Throat Flashcards
(74 cards)
1
Q
Define retropharyngeal abscess
A
Neck infection involving abscess formation in the space between the pre-vertebral fascia and the constrictor muscles
2
Q
Epidemiology of retropharyngeal abscess
A
Peak incidence in children between 3-5 years
- increased incidence of URTIs and oropharyngeal trauma
More common in males
3
Q
Pathophysiology of retropharyngeal abscess
A
45% occur secondary to URTI - strep viridians - staph aureus - strep epidermis - beta-haemolytic strep Occur with accidental trauma - foreign body ingestion 28% idiopathic
4
Q
Presentation of RPA
A
Spiking fever
Neck pain or torticollis - irritation of sternocleidomastoid
Odynophagia/dysphagia - difficult to swallow past abscess, drooling may occur
Neck/oropharyngeal swelling
Lymphadenopathy
Stridor
Decreased oral intake, malaise, irritability
5
Q
Ix for RPA
A
FBC
- raised WCC especially neutrophils
CT neck with contrast - ring-enhancing lesion in retropharyngeal space
X-ray of neck - if CT unavailable
USS - lymphadenopathy and fluid collection
Culture of pus from surgical drainage
6
Q
Mx of RPA
A
Emergency - airway compromise - IV corticosteroid - nebulised adrenaline - surgical drainage - ceftriaxone + clindamycin - supportive care and analgesia No airway compromise - ceftriaxone + clindamycin - IV corticosteroid - surgical drainage - supportive care + analgesia
7
Q
Complications of RPA
A
Recurrence of abscess
Necrotising fasciitis
Mediastinitis
8
Q
Define Ludwig’s Angina
A
Infection of space between floor of mouth and mylohyoid
- most commonly a/w dental infection
9
Q
Presentation of Ludwig’s Angina
A
Swelling of floor of mouth Painful mouth Protruding tongue Airway compromise Drooling
10
Q
Ix for Ludwig’s Angina
A
CT neck
Panoramic x-ray - periapical radiolucency around abscesses and periodontal bone loss
11
Q
Mx of Ludwig’s Angina
A
Secure airway
IV abx
Surgery to drain
12
Q
Define parapharyngeal abscess
A
Collection in parapharyngeal space - potential space postero-lateral to oropharynx and nasopharynx divided by styloid process Risk of damage to carotid sheath - common carotid artery - internal carotid artery - internal jugular vein - vagus nerve - deep cervical lymph nodes
13
Q
Presentation of parapharyngeal abscess
A
Hx of febrile illness Odynophagia Trismus (reduced opening of the jaw) Reduced neck movement Swelling in neck around upper part of SCM
14
Q
Mx of parapharyngeal abscess
A
Secure airway
IV abx
Surgical drainage
15
Q
Define acute epiglottitis
A
Cellulitis of supraglottis that may cause airway compromise
16
Q
Epidemiology of acute epiglottis
A
Most common between 3-5
17
Q
Pathophysiology of acute epiglottitis
A
Supraglottis becomes infected
- most commonly haemophilus influenzea
- strep pneumoniae, staph aureus and MRSA
- may occur secondary to trauma, ingestion or thermal injury
Inflammatory pathways lead to oedema and intense swelling of epiglottis
18
Q
Classification of acute epiglottitis
A
Class 1 - slight swelling - entire vocal cord visualised Class 2 - moderate swelling of epiglottitis - >50% posterior cord visible Class 3 - severe swelling - < 50% of posterior cord visible
19
Q
Presentation of epiglottitis
A
Acute onset High fever in very ill toxic looking child Intensely painful throat - prevents speaking and swallowing, may cause drooling Soft inspiratory stridor Rapidly increasing resp difficulty Tripod position Decreased oral intake Hot potato voice
20
Q
Ix for epiglottitis
A
Laryngoscopy - swelling of supraglottic structures
Lateral neck radiograph - enlarged epiglottitis
Blood cultures
21
Q
Mx of epiglottitis
A
Urgent hospital admission - call senior anaesthetist, paediatrician and ENT surgeon Secure airway Supplemental O2 IV abx Dexamethasone
22
Q
Prevention of epiglottitis
A
HiB vaccine
- part of 6 in 1 at 8, 12 and 16 weeks
HiB/MenC at 1 year
23
Q
Complications of epiglottitis
A
Resp failure
Mediastinitis - infection spreads to retropharyngeal then mediastinal space
24
Q
Features of parotid swelling
A
Anterior to ear
Swelling may be due to neoplasm, infection, obstruction or autoimmune
75% of tumours are benign
Surgical removal 1st line for neoplasms
25
Features of jugulodigastric node swelling
Angle of mandible
| Commonly enlarged in tonsillitis
26
Features of submandibular node swelling
Inferior border of mandible
May be enlarged due to salivary duct stones, sialadenitis, Sjogren's syndrome, cysts or infections
50% of neoplasms are malignant
27
Features of carotid body swelling
```
Tumour or aneurysm
At bifurcation of common carotid artery
Aneurysm mx
- watchful waiting - regular CT/MRI, anti-hypertensives, statins, thrombolysis
- surgical repair
- stent graphting
```
28
Features of thyroglossal cyst
Midline between hyoid bone and thyroid gland
Painless, smooth and cystic
Painful if infected
Caused by birth defect - remnant of thyroglossal duct cyst
Moves up on protrusion of tongue and swallowing
Only remove if affects breathing/swallowing or infected
29
Features of Branchial cyst
Anterior border of SCM
Generally present in late childhood/early adulthood
Painless mass that is noticed when becomes infected secondary to URTI
Remnant of brachial cleft - squamous epithelium surrounded by lymphoid tissue
Does not move on swallowing
Conservative mx of surgical excision - risk of damage to IJV, ICA, CN VII
30
Features of a thyroid nodule
At level of thyroid
Tissue or fluid within otherwise normal thyroid gland
Malignancy rare
- worrying symptoms = hoarse voice, rapid increase in size
- more common in males or prior radiotherapy
Located at edge of thyroid gland, often felt in a lump in throat
Measure TSH and anti-thyroid antibodies
Consider excision or treatment of thyroid disease
31
Features of Virchow's node
Left-sided supraclavicular lymph node
Metastases of malignancy
- abdo - gastric, kidney, ovarian, testicular
- lymphoma - Hodgkin's
32
Ix for neck masses
Neck USS
CXR
Bloods - FBC, TFTs
USS guided fine needle aspiration
33
Define obstructive sleep apnoea
Episodic complete or partial upper airway obstruction during sleep
34
Epidemiology obstructive sleep apnoea
4% of men
2% of women
Increases with age
35
Risk factors for OSA
```
Obesity
Large neck circumference
Maxillomadibular anomalies - excessive protrusion of upper or lower incisors
Adenotonsillar or tongue hypertrophy
FHx
Hypothyroidism
Down's syndrome
Smoking
```
36
Pathophysiology of OSA
Episodic apnoea caused by dynamic narrowing of upper airway during sleep
Upper pharyngeal dilator muscle activity decreases with sleep onset and more in REM sleep
Pharynx vulnerable to collapse at end of expiration due to loss of neural tone of dilators and loss of positive intraluminal pressure
37
Presentation of OSA
```
Collateral hx from bed partner
Episodic apnoea - terminated by loud snore
Episodic gasping
Restless sleep
Excessive daytime sleepiness
```
38
Ix for OSA
```
Polysomnography - apnoea hypopnea index
Portable multichannel sleep tests - assess nasal pressure, oximetry, thoracoabdominal effort sensors, HR
Fibreoptic endoscopy
TFTs
CXR - obstructive lung disease
ECG - right ventricular failure
```
39
Mx of OSA
```
CPAP
Upper airway surgery
Mandibular position devices
Weight loss
Modafinil - reduce persistent hypersomnolence
Positional therapy
```
40
Define tonsillitis
Acute infection of parenchyma of palatine tonsils
41
Epidemiology of tonsillitis
15-30% of children with sore throat have bacterial tonsillitis
Most common in ages -
Most common in winter and early spring
42
Pathophysiology of tonsillitis
```
Usually viral
- rhinovirus
- coronavirus
- adenovirus
Common bacteria
- group A beta haemolytic strep
- strep pneumoniae
- haemophilus influenzae
Local inflammatory pathways result in oropharyngeal swelling, oedema, erythema and pain
```
43
Presentation of tonsillitis
```
Pain on swallowing
Fever
Tonsillar exudate
Sudden onset sore throat
Headache
N+V
Abdo pain
Cough
Runny nose
Tonsillar erythema and enlargement
Swollen, painful anterior cervical lymph nodes
```
44
Ix for tonsillitis
Throat culture
| Rapid streptococcal antigen test
45
Criteria for Fever PAIN score
1 point for
- fever
- purulent tonsils
- acute onset - less than 3 days
- inflamed tonsils
- no cough/coryzal symptoms
46
Significance of fever pain score
```
0-1 = unlikely bacterial
- no abx
2-3 = possible bacterial
- delayed abx
4+ = likely bacterial
- abx
```
47
Mx of tonsillitis
```
Phenoxymethylpenicillin
- amoxicillin will cause maculopapular rash in presence of EBV
Supportive care
- paracetamol and ibuprofen
Corticosteroids
- severe swelling in children > 12
Tonsillectomy
- recurrent episodes
```
48
Differentials for tonsillitis
```
Infectious mononucleosis
- doesn't resolve within 1 week
- associated with generalised lymphadenopathy, splenomegaly, hepatomegaly, persistent weight loss
- avoid contact sports
Peri-tonsillar abscess (quinsy)
- more severe symptoms
- sore throat lateralised to one side
- hot potato voice
- confirmed by aspirate
- mx by draining abscess
```
49
Epidemiology of head and neck cancers
M:F = 2:1
50
Risk factors for head and neck cancers
Alcohol
Tobacco
Beetle nut chewing - oral cavity
Chinses ethnic origin - nasopharyngeal
51
Pathophysiology of head and neck cancers
90% squamous cell
52
Presentation of head and neck cancers
```
Dysphonia
Dysphagia
Stridor / dyspnoea
Neck mass/lump
Pain
Bleeding from nose/mouth
Nasal blockage
```
53
Ix for head and neck cancers
```
Examination under anaesthetic
- laryngopharyngoesophagoscopy
CT neck
USS guided fine needle aspiration
Open biopsy
CT chest
```
54
Mx of head and neck cancers
```
Palliation
Curative
- radiotherapy
- chemotherapy
surgery
```
55
Approach to a goitre
Confirm whether intra or extra thyroidal
Neck USS
Cervical lymph node USS to exclude malignancies
Assess hormonal activity
56
Presentation of a goitre
```
Hyperthyroidism
Hypothyroidism
Local compressive symptoms
- dysphonia
- dysphagia
- stridor
```
57
Risk factors for thyroid malignancy
```
Male
< 20 or > 60
Rapid growth
Prior neck radiotherapy
FHx
```
58
Causes of thyroid swelling
```
Benign, euthyroid hyperplasia/neoplasm
- colloid nodules - overgrowth of thyroid tissue
- thyroid adenomas - homogenous, solitary, well-encapsulated tumours of follicular epithelium
Benign, hyperthyroidic hyperplasia
- toxic adenoma - autonomously hyper-functioning thyroid nodules, increased uptake of radioactive iodine
Malignant neoplasm
- papillary thyroid cancer
- follicular thyroid cancer
- medullary thyroid cancer
- anaplastic thyroid cancer
Congenital
- thyroid cysts
- thyroglossal duct cysts
Infections/inflammatory
- acute suppurative thyroiditis
- subacute granulomatous thyroiditis
- hasimoto's
- graves
Non-thyroidal
- enlarged parathyroid glands
- metastasis
```
59
Mx of goitre
```
Non-neoplastic
- conservative
- surgery - compressive symptoms, cosmesis or patient preference
- hemithyroidectomy preferable
Neoplastic
- adenomas
- no further treatment after diagnostic hemithyroidectomy
- carcinoma
- total thyroidectomy
- post op radio-iodine
```
60
Complications of thyroid surgery
Post-op haemorrhage
Vocal cord palsy
Airway obstruction
Hypocalcaemia
61
Define acute sialadenitis
Inflammation and swelling of salivary glands
62
Causes of acute sialadenitis
```
Viral
- mumps
- coxsackievirus
- echovirus
- HIV
Bacterial
- staphylococcus
Chronic sialadenitis is rare
- TB
- sarcoidosis
- HIV
- syphilis
```
63
Presentation of acute sialadentits
```
Fever
Pain
Dysphagia
Facial swelling - unilateral
Exudates of pus from salivary gland opening
```
64
Ix of acute sialadenitis
Culture and sensitivities of exudate from duct
FBC - raised WCC
Facial radiographs - sialoiths
65
Mx of acute sialadentitis
```
Broad spec abx
Conservative
- hydration
- pain relief
- sialagogues
```
66
Define sialoliths
Stones in salivary duct causes obstruction and subsequently to pain and swelling
- worse during meals
Most likely in submandibular gland
67
Ix for sialoliths
USS
| Sialogram - x-ray looking at glands and ducts
68
Mx for sialoliths
```
Conservative
- analgesia
- hydration
- sialagogues
Radiological removal
Surgery
- intraoral removal of palpable stones
- removal of salivary gland
```
69
Complications of sialothis
Sialadenitis
| Abscess formation
70
Define Sjogren syndrome
Autoimmune lymphocytic inflammation into ductal tissue of secretory glands
71
Presentation of sjogren syndrome
Dry eyes
Dry mouth
Enlarged salivary glands
Increased risk of lymphoma
72
Types of Sjogrens syndrome
Primary
- without connective tissue disease
Secondary
- with connective tissue disease - RA
73
Diagnosis of Sjogrens syndrome
Schirmer's test - measures tears
Anti-Ro and anti-La antibodies
Minor salivary gland biopsy
74
Mx of Sjogrens syndrome
Artificial tears
| Salivary subsitutes
