Anatomy and pattern recognition of the upper respiratory system and neckNormal and abnormal Flashcards

Question

Nasal polyps: description, Causes, Symptoms, Diagnosis, Complications, Treatment, Differential diagnosis

Answer 1

Description Multiple benign polyps in the nasal cavity and paranasal sinuses Causes Most commonly seen in adults. Rare in children. May be associated with cystic fibrosis, asthma, rhinosinusitis Symptoms Patient has a feeling of nasal obstruction, facial pain, headache, loss of smell. May also have symptoms of sinusitis Diagnosis CT is the preferred imaging method but MRI can also be used You will see extensive mucosal polyps in the nasal cavity and/or sinuses. Usually hypodense. May see associated bone erosion May also see sinusitis signs Complications Impact on daily life for the patient Treatment Steroids. Surgery if advanced Differential diagnosis Other causes of mucosal thickening such as nasopharyngeal cancer. Foreign body

Answer 2

Description Life threatening infection involving the retropharyngeal space. Needs immediate diagnosis Causes Most commonly seen in young children (<5yrs) Commonly a complication of a primary infection elsewhere in the sinuses, ear or nasopharynx. These areas drain lymph to the retropharyngeal lymph nodes which become infected and develop into an abscess Symptoms Nonspecific symptoms of infection May have stridor and neck swelling Diagnosis Ultrasound Point of care has a use for screening. You will see a complex collection. Plain film Useful as patient can be upright Will see swelling posterior to the pharynx and widening or the paravertebral soft tissue CT Speedy – advantage as the patient's airway may be compromised when laying down Can assess any narrowing of the airway It can be difficult to assess the amount of infection or mucosal swelling from CT MRI Much better at assessing infection extent But takes longer and may be difficult for the patient Complications Infection can spread into the spine Complete airway occlusion Treatment Surgical drainage IV antibiotics If treatment is timely nearly 100% of patient recover fully Differential diagnosis Other causes of a mass e.g. tumour

Answer 3

Description Also known as a pharyngeal pouch Posterior outpouching of the hypopharynx through a weakness in the muscle Causes Advancing age Symptoms Food and liquid become trapped leading to a sensation of trapped food, dysphagia, regurgitation, chronic cough, aspiration pneumonia Diagnosis Barium swallow is the ideal imaging method You can see the diverticulum at the C5/6 level on the lateral view Complications Aspiration pneumonia Treatment Endoscopic surgery to resect it Differential diagnosis Other causes of patients symptoms

Answer 4

In America foreign body aspiration is the 4th leading cause of death in younger children. Upper airway compromise may present with choking and respiratory distress More distal obstruction may present with mild wheezing, cough and shortness of breath Once a foreign body is aspirated into the larynx or proximal trachea there is always the risk of respiratory compromise or further inhalation into the lungs Most foreign bodies are organic – seeds, nuts etc. Adults may present with ingestion of a bone – chicken / fish, dentures, hearing aid batteries etc. Never underestimate what people will put in their mouths! A lateral and AP soft tissue neck is the preferred imaging method to assess a foreign body in the upper airway. Patient should be upright to stop any confusion with mucosal thickening If the patient is unstable a lateral only may be performed In children who a poor historians this may progress to a CXR and possibly a AXR Important note – minimise patient and carer anxiety as carrying can exacerbate the patient's respiratory distress CT and MRI can be helpful for more accurate location and assessment of complications but are not the first line of imaging

Answer 5

Description Inflammation of any of the tonsils Causes Bacterial infection, commonly Strep A Symptoms Pain, dysphagia, fever Diagnosis Imaging is not indicated unless there is concern for complications such as an abscess CT and MRI will show tonsillar enlargement and if there is an abscess will show a fluid collection Complications Peritonsillar abscess (quinsy) Treatment Antibiotics. Oral if uncomplicated, IV if there is concern for quinsy Differential diagnosis Other causes of mucosal thickening such as lymphoma

Answer 6

Description The thyroid does not produce enough thyroid hormone resulting in decreased cellular metabolism. Causes Autoimmune diseases such as Hashimoto’s is the most common cause. Symptoms Affects nearly every system in the body SOB Muscle / joint pain Weight gain, cold intolerance Diagnosis US is the standard imaging method. Will see an abnormal size of the thyroid gland An alteration in the thyroid texture and abnormal colour flow patterns Complications Depends on body system most affected but can lead to heart arrythmias Treatment Drugs to replace the thyroid hormone – levothyroxine Differential diagnosis Vast!

Answer 7

Description The thyroid produces too much thyroid hormone Causes Graves disease, radiation or drug induced, tumours Symptoms Heart arrythmias most commonly Goitre Weight loss Diagnosis Generally a blood test Nuclear medicine thyroid scan to check for cause Complications Eye problems such as double vision, pregnancy complications Treatment Drugs, radioactive iodine treatment, surgery Differential diagnosis

Answer 8

Description As the name suggests! Causes Head and neck radiotherapy Family history There are many different types Symptoms Usually a palpable mass Diagnosis US – seen as a mass with an irregular outline Often needs a US fine needle aspiration to get a sample CT is best for staging and to check lymph nodes MRI has a slightly higher sensitivity than CT Complications Patients may be at risk of cancers elsewhere Treatment Surgery and radioactive iodine treatment Differential diagnosis Abscess or other reason for a mass11

Answer 9

Description Enlarged lymph nodes Causes Infection Neoplastic (due to cancer) Due to certain drugs Symptoms Depends in cause but can cause pain and difficulty in movement Diagnosis Can be seen and measured on CT and MRI. PET will show intense F-FDG uptake

Anatomy and pattern recognition of the upper respiratory system and neckNormal and abnormal Flashcards

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