Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Neuro & Special Senses > Throat > Flashcards

Throat Flashcards

(188 cards)

Start Studying
1
Q

Describe the borders of the anterior triangle

A

Midline
Mandible
SCM

Roof - Investing fascia
Floor - Visceral fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name the four subdivisions of the anterior triangle

A

Carotid Triangle
Submental triangle
Submandibular triangle
Muscular triangle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the borders of the Carotid Triangle?

A

Medial border of SCM
Posterior belly of Diagastric
Superior border of Omohyoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the contents of the Carotid Triangle?

A

Common Carotid (bifurcates within at C4)
IJV
Hypoglossal and Vagus
Baroreceptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is contained within the Submental triangle?

A

Submental lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is contained within the Submandibular triangle?

A

Submandibular salivary glands
Lymph nodes
Facial Artery and Veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is contained within the Muscular Triangle?

A

Infrahyoids
Pharynx
Thyroid
Parathyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name the four Suprahyoid muscles

A

Stylohyoid
Digastric
Myelohyoid
Geniohyoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name the four infrahyoid muscles

A

Omohyoid
Sternohyoid
Thyrohyoid
Sternothyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the borders of the Posterior Triangle?

A

Posterior SCM
Anterior Trapezius
Clavicle

Roof - investing fascia
Floor - prevertebral fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name three muscles in the Posterior Triangle

A

Omohyoid
Levator Scapulae
Scalenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name three vessels in the Posterior Triangle

A

EJV Superficially
Transverse Cervical
Suprascapular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name the nerves in the Posterior Triangle

A

Accessory nerve
Cervical plexus
Trunks of Brachioplexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name three distinguishing features of the cervical spine

A
  • Triangular Vertebral Foramen
  • Bifid Spinous Process
  • Transverse Foramina

(spinal nerves exit above level)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 6 ligaments of the Cervical Spine

A 
Anterior Longitudinal
Posterior Longitudinal
Ligamentum Flavum
Interspinous
Nuchal ligament
Transverse ligament of atlas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is the Hyoid Bone damaged?

A

Strangulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name the three Deep Cervical Fascial Layers

A

Investing
Pre Tracheal
Pre Vertebral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the investing layer of Deep Cervical Fascia

A

Most superficial, surrounding all structures in the neck

Splits around trapezius and SCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the pre-tracheal layer of Deep Cervical Fascia

A

Spans between Hyoid and Thorax and fuses with Pericardium

Muscular part - encloses infrahyoids
Visceral part - encloses thyroid, trachea, oesophagus
Posterior Visceral - buccopharyngeal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the pre-vertebral layer of the Deep Cervical Fascia

A

Surrounds vertebral column/scalenes/prevertebral muscles

Anterolateral portion forms floor of the Posterior Triangle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the Pharynx?

A

Muscular tube connecting oronasal cavity to larynx and oesophagus
Begins at base of skull and descends to C6

Split into Nasopharynx, Oropharynx and Laryngopharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the structure of the Nasopharynx

A
  • Base of skull to the soft palate
  • Lined with ciliated pseudostratified columnar epithelium with goblet cells
  • Contains Adenoids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the structure of the Oropharynx

A

From soft palate to superior border of epiglottis

Contains posterior 1/3 tongue, lingual tonsils, palantine tonsils and superior constrictor muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the structure of the Laryngopharynx

A

Between superior border of epiglottis and inferior border of cricoid

Contains Piriform Fossae and Middle/Inferior constrictors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
The muscles of the Pharynx include Circular and Longitudinal. Describe the circular muscles
Superior, Middle and Inferior constrictors Contract sequentially for Peristalsis Inferior splits into two parts so if inferior part doesn't relax - diverticulum Innervated by Vagus
26
The muscles of the Pharynx include Circular and Longitudinal. Describe the longitudinal muscles
Stylopharyngeus, Palatopharyngeus, Salpingopharyngeus Shorten and widen pharynx, and elevate larynx in swallowing All Vagus innervation (except Stylopharyngeus - CNIX)
27
Describe the blood supply to the Pharynx
Branches of the ECA
28
Name the four roles of the Larynx
Phonation, Ventilation, Coughing, Protection of LRT
29
Describe the anatomy of the Larynx
Spans C3-C6 Covered anteriorly by infrahyoids Anterior to Oesophagus 3 Subsections (Supra, Glottis, Infra)
30
Describe the blood supply to the Larynx
``` Superior Laryngeal (Branch of Superior Thyroid) Inferior Laryngeal (Branch of Inferior Thyroid) ```
31
Describe the innervation of the Larynx
RLN - Sensory to Infraglottis and Motor to all except Cricothyroid Superior Laryngeal - Sensory to Supraglottis and Motor to Cricothyroid
32
Name the three unpaired cartilages of the Larynx
Thyroid Cartilage (Laryngeal Prominence) Cricoid (complete ring) Epiglottis
33
Why is the fact that the Cricoid is a complete ring relevant?
Pressure can be applied to occlude the oesophagus and prevent regurgitation of contents during Emergency Intubation
34
Name the three paired cartilages of the Larynx
Arytenoid Corniculate Cuneiform
35
There are extrinsic and intrinsic Laryngeal ligaments. Name the two main intrinsic ligaments
Cricothyroid (upper margin is free edge - vocal ligament) Quadrangular (lower margin is thickened to become vestibular)
36
Describe the histology of vocal cords
Stratified Squamous Epithelium Reinke's Space (Watery GAG layer vibrates to make sound) Vocal Ligament Vocal Muscle Relatively avascular
37
What is the Vestibular Ligament?
AKA False Vocal Cord Lies above true vocal cord
38
What is the role of the extrinsic laryngeal muscles?
Suprahyoids - laryngeal elevation | Infrahyoids - laryngeal depression
39
What do the intrinsic muscles of the larynx do (except Cricothyroid)?
Control Rima Glottidis, and length/tension of vocal cords Innervated by inferior laryngeal nerve (from RLN)
40
What does the Cricothyroid Muscle do?
Stretches and tenses vocal ligament Innervated by External Branch of Superior Laryngeal
41
Why is the Posterior Cricoarytenoid Muscle so important?
It is the sole Abductor of the larynx/vocal cords, allowing breathing
42
Describe the anatomical relations of the Thyroid Gland
Anterior - Infrahyoids Lateral - Carotid Sheath Medially - larynx/pharynx/RLN/External branch
43
Describe the blood supply of the Thyroid Gland
- Superior Thyroid (first branch of ECA) - Inferior Thyroid (From thyrocervical trunk - branch of subclavian) - 10% have additional Thyroid IMA artery from Braciocephalic trunk
44
Describe the venous drainage of the Thyroid Gland
Superior Middle and Inferior Thyroid Veins form a plexus Superior and Middle drain into IJV and Inferior drains into braciocephalic
45
Describe the lymphatic drainage of the Thyroid Gland
Paratracheal | Deep cervical
46
What are the Parathyroid Glands?
Located on posterior aspect of thyroid gland (between 2 and 6 in number) Superior from fourth pharyngeal arch Inferior from third pharyngeal arch
47
What is the Cervical Plexus?
Anterior Rami of C1-C4 Clinically relevant for sensory nerve block at Erb's Point (middle of posterior SCM)
48
Name the four tonsils in Waldeyer's Ring
Lingual Palantine Tubal Adenoid
49
Describe the pathway of the Carotid Arteries
Right - Braciocephalic Left - Aortic Arch Ascend until C4 where they split in Carotid Triangle External branches - Superior Thyroid, Ascending Pharyngeal, Lingual, Facial, Occipital, Posterior Auricular, Maxillary, Superficial Temporal
50
Describe the anatomy of the Thyrocervical Trunk
Branch of the Subclavian Artery Inferior Thyroid, Ascending Cervical, Transverse Cervical, Suprascapular Artery
51
Retropharyngeal Abscesses are often seen in young children, describe the aetiology
URTI causes adenitis in retropharyngeal nodes with then causes an abscess Normally polymicrobial (S.Aureus, H.Parainfluenza)
52
How do Retropharyngeal Abscesses present?
``` Severe sore throat Dysphagia Trismus Stridor Neck stiffness and head tilted back ```
53
Give three differentials for a Retropharyngeal Abscess
Angio-oedema Epiglottitis Foreign Body
54
Name four investigations for Retropharyngeal Abscess
Bloods (WCC and CRP very high) - Blood Cultures (often negative) - Pus Culture (after drainage) - Lateral Neck Xray (prevertebral soft tissue swelling and widening of retropharyngeal space) If above is not diagnostic - CT with IV Contrast
55
What would a CT of Retropharyngeal Abscess show?
Hypodense lesion in retropharyngeal space with peripheral ring enhancement
56
How would you manage a Retropharyngeal Abscess?
?Surgical Airway IV Fluids Per Oral drainage under anaesthetic IV Co-Amoxiclav
57
Name three complications of Retropharyngeal Abscesses
Airway Obstruction Mediastinitis Pericarditis
58
Parapharyngeal Abscesses are the second most common (after Peritonsillar). Where is the Parapharyngeal Space?
Lateral to superior pharyngeal constrictor and medial to pterygoids
59
How does a Parapharyngeal Abscess present?
Fever Sore Throat Neck Swelling Anterior - Lock jaw and hard mass along mandible Posterior - minimal lock jaw but can involve carotid sheath (rigors, high fever, carotid rupture)
60
How are Parapharyngeal Abscesses investigated?
CT | FNE
61
How are Parapharyngeal Abscesses managed?
``` IV Co-Amoxiclav Surgical Drainage (usually through submaxillary fossa) ``` This may have to be repeated if reaccumulations
62
What is Ludwig's Angina?
Bilateral aggressive cellulitis involving the sub mandibular space. Rapidly spreading and normally without abscess formation
63
What is the cause of Ludwig's Angina?
Usually dental infections Oral Ulcerations Malignancy Penetrating Injuries
64
How does Ludwig's Angina present?
``` Swelling on the floor of mouth Painful mouth Protruding tongue Airway compromise Drooling ```
65
How is Ludwig's Angina investigated?
CT Neck Orthopanomogram (wide view XRay of lower face) Culture
66
How is Ludwig's Angina managed?
Airway management (upright with O2 supplementation - unless surgery where nasal intubation is required) IV Benzylpenicillin and IV Metronidazole Surgical debridement if failing to respond to abx within 24h or if severe
67
Name three investigations for Hoarse Voice
Flexible Nasal Endoscopy Microlaryngobronchoscopy (similar to FNE but under GA) Stroboscopy (synchronised flashing lights makes vocal cord movement appear slower)
68
Name 5 benign causes of Hoarse Voice
``` Vocal Cord Nodules Muscle Tension Dysphonia Vocal Cord Polyps Larygneal Papilloma Reinke's Oedema ```
69
What are Vocal Cord Nodules?
Commonly secondary to Phonotrauma Frequently bilateral Breathy and Husky with low pitch Managed by SALT team, rarely requires microlaryngoscopic surgery
70
What is Muscle Tension Dysphonia?
Often caused by stress/anxiety Hoarse voice towards EOD or after extended use Confirmed by Stroboscopy Managed by SALT
71
What are Vocal Cord Polyps?
Caused by acute injury/GORD/smoke inhalation Typically benign but unilateral so requires excision to rule out malignancy
72
What is a Laryngeal Papilloma?
Benign lesion of the larynx, commonly caused by HPV6 and HPV11 Confirmed by histology Requires excision as they can cause airway obstruction
73
What is Reinke's Oedema?
Oedema of vocal cords strongly linked to female smokers Managed by smoking cessation and voice therapy
74
Name two infective causes of Hoarse Voice
Larygnitis | Epiglottitis
75
What is Laryngitis?
- Inflammation of the vocal cords, normally following --------Respiratory Tract Infection - May be associated with pain - Normal clinical assessment - FNE - inflamed larynx with dilated vessels - Self limiting
76
Name a neurological cause of Hoarse Voice
RLN palsy (stroke, MS, Thyroidectomy, malignancy)
77
Name three malignant causes of Hoarse Voice
Laryngeal Ca Lung Ca Thyroid Ca
78
What is Stridor?
Noise made by forced air through a narrow upper airway Narrowing occurs below Supraglottis (Stertor) but above Bronchioles (wheeze)
79
What is the Bernculli Principle?
As airway begins to narrow, velocity increases and linear pressure exerted decreases, causing airway collapse
80
How can the characteristics of the Stridor help to determine the location?
Inspiratory - Laryngeal Expiratory - Tracheobronchial Biphasic - Subglottic or Glottic
81
Name three red flags associated with Stridor (other than Stridor itself)
Quiet Trismus Drooling
82
Management should be initiated before definitive cause is found. Name three possible investigations
FNE Bronchoscopy CT
83
Describe Acute Stridor management
1) Stabilise, Start O2, Contact specialists 2) Suction any secretions 3) Adrenaline or Steroids as necessary 4) Take bloods
84
Give four acute causes of Stridor
FB Inhalation Epiglottitis Croup Anaphylaxis
85
State four chronic causes of Stridor
Laryngomalacia Subglottic Stenosis Vocal Cord Paralysis Subglottic Haemangioma
86
What is Laryngomalacia?
Congenital abnormality where larynx collapses in breathing Types: 1) Tight Aryepiglottic Folds 2) Redundant soft tissue in Supraglottis 3) NMD/GORD Normally self resolves
87
What is Subglottic Stenosis?
Can be congenital, idiopathic, or acquired (eg post intubation) Graded using Cotton Myer classification Managed with daily prednisolone
88
What is a Subglottic Haemangioma?
Most common head and neck tumour in children Nasal breathing but normal cry Diagnosed with microlaryngoscopy/bronchoscopy Treated with Steroids/Propanolol/Excision
89
Give three causes of Acute Throat Pain
Pharyngitis Tonsillitis Peritonsillar Abscess
90
Give three causes of Chronic Throat Pain
Pharyngitis (Tobacco, Alcohol) Gastric Reflux Vitamin Deficiency (D,B12, Folate)
91
Peritonsillar Abscesses are a complication of Tonsillitis. Describe the pathophysiology
Usually starts with acute follicular tonsillitis, then peritonsillitis Pus then becomes trapped between tonsillar capsule and lateral pharyngeal wall Normally S.Pyogenes/S.Aureus/H.Influenza
92
How do Peritonsillar Abscesses present?
``` Severe throat pain which may become unilateral Fever Drooling Foul Breath Hot Potato voice Trismus ```
93
Peritonsillar Abscesses should be treated as a clinical diagnosis and referred to ENT that day. Describe the management
Fluids and Analgesia Initial IV Benzylpenicillin and Metronidazole, before switching the Oral Pen V and Metronidazole Needle aspiration and incision drainage
94
Name three risk factors for Oral Candidiasis
Broad Spectrum Antibiotics Immunocompromised Steroid Inhalers
95
Name three types of Oral Candidiasis
Oral Thrush (curd like white patches that can be rubbed off) Erythematous (Marked erythema and soreness after oral abx) Median Rhomboid
96
How is Oral Candidiasis managed?
Children - Muconazole gel Immunocompetent - Muconazole gel or Nystatin Immunosupressive - Fluconazole
97
Name four red flags associated with Neck Lumps
Hard and Fixed Epistaxis Constitutional Symptoms Cranial Nerve Palsy
98
Name two infective causes of Neck Lumps
Reactive Lymphadenopathy | Sialadenitis
99
Name two Neoplastic causes of Neck Lumps
Lymphoma | H and N Cancer
100
Name two Inflammatory causes of Neck Lumps
Sarcoidosis | Thyroid Nodule
101
Name two congenital causes of Neck Lumps
Cystic Hygroma | Branchial Cyst
102
Name a vascular cause of Neck Lumps
Carotid Body Tumour
103
How are neck lumps investigated?
USS +/- FNA Excisional Biopsy if Lymphoma CT/MRI
104
What is a Cystic Hygroma?
Benign fluid filled sac caused by malformation of the lymphatic system Can be anywhere but classically posterior triangle
105
How does a Cystic Hygroma present?
Soft painless fluctuant mass that transilluminates Can grow large enough to cause airway compression/dyphagia Can be associated with clinical syndromes (eg Turners)
106
How are Cystic Hygromas managed?
Only required if symptomatic | Surgical excision or Lymphatic Sclerotherapy
107
Carotid Body tumours are neuroendocrine tumours arising from Paraganglion cells. How do they present?
Pulsatile Painless Neck Lump | Typically can move side to side but not up and down
108
How are Carotid Body Tumours managed?
Can be managed conservatively with active monitoring via serial imaging May require surgical excision Radiotherapy for unresectable tumours
109
What is a Thyroglossal Cyst?
Congenital fluid filled sac due to remnant of Thyroglossal Duct Painless midline cyst that moves up and down on tongue protrusion
110
How are Thyroglossal Cysts managed?
Surgical intervention with Sistrunk Procedure Central body of Hyoid is removed to allow complete removal of tract
111
What are Branchial Cysts?
Congenital masses arising in the lateral aspect of the neck due to incomplete obliteration of branchial clefts (typically anterior to SCM) If large can compress
112
How are Branchial Cysts managed?
FNA to exclude cystic metastases of SCC Surgical Excision +/- Sclerotherapy
113
How does Oral Cavity SCC present?
Painless mass Bleeding May have preceding Leukoplakia/Erythroplakia
114
How does Pharyngeal Cavity SCC present?
Odynophagia Dysphagia Stertor Often metastasise early due to extensive lymphatics
115
How does Nasopharyngeal SCC present?
Trotter's Triad Unilateral conductive deafness Trigeminal Neuralgia Defective Soft Palate Motility
116
How does Laryngeal SCC present?
Hoarse voice Dysphagia Persistent Cough Glottis has could prognosis due to poor lymphatic drainage
117
How are Head and Neck SCCs investigated?
Examination under anaesthesia (+laryngopharyngooesophagoscopy) Biopsy CT FNA Neck metastases
118
How is SCC of the Oral Cavity managed?
Small - Wide local excision +/- Neck dissection Large- Resection, Neck Dissection, Flap Reconstruction, Radio/Chemo
119
How is SCC of the Oropharynx managed?
Small Tonsil - Resection Large Tonsil - Solely chemoradio Small Tongue Base - Resection Large Tongue base - Chemoradio
120
Name 5 subtypes of Thyroid Cancer
``` Papillary Follicular Medullary Anaplastic Lymphoma ```
121
Describe Papillary Thyroid Cancer
Commonest type, usually in 40-50y Papillary and Colloid filled follicles May have hx of irradiation to the neck
122
Describe Follicular Thyroid Cancer
Second most common Microscopic capsular invasion Usually Haematogenous spread
123
Describe Medullary Thyroid Cancer
Arise in Parafollicular (C) cells therefore cause a rise in Calcitonin Associated with MEN2 Syndrome
124
Describe Anaplastic Thyroid Cancer
Rare, Aggressive and normally in elderly Poor Prognosis
125
Describe Lymphoma Thyroid Cancer
Rare | Grow Rapidly with marked compressive and B symptoms
126
Name four risk factors for Thyroid Cancer
Female FH (MEN) Childhood Radiation Hashimotos
127
Thyroid Cancer normally presents as palpable lump (S). Describe some red flags
Rapid growth and pain Cough/Hoarse Voice Lump Tethering
128
Name three differentials for Thyroid Cancer
Benign Thyroid Adenoma Toxic Multinodular Goitre Thyroglossal Duct Cyst
129
How is Thyroid Cancer investigated?
TFTs Ultrasound Thyroid FNA
130
Describe the Ultrasound features of Thyroid Cancer
Microcalcification Hypoechogenicity Irregular Margin Allocated a score U1-U5 (U3-U5 requiring FNA)
131
Describe the FNA classification of Thyroid Cancer
``` Thy1 - Inconclusive Thy2 - Non Malignant Thy3 - Follicular, excision and histology Thy4 - Suspicious, Hemithyroidectomy Thy5 - Malignant ```
132
Describe the surgical management of Thyroid Cancer
Hemithyroidectomy Total Thyroidectomy Neck Dissection
133
Describe the non surgical management of Thyroid Cancer
Radioiodine Theraoy (Papillary or Follicular) External Beam Radiotherapy Chemotherapy
134
Name three complications of Thyroidectomy
Haematoma RLN Damage Hypocalcaemia
135
Describe the anatomy of the Parotid Salivary Gland
- Anterior to Pinna and Lateral to Mandibular Ramus - Split into deep and superficial lobes by the facial nerve - Opens into Stensons duct - 80% Salivary Gland Neoplasms are here
136
Describe the anatomy of the Submandibular Salivary Gland
Inferior to body of mandible and superior to Digastric Duct opens up into Wharton's Duct (close to tongue frenulum) Mixed mucous and serous secretions
137
Describe the anatomy of the Sublingual Salivary Gland
Located on the floor of the mouth Secretes into Rivinus Duct
138
What is Sialoadenitis? Give five causes
Inflammation of the Salivary Gland (can be acute or chronic) Infective (eg mumps), Stones, Malignancy, Autoimmune, Idiopathic
139
What is Heerfordt's Syndrome?
A form of Sarcoidosis Parotid Enlargement, Anterior Uveitis, Facial Nerve Palsy
140
How does Sialoadenitis present?
Painful swelling and tenderness of gland Pyrexia Lymphadenopathy Purulent discharge from ducts
141
How is Sialoadenitis investigated?
Routine bloods (inc ESR if autoimmune suspicious) - Blood/Pus swabs - FNA if suspecting malignancy - USS
142
How is simple Sialoadenitis managed?
- Initially conservative with hydration, analgesia and artificial saliva - Use Sialogogues - Abx if suspecting bacterial
143
What are Sialogogues
Lemon Juice Massage Gland Promoting salivation
144
How is a Sialoadenitis Abscess managed?
Incision and drainage | Abx
145
What is Sialolithiasis?
Presence of calculi in the salivary glands or ducts
146
Describe the pathophysiology of Sialolithiasis
Typically following stagnation of saliva, and is composed of calcium phosphate and hydroxyapatite (as saliva is calcium rich) Usually in the Submandibular gland as it has a long duct and secretions are more mucoid
147
Give three risk factors for Sialolithiasis
Medication Dehydration Smoking
148
How does Sialolithiasis present?
May be asymptomatic Intermittent facial swelling associated with eating (can be painful or painless) Stones may feel palpable or glands may feel tender
149
What three investigations could be done for Sialolithiasis?
USS - normally first line XRay - as most stones are radio-opaque Sialography - not routinely performed as invasive
150
Sialolithiasis is initially managed conservatively. How could recurrent/persistent disease managed?
- Sialoendoscopy and removal - Transoral surgical removal - Extracorporeal Shock Wave Lithotripsy - Gland removal
151
Give two examples of benign salivary tumours
``` Pleomorphic Adenoma (can undergo malignant change) Warthin's Tumour ```
152
Give four examples of malignant salivary tumours
Mucoepidermoid Carcinoma Acinic Cell Carcinoma Adenoid Cystic Carcinoma SCC
153
Give three risk factors for Salivary Gland Malignancy
Radiation EBV Smoking
154
How can a Salivary Gland Malignancy present?
Slowly enlarging painless mass (maybe associated facial nerve palsy) Large - airway obstruction, dysphagia
155
How are Salivary Gland Malignancies investigated?
USS and FNA CT Staging
156
Describe the management of Salivary Gland Malignancies
- Surgical Excision (may have to sacrifice facial nerve if parotid) - Selective neck dissection - Radiotherapy DO NOT RESPOND WELL TO CHEMOTHERAPY
157
Describe three early complications of Salivary Gland Malignancy management
Haematoma Facial Nerve Injury Marginal Mandibular/Hypoglossal/Lingual damage
158
Describe three late complications of Salivary Gland Malignancy management
Frey's Syndrome (Post parotidectomy - autonomic fibres reform inappropriately, causing inappropriate redness and sweating) Salivary Fistula
159
What is Sjogren's Syndrome?
Autoimmune inflammatory disorder characterised by diminished lacrimal and salivary excretion (due to lymphocytic infiltration of glands)
160
Describe the clinical features of Sjogren's
MAD FRED Myalgia, Arthralgia, Dry mouth, Fatigue, Raynauds, Enlarged Parotids, Dry Eyes
161
How is Sjogren's investigated?
Autoantibodies - Anti Ro Schirmers tear volume (reduced) Salivary gland biopsy (lymphocytic infiltration
162
How is Sjogren's managed?
Avoid dry/smoky atmosphere Hypermellose tears/artificial saliva Beware of neonatal HB
163
Define OSA
Obstructive Sleep Apnoea Upper airway narrowing, provoked by sleep causing daytime sleepiness
164
Describe some causes of OSA
Small Pharyngeal Size - Neck Fat, Large Tonsils, Craniofacial abnormalities Excess narrowing - Obesity, NMD, Muscle relaxants
165
How does OSA present?
Excessive snoring Daytime sleepiness Nocturia
166
How is OSA investigated?
Epworth Sleepiness Scale Overnight Oximetry Sleep Study EEG
167
Describe the management options for OSA
Conservative - lose weight Surgical - Pharyngeal surgery to remove excess tissue from soft palate and pharynx, and removes tonsils CPAP/BiPAP
168
How can Post Tonsillectomy Bleeds present?
Can occur in surgery or secondary (after 24h) Herald bleed (small and stops itself) signals an incoming larger haemorrhage so should be treated as an emergency
169
Give 6 Structural Causes of Dysphagia
``` FB Benign Stricture (eg GORD) Pharyngeal Pouch Scleroderma (CREST) Plummer Vinson Syndrome Tumour ```
170
What is a Pharyngeal Pouch?
- Inferior pharyngeal constrictor is split into two parts (thyropharyngeus and cricopharyngeus) - Normally in swallowing cricopharyngeus will relax when thyropharyngeus contracts (if not then high pressure and diverticulum forms) - Halitosis, Regurgitiation, Palpable lump Req surgery
171
What is Plummer Vinson Syndrome?
Long term iron deficiency leading to tissue growth
172
Name 5 structural causes of Dysphagia
``` Achalasia Presbyoesophagus Myasthenia Gravis Bulbar Palsy ALS (Motor Neurone Disease) ```
173
Describe the pathophysiology of Achalasia
Impaired peristalsis and increased lower oesophageal sphincter pressure (with inadequate relaxation on swallowing)
174
Name three presenting features of Achalasia
Dysphagia Retrosternal Chest Pain Bolus Impaction
175
How is Achalasia investigated? What would they show?
Barium Swallow (dilation of oesophagus behind heart - bird's beak) Oesophageal Manometry (abnormal peristalsis and high LOS pressure)
176
How is Achalasia managed?
Heller Myotomy | Pneumatic Dilation
177
What are causes of tonsillitis?
Group A strep, strep pyogenes Haemophilus influenzae Moraxella catarrhalis staph aureus
178
What is the typical presentation of tonsillitis?
Sore throat, fever above 38, pain on swallowing Red inflamed enlarged tonsils Centor criteria - score of 3 or more, offer abx Fever over 38, tonsillar exudates, absence of cough, tender anterior cervical lymph nodes ``` FeverPAIN score - score of 4-5 higher probability Fever during prev 24 hours Purulence Attended within 2 days of symptoms Inflamed tonsils No cough or coryza ```
179
When and what abx are given for tonsillitis?
Penicillin V/phenoxymethylpenicillin - 10 day course or clarithromycin If centor >3 or fever PAIN >4
180
What are the complications of tonsillitis?
``` Peritonsillar abscess - quinsy Otitis media Scarlet fever Rheumatic fever Post strep glomerulonephritis Post strep reactive arthritis ```
181
What is the presentation of quinsy?
Sore throat, painful swallow Fever, neck pain, ear pain Swollen tender lymph nodes Trismus - cannot open mouth Change in voice - hot potato Swelling and erythema
182
What is the management of quinsy?
Incision and drainage under GA, broad spectrum abx e.g. co-amoxiclav before and after surgery Some give steroids e.g. dexamethasone to settle inflammation and help recovery
183
What are the indications for a tonsillectomy?
7 or more in 1 year 5 per year for 2 years 3 per year for 3 years Recurrent tonsillar abscesses - 2 episodes Enlarged tonsils causing difficulty breathing, swallowing or snoring
184
What is the management of a post tonsillectomy bleed?
``` Call ENT IV access Send bloods - FBC, clotting, group and save Keep patient calm, adequate analgesia Sit up, spit out blood Make patient NBM IV fluids ``` If severe bleeding or airway compromise - anaesthetics If less severe - hydrogen peroxide gargle, adrenalin soaked swab applied topically
185
What is glossitis and some causes?
Inflamed tongue - red, sore, swollen, papillae of tongue shrink, tongue looks smooth ``` Iron deficiency anaemia B12 deficiency Folate deficiency Coeliac disease Injury/irritant ``` Management is to correct underlying cause
186
What is geographic tongue?
Inflammatory condition Patches of tongue lose epithelium and papillae Patches are irregular Can last days to weeks, tend to relapse and remit Stress and mental illness Psoriasis Atopy Diabetes
187
What are the causes of strawberry tongue?
Tongue is swollen and red, papillae enlarged, white and prominent. Scarlet fever Kawasaki disease
188
What is black hairy tongue?
Decreased shedding of keratine Papillae elongate, appear as hairs Bacteria and food cause dark pigmentation Sticky saliva Metallic taste Due to dehydration, dry mouth, poor oral hygiene, smoking

Neuro & Special Senses (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions