ENT (throat)

Question 1

What is tonsillitis?

Answer 1

Inflammation of the tonsils (typically the palatine tonsils)

Question 2

What are the common causes of tonsillitis?

Answer 2

Mainly viral.
If bacterial then group A streptococcus (strep pyogens or strep pneumoniae)
Can also be caused by haemophilius influenzae, moraxella catarrhalis or staph aures.

Question 3

What is waldeyer’s tonsillar ring made up of?

Answer 3

6 lymphoid tissues in the pharynx

• adenoid
• tubal tonsils
• palatine tonsils
• lingual tonsil

Question 4

How does tonsillitis present?

Answer 4

Sore throat
Fever
Pain on swallowing
On examination there is swollen, red tonsils which may have white exudate (if bacterial)
Cervical lymphadenopathy

Question 5

What is the FeverPAIN score used for?

Answer 5

The probability that tonsillitis is bacterial

Question 6

What does the FeverPAIN score involve?

Answer 6

Fever in the last 24 hrs
P - pus on tonsils
A - attended within 3 days of onset of symptoms
I - inflamed tonsils
N - no cough

Question 7

What antibiotic is first line for bacterial tonsillitis?

Answer 7

Penicillin V (phenoxymethylpenicillin) - 500mg qid (4 times a day) for 5 to 10 days.

or clarithromycin if allergy to penicillin.

Question 8

What are some possible complications of tonsillitis?

Answer 8

Peritonsillar abscess - quinsy
Otitis media
Scarlet fever
Rheumatic fever
Post streptococcal glomerulonephritis
Post streptococcal reactive arthritis

Question 9

What are the symptoms of quinsy?

Answer 9

Same as tonsillitis - sore throat, painful swallowing, fever, lymphadenopathy
Sore neck
Referred ear pain
Trismus (unable to open mouth)
Change in voice (due to pharyngeal swelling)

Question 10

How is quinsy managed?

Answer 10

Hospital admission for incision and drainage
Antibiotics (broad spec such as co-amoxiclav)
Steroids to reduce inflammation (dexamethasone)

Question 11

What is quinsy?

Answer 11

An abscess (a collection of pus) forms between one of your tonsils and the wall of your throat. 
Due to the spread of the bacterial infection from the tonsil to surrounding tissues.

Question 12

What is another name for quinsy?

Answer 12

A peritonsillar abscess

Question 13

What bacteria most commonly cause tonsilitis?

Answer 13

Streptococcus pyogens (group A)
Staphylococcus aureus
Haemophilius influenza

Question 14

What bacteria most commonly cause tonsilitis?

Answer 14

Streptococcus pyogens (group A)
Staphylococcus aureus
Haemophilius influenza

Question 15

What is glandular fever?

Answer 15

A viral infection caused by the Epstein-Barr virus that commonly causes fever, lymphadenopathy and a sore throat

Question 16

What is another name for glandular fever?

Answer 16

Infectious mononucleosis

Question 17

How is glandular fever spread?

Answer 17

Saliva - kissing, sharing food utensils

Can also be spread through blood and semen (sexual contact)

Question 18

How is glandular fever managed?

Answer 18

In most it is self limiting and lasts 2-4 weeks.
Pain relief and rest.
Avoid heavy lifting and intense exercise as there is risk of splenic rupture for 1 mnth after.

Question 19

What are the symptoms of glandular fever?

Answer 19

Mainly presents in 15-24 year olds.
Fever
Lymphadenopathy
Sore throat
Fatigue

Question 20

What are some of the serious complications of glandular fever?

Answer 20

Chronic fatigue
Upper airways obstruction
Splenic rupture
Neutropenia
If patient is immunocomprised can lead to malignancy - e.g. Hodgkins lymphoma and nasopharyngeal cancers

Question 21

What are some common causes of sore throats?

Answer 21

Tonsilitis
Acute pharyngitis
Glandular fever
Common cold

Question 22

What is glossitis?

Answer 22

Inflammation of the tongue

Question 23

How does glossitis present?

Answer 23

Red, sore and swollen tongue.

The papillae atrophy giving a smooth appearance

Question 24

What can cause glossitis?

Answer 24

Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury
Irritant exposure
Some infections

Question 25

How is glossitis managed?

Answer 25

Treat underlying cause | Maintain good oral hygiene

Question 26

What is oral candidiasis?

Answer 26

Also known as oral thrush. When the fungus, candida, overgrows in the mouth - resulting in white spots / patches that coat the tongue.

Question 27

What can predispose someone to developing oral candidiasis?

Answer 27

``` Inhaled corticosteroids - not using a spacer and rinsing mouth out properly afterwards Antibiotics Diabetes Immunodeficiency Smoking Dental issues - poor hygiene, dentures ```

Question 28

How is oral candidiasis managed?

Answer 28

General advise - e.g. about oral hygiene Miconazole oral gel - 2.5ml of gel qid (4x daily) after meals for up till 7 days after symptoms disappear Nystatin suspension - 1 ml dropped into the mouth qid (4x daily) for 7 days Oral fluconazole - 50mg daily for 7-14 days

Question 29

What is fluconazole?

Answer 29

An antifungal

Question 30

What is leukoplakia?

Answer 30

White patches appear in the mouth and tongue. These are not painful, can be slightly raised and will not rub away.

Question 31

What is the risk associated with leukoplakia?

Answer 31

Small risk of it developing into mouth cancer over time.

Question 32

How can leukoplakia be managed?

Answer 32

Stop smoking Reduce alcohol intake Good oral hygiene Operation - surgery or laser if worried about tongue cancer

Question 33

What is geographic tongue?

Answer 33

An inflammatory condition where patches of the tongues surface lose the epithelium and papillae. This forms irregular patterns on the tongue which tends to relapse and remit (comes and goes). It commonly does not have any symptoms.

Question 34

What causes geographic tongue?

Answer 34

No known cause

Question 35

What conditions is geographic tongue associated with?

Answer 35

Stress and mental illnesses Psoriasis Atopy Diabetes

Question 36

What are the complications of geographic tongue?

Answer 36

Anxiety | It is benign - no link to cancer and malignancies

Question 37

What conditions can strawberry tongue indicate?

Answer 37

Scarlet fever | Kawasaki disease

Question 38

What is black hairy tongue?

Answer 38

A temporary, harmless condition where there is decreased shedding of keratin from the tongues surface. The papillae elongate to look like hairs. Bacteria and food then cause dark pigmentation.

Question 39

What can cause black hairy tongue?

Answer 39

Dehydration Dry mouth Poor oral hygiene Smoking

Question 40

How is black hairy tongue managed?

Answer 40

Adequate hydration Gentle brushing of tongue Stopping smoking

Question 41

What are the symptoms of black hair tongue?

Answer 41

- black, hair like appearance of the tongue - dry mouth - metallic taste - bad breath

Question 42

What is xerostomia?

Answer 42

Dry mouth