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1
Q

Borders of the anterior triangle in the neck

A

Superiorly – inferior border of the mandible (jawbone).
Laterally – anterior border of the sternocleidomastoid.
Medially – sagittal line down the midline of the neck.

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2
Q

The contents and boundaries of the anterior triangle in the neck

A

Carotid triangle

  • Sup – post belly digastric; Lat - med SCM; infer - sup belly omohyoid
  • common carotid artery (bifurcates; + carotid sinus - BaroR), internal jugular vein, hypoglossal and vagus nerves.

Submental triangle

  • Inf – hyoid bone; Med– midline of neck; La - ant belly digastric
  • submental lymph nodes

Submandibular Triangle
- Sup – body of mandible; Ant – ant belly digastric;
Post – post belly digastric
- submandibular gland (salivary), and lymph nodes.

Muscular Triangle

  • Sup– hyoid bone; Med – midline of the neck; Supero-lat – sup belly omohyoid; Infero-lat – inf portion SCM
  • Infrahyoid muscles, the pharynx, and the thyroid, parathyroid glands.
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3
Q

Borders of the posterior triangle and its contents

A

Ant – post SCM; Post– ant trapezius; Inf– middle 1/3 clavicle.
Split by omohyoid into - occipital triangle (larger + sup) and subclavian triangle (contains distal subclavian A)

  • Muscles –> omohyoid;
  • external jugular vein –> empties into the subclavian vein
  • distal part of the subclavian artery
  • accessory nerve (CN XI) and cervical plexus (+phrenic N)
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4
Q

Where is the thyroid gland located and its blood supply

A
  • anterior neck (post to muscles)
  • C5 and T1 vertebrae; inferior to thyroid cartilage
  • divided into 2 lobes connected by an isthmus
  • butterfly shape.
  • superior and inferior thyroid A; drainage via super, middle and infer thyroid veins –> int jug vein
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5
Q

Pathophysiology and presentation of thryoglossal cysts

A

As the thyroid gland descends during development, it moves through a duct called the thyroglossal duct. This duct normally fuses and regresses in the adult.

However, in 50% of individuals, the distal portion of the duct continues as a pyramidal lobe – effectively an extra piece of thyroid tissue. (No clinical consequences).

Other portions of the duct may persist as thyroglossal cysts. These present with a mass in the midline of neck, and can be excised surgically.
Sx - non-tender fluctuant swelling in the midline. Move up when pt extends tongue.

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6
Q

Where are the parathyroid glands located and how many are there

A

Posterior aspect of the lateral lobes of the thyroid gland. They are flattened and oval in shape, situated external to the gland itself, but within its sheath.
Most people have 4 - 2 from sup parathyroid (from 4th pharyngeal pouch); 2 from inf parathyroid ( from 3rd pharyngeal pouch)
- supplied by inf thyroid A

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7
Q

What are the paranasal sinuses and where do they empty

A

Extensions of the respiratory part of the nasal cavity - air filled space lined by ciliated pseudostratified resp epi.
4 pairs:
named according to the bone in which they are located; - - maxillary - middle meatus
- frontal- middle meatus
- sphenoid - roof or nasal cavity
- ethmoid - post= sup meatus; middle/ant = middle meatus

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8
Q

Where is epistaxis most likely to develop from

A

Kiesselbach/ Littles area.

kiesselbachs plexus:

  • -> anterior ethmoidal artery
  • -> sphenopalatine artery (max A branch)
  • -> greater palatine artery (max A branch)
  • -> superior labial artery (branch facial A)
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9
Q

Types of audiometry

A

Quantify loss and determine its nature.

Pure tone audiometry (PTA)
- tones at different frequencies and strengths
-Pt. indicates when sound appears and disappears
-Mastoid vibrator –>bone conduction threshold.
- Threshold at different frequencies are plotted to
give an audiogram.
> age-related hearing loss and sensoineural - lose high freq
> otosclerosis + menieres- lose all freq

Tympanometry

  • Measures stiffness of ear drum
  • Evaluates middle ear function
  • Flat tympanogram: mid ear fluid or perforation
  • Shifted tympanogram: +/- mid ear pressure

Evoked response audiometry

  • Auditory stimulus –> measurement of elicited brain response by surface electrode.
  • Used for neonatal screening (if otoacoustic emission testing negative)
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10
Q

What is the normal range of hearing and the grades of hearing loss

A
  • 0-20dB

mild - 20-40
mod - 41-70
severe - 71-95
profound - >95

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11
Q

Causes of hearing loss

A 
Conductive - problem with transmission of soundwaves from external ear through middle ear --> WIDENING
Wax/FB
Infection (otitis media +/- effusion)
Drum perf (trauma/infection)
Extra - otosclerosis
Neoplasia / no vent of middle ear
Injury (barotrauma)
Granulomatous (wegeners/sarcoid)

Sensoineural - problem in cochlear, cochlear N or brainstem –> DIVINITY
Development (alport/TORCH/perinatal anoxia) and degen (presby)
Infection - VZV, measles, mumps, influenza, meningitis, HZV
Vasc - int aud A ischaemia (+vertigo), stroke
Inflam (vasculitis/sarcoid)
Neoplasia (CPA tumour, acoustic neuroma)
Injury (noise, head trauma)/ MS/ low b12
Toxins (gentamycin, furosemide, aspirin, vancomycin)
lYmph (menieres, perilymphatic fistula (rupture round window))

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12
Q

Presentation, causes and differential of otitis externa

A

Presentation
􏰀 Purulent discharge; 􏰀 Itch/ ear fullness 􏰀 Pain and tragal tenderness; 􏰀 localised red +swelling; warm 􏰀 +/- blood; 􏰀 conductive hearing loss
- narrowing of the canal + accumulation of debris, leads to further entrapment of pathogens and propagating the infective process.

Discharge - White-yellow – bacterial; Thick white grey with visible hyphae or spores – fungal;

Causes –> Any interruption in wax formation

  • repeated water exposure
  • trauma to the canal (e.g. cotton buds)
  • blockage (e.g. debris)

Organisms –> Mainly pseudomonas; S. Epidermidis; S.aureus

Differential - Clear grey – otitis media +/- blood - perf. Relief of pain.

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13
Q

Mx and complications of otitis media

A
  • prevention - debris removed by microsuction; avoid swimming; mx eczema
  • aural toileting
  • topical antibiotics (depending on local protocol)
  • simple analgesia
  • Steroid drops (if canal inflam)

Complication - Malignant otitis externa –> extension –> skull osteomyelitis
-90% of pts. are diabetic (or other immune compromise)
Presentation
- Severe otalgia which is worse @ night +/- headache
- Copious otorrhoea
- Granulation tissue in the canal
- can involve CN VII
Ix - urgent CT scan
Rx - Surgical debridement; IV abx

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14
Q

What is Bullous Myringitis

A

Painful haemorrhagic blisters on deep meatal skin and TM.

Assoc. ̄c influenza infection

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15
Q

presentation of TMJ dysfunction

A 
- Symptoms
􏰀 Earache (referred pain from auriculotemporal N.)
􏰀 Facial pain
􏰀 Joint clicking/popping
􏰀 Teeth-grinding (bruxism)
􏰀 Stress (assoc.  ̄c depression)

Signs
􏰀 Joint tenderness exacerbated by lateral movements of an open jaw.

Investigation –> MRI
Management –> NSAIDs; Stabilising orthodontic occlusal prostheses

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16
Q

Presentation and mx of Ramsay-Hunt Syndrome

A

Herpes Zoster oticus - unilateral facial palsy caused by reactivation of VZV from the geniculate nucleus on CNVII

Clinical Features

  • moderate to severe ear pain
  • facial palsy within few days (more severe than bells) + ipsilateral vertigo, hyperacusis, and tinnitus.

O/E - Vesicles will be visible during this latter period, covering the concha, anterior ⅔ tongue, +/- soft palate

Mx - prednisolone and acyclovir ASAP
~ 75% of cases will resolve
Complications - chronic tinnitus + vestibular dysfunction.

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17
Q

Presentation, RF and common organisms causing acute otitis media

A 
Presentation
􏰀 Usually children post viral URTI
􏰀 Rapid onset ear pain, tugging @ ear.
􏰀 Irritability, anorexia, vomiting
􏰀 Purulent discharge if drum perforates
\+/- malaise, fever, and coryzal symptoms
o/e
􏰀 Bulging, red TM; 􏰀 Fever
- make sure test function of facial N

Common organisms - RSV, H. influenzae, S. pneumoniae, Moraxella catarrhalis, and S.pyogenes,

RF - Age (peak age 6-24 months); Parenteral / passive smoking; Previous URTI; Presence of enlarged adenoids; Bottle feeding or dummy use (breast feeding is protective); GORD and ­BMI (in adults)

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18
Q

Ix, Mx and complications of acute otitis media

A

Ix - cultures if pyrexial, swab discharge if present

Mx -majority resolve < 24 hours, nearly all within 3 days.

  • simple analgesics
  • if systemically unwell - Amoxicillin

Complications
Mastoiditits; Meningitis; Facial nerve paresis; Intracranial abscess; Sigmoid sinus thrombosis; Chronic Otitis Media; OME; perforation TM; sepsis; IE; septic arthritis

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19
Q

Presentation, ix and rx of otitis media with effusion

A 
Presentation
􏰀 Inattention at school
􏰀 Poor speech development
􏰀 Hearing impairment/ aural fullness
Hx previous acute otitis media
o/e
􏰀 Retracted dull TM; 􏰀 Fluid level
Ix
􏰀 Audiometry: flat tympanogram 
Rx
􏰀 Usually resolves spontaneously,
􏰀 Consider grommets if persistent hearing loss
SE: infections and tympanosclerosis
Same complications as acute otitis media
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20
Q

Presentation of chronic suppurative otitis media

A

Painless discharge and hearing loss (conductive)
- chronic discharging ear >6 weeks
o/e –> TM perforation +/- discharge

Rx
- Aural toilet; Abx / Steroid ear drops
+/- tympanoplasty if ear drum doesn’t repair itself

Complications
- Cholesteatoma; labyrinths

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21
Q

presentation and mx of mastoiditis

A

Middle-ear inflam - destruction of mastoid air cells and abscess formation.
Sx - Fever; Mastoid tenderness/ swelling; Protruding auricle
Rx- IV Abx; CT head if no improvement >24 hr
? Myringotomy ± mastoidectomy

Risk meningitis

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22
Q

presentation and mx of Cholesteatoma

A

Locally destructive expansion of stratified squamous epithelium within the middle ear.
- congenital/ acquired secondary to chronic OM

Presentation
􏰀 Foul smelling white discharge
􏰀 Headache, pain
􏰀 CN Involvement –> Vertigo; Deafness (conductive) ; Facial paralysis
o/e –> Appears pearly white - surrounding inflammation

Complications
􏰀 Deafness (ossicle destruction); 􏰀 Meningitis; 􏰀 Cerebral abscess

Mx
Surgery to remove (open/closed)

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23
Q

Define and name causes of tinnitus

A 
Sensation of sound w/o external sound stimulation Causes
- Specific
􏰂 Meniere’s (vertigo+deafness))
􏰂 Acoustic neuroma (unilateral +vertigo+ deafness)
􏰂 Otosclerosis (?FH)
􏰂 Noise-induced
􏰂 Head injury
􏰂 Hearing loss: e.g. presbyacusis
  • General
    􏰂 high BP
    􏰂 anaemia
- Drugs
􏰂 Aspirin
􏰂 Aminoglycosides 
􏰂 Loop diuretics
􏰂 EtOH
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24
Q

Mx of tinnitus

A

Treat any underlying causes
􏰀 Psych support: tinnitus retraining therapy
􏰀 Hypnotics @ night may help

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25
Presentation and mx of otosclerosis
AD condition characterised by fixation of stapes at the oval window. F>M=2:1 Presentation 􏰀 Begins in early adult life 􏰀 Bilateral conductive deafness + tinnitus 􏰀 HL improved in noisy places: Willis’ paracousis 􏰀 Worsened by pregnancy/ menstruation/ menopause 􏰀 difficulty hearing low, deep sounds and whispers 􏰀 ?dizziness Ix - PTA shows dip (Caharts notch) @ 2kHz Rx - Hearing aid or stapes implant
26
Causes of vertigo
IMBALANCE Infection/injury e.g. labyrinthitis/ head injury Meniere's BPV Aminoglycosides/Fudrosemide/ metronidazole Lypmph - peri-fistula Arterial - migraine; TIA; stroke Nerve - acoustic neuroma /vestibular schwannoma Central lesion - demyelination (MS), tumour, infarct Epilepsy - complex partial
27
Presentation and mx of menieres disease
Dilatation of endolymph spaces of membranous labyrinth (endolymphatic oedema) Presentation 􏰀 Attacks of recurrent vertigo (~20mins) occur in clusters and last up to 12h 􏰀 Progressive SNHL 􏰀 +/- N&V 􏰀 Tinnitus 􏰀 Aural fullness Audiometry --> low-freq SNHL which fluctuates Rx - Medical --> cyclizine, betahistine Surgical --> Gentamicin instillation via grommets OR Saccus decompression Inform DVLA
28
Presentation and mx of Vestibular neuronitis (Labyrinitis)
neuronitis - Inflammation of the vestibular nerve - lasts for days. Presentation 􏰀 Follows febrile illness (e.g. URTI) 􏰀 Sudden vomiting 􏰀 Severe vertigo exacerbated by head movement Mx - cyclizine - if persists --> vestibular rehab via Cawthorne-Cooksey exercises.
29
Presentation and mx of BPPV
Displacement of otoliths in semicircular canals Presentation 􏰀 Sudden rotational vertigo for <30s 􏰂 Provoked by head turning 􏰀 Nystagmus Causes 􏰀 Idiopathic 􏰀 Head injury 􏰀 Otosclerosis 􏰀 Post-viral Dx --> Hallpike manoeuvre - upbeat-torsional nystagmus Rx 􏰀 Self-limiting; advise not to drive when dizzy; reduce head movements 􏰀 Epley manoeuvre to redistribute particles 􏰀 Betahistine: histamine analogue
30
What is an acoustic neuroma and the presentation +mx
also called vestibular schwannoma - Benign, slow-growing tumour of schwann cells surrounding vestibulocochlear N 􏰀 Acts as SOL--> Cerebellopontine angle syndrome (80% of CPA tumours) 􏰀 Assoc. ̄c NF2 (bilateral) ``` Presentation 􏰀 Slow onset, unilat SNHL, tinnitus ± vertigo 􏰀 Headache (Raised ICP)/ seizures 􏰀 CN palsies: 5,7 and 8 􏰀 Cerebellar signs ``` ``` Ix 􏰀 MRI of cerebellopontine angle 􏰀 PTA Differentials 􏰀 Meningioma 􏰀 Cerebellar astrocytoma 􏰀 Mets Rx - monitor - 􏰀 Gamma knife 􏰀 Surgery (risk of hearing loss) ```
31
What is Presbyacussis
Age-related hearing loss Presentation 􏰀 >65yrs 􏰀 Bilateral 􏰀 Slow onset 􏰀 ± tinnitus Ix: Loss of higher frequencies Rx: hearing aid - external/ internal (cochlear implant)
32
Causes of Tympanic membrane perforation
- OM - FB - Barotrauma - Trauma (e.g. ear buds) 90% resolve <4weeks
33
When would you refer tinnitus as an emergency
``` If they have features of: Sudden onset pulsatile tinnitus Significant neurology Severe vertigo Secondary to head trauma Unexplained sudden hearing loss ```
34
Causes of hearing loss in children
Congenital Causes Conductive 􏰀 Anomalies of pinna, external auditory canal, TM or ossicles. 􏰀 Congenital cholesteatoma ``` SNHL 􏰂 Waardenburgs: SNHL, heterochromia + telecanthus 􏰂 Alport’s: SNHL + haematuria 􏰀 Infections: TORCH 􏰀 Ototoxic drugs ``` ``` Perinatal 􏰀 Anoxia 􏰀 Cerebral palsy 􏰀 Kernicterus 􏰀 Infection: meningitis ``` Acquired Causes 􏰀 OM/OME 􏰀 Infection: meningitis, measles 􏰀 Head injury
35
Presentation and mx of pinna haematoma
Caused --> Blunt trauma -->subperichondrial haematoma. --> ischaemic necrosis of cartilage and subsequent fibrosis to “cauliflower ears”. Mx: aspiration + firm packing to auricle contour.
36
Presentation and mx of Exostoses
Bony hypertrophy due to cold exposure e.g. from swimming / surfing --> smooth, symmetrical narrowing of external canal Symptoms 􏰀 Asympto unless narrowing occludes 􏰁 conductive deafness. Rx: conservative or surgical widening
37
Mx of ear wax
Cerumen Auris - Secreted in outer 3rd of canal to prevent maceration - Wax accumulation can --> conductive deafness. Mx 􏰂 Suction under direct vision - microscope 􏰂Syringing after 1wk softening with olive oil
38
Mx of epistaxis
Examine - anterior (littles) or posterior bleed Pressure - over nose with compression device or fingers and head tilted down Insert gauze - soaked in xylometazoline +lignocaine (Ant) Silver nitrate to cauterise- locally (Ant) Then pack Admit and pack 48h (ant + post) if posterior Interventional radiology- embolization (post) Surgical consultation - ENT consult for severe or high risk bleeding
39
Causes of epistaxis
- nose picking - # - URTI - Pyogenic granuloma (overgrowth littles) - HHT - Coagulopathy - warfarin, NSAIDs, Haemophilia, low plt, vWD, high alcohol - neoplasm
40
Mx after epistaxis
``` 􏰀 Don’t pick nose 􏰀 Sit upright, out of the sun 􏰀 Avoid bending, lifting or straining 􏰀 Sneeze through mouth 􏰀 No hot food or drink 􏰀 Avoid EtOH and tobacco ```
41
Presentation, pathophysiology and mx of allergic sinusitis
- sneezing, pruitis, rhinorrhoea +/- nasal polps Seasonal - pollen; persistent - dust mites/pets; occupational - wood dust; latex etc IgE -mediated inflammation of nasal mucosa; causing large release of histamine from mast cells within mucosa Mx - allergen avoidance + regularly wash bedding on high heat; dont go outside when pollen count high 1) anti-hist; beclometasone nasal spray 2) intranasal steroids 3) immunotherapy
42
Cause, sx and mx of sinusitis
Majority are bacterial infection (pneumoccocas, haemophilus, moraxella) secondary to viral Acute 7-30d; chronic >90d ``` Sx 􏰀 Pain - Maxillary (cheek/teeth) - Ethmoidal (between eyes) - increase on bending / straining 􏰀 Discharge: from nose--> post-nasal drip and foul taste 􏰀 Nasal obstruction / congestion 􏰀 Anosmia or cacosmia (bad smell w/o external source) 􏰀 Systemic symptoms: e.g. fever ``` Mx - acute --> bed rest, decongestants, analgesia +/- nasal douching and topical steroids - chronic - stop smoking, fluticasone nasal spray ? functional endoscopic sinus surgery
43
Complications of sinusistis
rare - meningitis - orbital cellulitis - osteomyelitis - cavernous sinus thrombosis
44
Pathophysiology and presentation of nasal polyps
Lesions developing from nasal mucosa, linked with asthma; CF; Allergic / non-allergic rhinitis. Often M >40 y/o Sites 􏰀 Middle turbinates 􏰀 Middle meatus 􏰀 Ethmoids ``` Symptoms 􏰀 Watery, anterior rhinorrhoea 􏰀 Purulent post-nasal drip 􏰀 Nasal obstruction 􏰀 Sinusitis 􏰀 Headaches 􏰀 Snoring ``` Signs - Mobile, pale, insensitive Single Unilateral Polyp- May be sign of rare but sinister pathology: 􏰂 Nasopharyngeal SCC 􏰂 Glioma 􏰂 Lymphoma 􏰂 Neuroblastoma 􏰂 Sarcoma --> Do CT and get histology Nasal Polyps in Children 􏰀 Rare <10yrs old; consider neoplasms and CF Mx - Stop smoking, weight loss 􏰂 Betamathasone drops for 2/7 􏰂 Short course of oral steroids 􏰀 Endoscopic Polypectomy
45
What is the commonest congenital abnormality of the nose
- choanal atreia --> bony septum between nose and pharynx - if bilateral --> present as airway obstruction with cyclical cyanosis and crying relieves resp distress in neonates (as obligate nasal breathers)
46
Mx of fractures nose
- exclude septal haematoma (can lead to septal necrosis and nasal collapse --> swelling and nasal obstruction. Mx - evacuate and pack) - exclude basal skull # re-examine after 1 weeks (swelling reduced) reduction under GA and post-op splinting <2weeks
47
Causes of a hoarse voice
- infection e.g. acute laryngitis - inflammation - laryngeal ca - vocal cord nodule - hypothyriod, acromegaly, goitre - damage to nerve (surgery/disease) - trauma - oesophageal/ lung cancer - AA - neuropathic/ DM - cervical lymphadenopathy - stroke - MG (fatigue)
48
Presentation and criteria for tonsilitis
``` Sore throat, inflamed tonsils and oropharynx CENTOR Criteria 1) Age <14 2) Tonsillar exudates 3) Tender anterior cervical adenopathy 4) No cough 5) Fever ``` Organisms - EBV; GAS: Pyogenes; Staphs; Moraxella Mx Analgesia: Ibuprofen / Paracetamol ± gargle Centor >4 = Abx - PenV 10 days
49
Complications of strep throat + their presentation and the mx
Peritonsillar Abscess (Quinsy) - Typically adults Symptoms - Trismus; Odonophagia: unable to swallow saliva/drooling; Halitosis Signs - Tonsillitis; Unilateral tonsillar enlargement; Contralateral uvula displacement; Cervical lymphadenopathy Rx --> Admit and IV Abx 􏰂 Incision and drain under LA or tonsillectomy under GA Retropharyngeal Abscess - children - Unwell child - stiff, extended neck +refuses to eat/ drink + sx of quinsy; Fails to improve on IV Abx 􏰂 Unilateral swelling of tonsil and neck (one sided due to median raphe) Ix- Lat. neck x-rays show soft tissue swelling - CT from skull-base to diaphragm (hypodense lesion) Rx --> IV Abx; Incision and drainage Lemierre’s Syndrome 􏰀 IJV thrombophlebitis --> septic embolization most commonly affecting the lungs. Organism: Fusobacterium necrophorum Rx --> IV Abx: pen G, clinda, metro Scarlet Fever 􏰀 “Sandpaper”-like rash on chest, axillae or behind ears 12-48h after pharyngotonsillitis. 􏰀 Circumoral pallor 􏰀 Strawberry tongue Rx --> Start Pen V/G and notify HPA. Rheumatic Fever 􏰀 Carditis 􏰀 Arthritis 􏰀 Subcutaneous nodules 􏰀 Erythema marginatum 􏰀 Sydenham’s chorea Post-streptococcal Glomerulonephritis 􏰀 Malaise and smoky urine 1-2wks after a pharyngitis
50
Indications for tonsillectomy
Recurrent tonsillitis if all the below criteria are met: 􏰂 Caused by tonsillitis 􏰂 5+ episodes/yr 􏰂 Symptoms for >1yr 􏰂 Episodes are disabling and prevent normal functioning Airway obstruction: e.g. OSA in children Quinsy Suspicion of Ca: unilateral enlargement or ulceration
51
Presentation and mx of epiglottitis
No cough, sore throat, fever, dyspnoea, voice changes, dysphagia, tender anterior neck +/- cellulitis, hoarseness, pharyngitis; drooling Most commonly caused by s.pneumonia Mx - take to ITU, dont examine (risk resp arrest) - call ENT + anaesthetist - NEB Adr and IV dex and IV abx - cultures - pain relief
52
Presentation and mx of Laryngitis
Usually viral and self-limiting - 2O bacterial infection may develop Symptoms: pain, hoarseness and fever +/- globus pharygeus o/e redness and swelling of the vocal cords Rx: Supportive - rest voice, no smoking/alcohol/ hydration -Pen V if fever >48h
53
Presentation and mx of Ludwigs angina
Infection of the space between the floor of the mouth and mylohyoid, most commonly associated with dental infection (group A strep, s,aureus, bacteriodes) Clinical Features  Swelling of the floor of the mouth  Painful mouth  Protruding tongue  Airway compromise  Drooling Investigations  CT neck  OPG Management 1. Secure airway if any concerns 2. IV antibiotics 3. Surgery to drain any collection
54
What is laryngomalacia
Immature and floppy aryepiglottic folds and glottis -->laryngeal collapse on inspiration ``` Presentation Stridor: commonest cause in children - w/i first wks of life. Noticeable @ certain times 􏰂 Lying on back, 􏰂 Feeding 􏰂 Excited/upset Problems can occur - concurrent laryngeal infections or feeding. ```
55
Functions of the larynx
􏰀 Phonation 􏰀 Positive thoracic pressure: inc. auto-PEEP 􏰀 Respiration 􏰀 Prevention of aspiration
56
Causes of neck swellings
Reactive - bacteria (beta haem strep; s.aurues, TB) --> unilat - viral (EBV -glandular fever, CMV) --> bilat - parasitic - head lice - non-infective - sarcoidosis, CT disease benign - lipoma - benign ca (fibroma, chrondroma, neuroma, thyroid) - blocked salivary gland Malignant - leukaemia, lymphoma, mets, thyroid Congenital - thyroglossal cyst - branchial cyst
57
Ix of neck swellings
- bloods +/- film - viral serology - throat swab +culture - imaging > USS +/- FNA (superficial) > CXR/ CT/ MRI +/- biopsy - mass extension and additional LN involvement
58
Red flags for neck swellings
- fever - night sweats - weight loss - HSM - supraclavicular LN - >2cm LN - LN hard - SOB
59
Presentation and mx of laryngeal cancer
Majority SCC Presentation 􏰀 Male smoker 􏰀 Progressive hoarseness 􏰁 stridor 􏰀 Dys-/odono-phagia 􏰀 Wt. loss +/- neck lump/cough Ix -->Laryngoscopy + biopsy (inc. nodes); MRI staging Based on stage --> RT; Laryngectomy After laryngectomuy --> permanent tracheostomy (Speech valve and Electrolarynx) + Oseophageal speech (swallowed air) Regular f/up for recurrence
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Presentation, causes and mx of Subglottic Stenosis
Subglottis is narrowest part of respiratory tract in children. Symptoms: stridor, FTT Causes - Prolonged intubation; Congenital abnormalities Rx 􏰂 Mild: conservative 􏰂 Severe: Tracheostomy or partial tracheal resection
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Causes of thyroid nodules
Non – neoplastic nodules  Single nodule – colloid, cystic  Multinodular goitre Benign o Adenoma – Mainly follicular Malignant o Papillary adenocarcinoma – 70% - younger pt/ hx irradiation of the neck. o Follicular carcinoma – 20% - mets to bones and lungs. o Medullary carcinoma – 5% - C-cells, seen in MEN o Anaplastic carcinoma - ~5% - older patients, poor prognosis
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Red flags and Ix for thyroid nodules
Red flags - FH - High radiation exposure - painless rapidly enlarging mass - insidious pain lasting several weeks Ix (i) Thyroid function tests (calcitonin high in medullary) (ii) Ultrasound guided fine needle aspiration +/- CT/MRI
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Mx of thyroid cancer
- Thyroidectomy (SE recurrent laryngeal nerve damage and hypoparathyroid) - lifelong levothyroxine - if anaplastic - chemo/RT
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Types, presentation and mx of salivary gland cancers
80% of salivary gland neoplasms occur in parotid gland. - malignant mucoepidermoid carcinoma - benign - pleumorphic adenoma (80%) submandibular gland - 50% malignant. sublingual gland - 80% malignant Presentation - slowly enlarging painless mass - fullness in gland region Red flags - facial N palsy; mucosal ulceration, painless enlarging mass (hard and craggy) , increasing pain Ix - USS + FNA +/- CT/MRI Mx - Chemo/ radio; parotidectomy
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Presentation of sialadenitis
Sialadenitis - infection of salivary glands - Bacterial --> staphylococcal typically seen in dehydrated or immunocompromised individuals. - Viral - 1. Paramyxovirus – Mumps 2. Coxsackievirus 3. Echovirus 4. HIV Chronic sialadenitis is rare, and sometimes seen in TB, sarcoidosis, HIV, and syphilis.
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Presentation of Sialolithiasis
- Stones in the salivary duct cause obstruction and subsequently lead to pain and swelling which is worse during meals. Stones are 9 times more common in the submandibular gland than the parotid. Ix --> Ultrasound or sialogram Management Conservative - most settle with analgesia and hydration Or --> Radiological or surgical removal Complications  Sialadenitis  Abscess formation

Finals (6 decks)

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