neck) Flashcards

1
Q

What neck lumps do you get anteriorly? (infront of sternocleidomastoid)

And defining features

A
  • Branchial cyst (congenital but unnoticed until inflamed URTI)
  • Carotid body cyst (pulsatile)
  • Thyroid nodule (thigh thyroxine)
  • Laryngocele (HOARSENESS, trombone players, inflate with valsalva)
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2
Q

What neck lumps do you get posteriorly? (behind of sternocleidomastoid)

And defining features

A
  • Cystic hygroma (transilluminate, noted at birth)
  • Cervical ribs (hard lump, tingling arms)
  • Virchows node (?GI cancer symptoms)
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3
Q

What neck lump do you commonly find at the back of neck?

A

Lipoma

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4
Q

What lumps can you get at the midline (and how can you tell them apart?)

A

Midline

  • Dermoid cyst (Teratoma-nails/hair)-dont move-
  • Thyrogloassal cyst (move on swallowing+tongue)
  • Thyroid isthmus swelling (move on swallowing)
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5
Q

What is a branchial cyst?

A
  • MOBILE cyst made in embryonic development
  • Lateral aspect of neck
  • Anterior to sternocledomastoid (URTI)
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6
Q

What is a cystic hygroma?

A
  • Error in development of lymph sacs
  • lump typically on left side of neck (posterior)
  • Noted at birth
  • transilluminates
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7
Q

What can people with a cervical rib develop?

A

Thoracic outlet syndrome (10%)

  • pain in shoulders/neck
  • tingling fingers
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8
Q

What is the most common cause of neck swelling?

A

Reactive lymphadenopathy

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9
Q

Symptoms of pharyngeal pouch?

A 
dysphagia
regurgitation
HALLITOSIS 
aspiration
chronic cough
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10
Q

Investigations for neck lumps?

A

USS and FNA (fine needle aspiration)

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11
Q

What are the two main causes of a sore throat?

A

Acute pharyngitis = inflammation of the oropharynx
Tonsillitis

Often in combination = tonsillopharyngitis

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12
Q

What is centor criteria?

What makes up the centor criteria and how is it scored?

A

CENTOR-look for bacterial features

C - Cough absent
E - tonsillar Exudate 
N - Nodes 
T - Temperature 
OR - young (more likely) OR old (less likely)

3 or 4 of these suggest strep throat and would benefit from abx

All 4 absent, unlikely to be bacterial (80% negative predictive value)

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13
Q

What is the age modification of the centor criteria?

A 
3-14yrs = 1 point
15-44yr= 0 points 
>45 = -1 point

(must be older than 3 years)

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14
Q

What is the management of a bacterial sore throat?

A

Penicillin V 500mg QDS for 10 days

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15
Q

What is the management of a bacterial sore throat if penicillin allergic?

A

Clarithromycin 250-500mg BD for 5 days

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16
Q

What is the management of a bacterial sore throat if pregnancy?

A

Erythromycin 250-500mg QDS for 5 days

17
Q

What are some complications of tonsillitis?

A 
Otitis media
Sinusitis 
Quinsy 
Pharyngeal abscess 
Lemierre syndrome (infectious thrombophlebitis of the internal jugular vein)
18
Q

What is Lemierre syndrome?

A

Acute septicaemia and jugular vein thrombosis secondary to infection with Fusobacterium species

Septic emboli to lungs, bone, muscle, kidney, liver

19
Q

What clinical features of tonsillitis point towards viral?

A

Headache
Earache
Nasal congestion
Cough

20
Q

What indicates a peritonsillar abscess may be forming as a complication of tonsillitis?

A

Trismus (lockjaw due to spasms of the jaw musculature)

Changes in voice quality

21
Q

What causes most sore throats

A

Viruses
eg rhinovirus, coronavirus, parainfluenza virus

Bacteria
Group A strep- Strep pyogenes

22
Q

What is a submandibular space infection that can present with mouth pain?

A

Ludwig angina

23
Q

How does ludwig angina present

A 
Mouth pain
Fever 
Stiff neck 
Difficulty swallowing 
Trismus 
Airway obstruction may occur
24
Q

How does EBV present?

A

-Fever
-Pharyngitis
-Enlarged erythematous tonsils with white and grey deposits
-Generalised lymphadenitis
+/- liver, spleen and skin involvement

25
Q

What should a sore throat not be treated with? why?

A

Amoxicillin

Causes maculopapular rash if caused by EBV

26
Q

Why are NSAIDs contraindicated for post tonsillectomy pain relief?

A

Increased risk of bleeding

27
Q

What are options for tonsillectomy?

A

Subtotal tonsillectomy - tonsils partially removed while capsule remains

Total tonsillectomy

28
Q

Recall tonsillectomy eligibility criteria

A

≥ 7 episodes in the past year, OR
≥ 5 episodes/year in the past 2 years, OR
≥ 3 episodes/year in the past 3 years

29
Q

Strep PHyogenes can lead to what?

A

Streptococcus “PH”yogenes is the most common cause of bacterial pharyngitis

which can result in rheumatic “PHever”

and poststreptococcal glomerulonePHritis

30
Q

Managment of epiglottis?

A
  • Immediately admit and contact paediatrics (dont lie them down)
  • take blood cultures and start IV CEFOTAXIME (or ceftriaxone)
  • Will likely have to be intubated by experienced anaesthetist (HDU/PICU)
  • ET tube can usually be removed after 24 hours when antibiotics have started to work. Abx continued for 3-5 days
31
Q

What is globus pharyngeus?

A

Feeling of a lump in the throat where no true lump exists

Can lead to frequent clearing of throat

Noticed most when swallowing saliva
(diagnosis of exclusion)

32
Q

List types of oral cavity cancers (3)

A

Oral mucosal cancer
Salivary gland cancer
Tonsillar cancer

*they are most often SCC

33
Q

How do oral cavity cancers present?

A 
Halitosis
Pain eg earache 
Dysphagia 
Non healing ulcers 
Unusual bleeding in mouth 
Facial swelling 
Lymphadenopathy
34
Q

How are oral cavity cancers investigated?

A 
Biopsy and histopathology
Panendoscopy (mouth, nose, voice box and oesophagus) 
HPV testing 
CXR 
Axial CT 
PET CT
35
Q

What is the management of oral cavity cancers?

A

Surgical resection

  • Maxillectomy
  • Mandibulectomy
  • Glossectomy
  • Laryngectomy
  • Radical neck dissection

Chemo (HPV have better responce)
Radio (HPV have better responce)

36
Q

How does trigeminal neuralgia present?

A

-Unilateral facial pain

  • Severe shooting / stabbing followed by burning ache
  • Typically from mouth to angle of jaw
  • Lasts several seconds but can last up to minutes, can occur up to 100 times a day
  • At rest or triggered by movements eg chewing
  • Facial spasms may occur
37
Q

How is trigeminal neuralgia diagnosed?

A

Clinical diagnosis

MRI to exclude structural cause

38
Q

What is the management of trigeminal neuralgia?

A

Carbamazepine

5thyr (18 decks)

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