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Throat Flashcards

1
Q

What is the anterior cylinder called

A

Larynx

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2
Q

What is the posterior cylinder

A

Pharynx

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3
Q

What does larynx continue into?

A

Larynx-trachea-airway

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4
Q

What does pharynx continue into?

A

Pharynx- oesophagus

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5
Q

Extension of larynx?

A

From C3 to C6

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6
Q

What is larynx is made up of?

A

Muscles in between cartilages

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7
Q

Cartilages of larynx

A

Total 6
3 paired
3 unpaired

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8
Q

What is the Largest laryngeal cartilage?

A

Thyroid cartilage

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9
Q

What are the three unpaired cartilages of the larynx?

A

ETC

Thyroid

Cricoid (ring like)

Epiglottis (leaf like, rises above the glottis)

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10
Q

What are the three paired cartilages of larynx?

A

CAC

Arytenoid
Cuniform
Corniculate

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11
Q

Which cartilage does not ossify with age?

A

Elastic cartilages:

Epiglottis will never ossify

Cuniform and corniculate aswell but they are rudimentary so not that important.

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12
Q

What are the hyaline cartilage of larynx ?

A

CAT

Thyroid
arytenoid
Cricoid

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13
Q

What are Vocal cords made up of?

A

Anterior 2/3rd membranous
Posterior 1/3rd cartilaginous

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14
Q

Which cartilages make posterior one third of vocal cords?

A

Arytenoid Cartlidge

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15
Q

What are pharyngeal arches made up of?

A

Mesoderm

(4 and 6.
5th obliterates)

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16
Q

4th pharyngeal arch structures?

A

3 cartilages.

CuTE

Cuniform
Thyroid
Epiglottis
+
ALL pharyngeal muscles EXCEPT stylopharyngeous muscle
+
All extrinsic muscles of larynx
+
superior laryngeal nerve

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17
Q

From which arch stylopharyngeus muscle is made of?

A

Third arch

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18
Q

What are the two nerves that supply the larynx?

A

Superior laryngeal nerve (SLN)
Recurrent laryngeal nerve (RLN)

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19
Q

6th pharyngeal arch structures?

A

CAC cartilages

Cricoid
Arytenoid
Coniculate
+
ALL intrinsic muscles of larynx EXCEPT cricothyroid muscle
+
Recurrent laryngeal nerve

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20
Q

From which arch does cricothyroid muscle develop from?

A

4th pharyngeal arch

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21
Q

What are the three pharyngeal constrictor muscles?

A

Superior, middle and inferior constrictor muscles

All supplied by vagus nerve

All Present Retropharyngeal

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22
Q

All muscles of the pharynx are supplied by vagus nerve, except which muscle?

A

Stylopharyngeus

innervated by the glossopharyngeal nerve CN9

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23
Q

What is Torus Tubarius?

A

It is an area of cartilage covered in mucosa raised above the auditory tube present in the nasopharynx

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24
Q

What is pharyngeal plexus composed of?

A

CN8, CN9 and sympathetic fibres

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25
Q

Nerve supply of pharyngeal muscles

A

Vagus nerve- All muscles *except *
Stylopharyngeous- CN9
Tensor veli palatini- Mandibular div. Of CN5

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26
Q

Blood supply of pharynx

A

Common carotid artery — external carotid artery — acsending pharyngeal artery

Drained into pharyngeal venous plexus

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27
Q

lymphatic drainage of pharynx

A

Jugulodigastric nodes (tonsillar nodes)

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28
Q

What is the Adams apple?

A

It is laryngeal prominence present medially at the spine of the thyroid cartilage

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29
Q

Only complete ring of cartilage in the airway?

A

Cricoid cartilage

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30
Q

Innervation of larynx- Motor

A

The larynx is innervated by branches of the vagus nerve (CN X):

Superior laryngeal n.
• External branch - innervates cricothyroid m

Recurrent laryngeal n.
Motor - to all intrinsic muscles of larynx (except cricothyroid m.)

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31
Q

What are the intrinsic muscles of larynx

A

Adductors Abductors and tensors

Vocalis m. in vocal folds, produces minor adjustments in vocal ligament tension

Arytenoid m. (thyro, inter.) - adduct vocal folds (close glottis)

Posterior cricoarytenoid m. - abduct vocal folds (open glottis)
only muscle that opens the airway!

All innervated by recurrent laryngeal n. except cricothyroid

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32
Q

Lymphatics of larynx

A

Above vocal folds - superior deep cervical lymph nodes

Below vocal folds - pretracheal or paratracheal lymph nodes, then to inferior deep cervical lymph nodes

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33
Q

Blood supply of larynx

A

Arteries - branches of superior and inferior thyroid arteries

Superior laryngeal a. branch of superior thyroid a., pierces thyrohyoid membrane

Inferior laryngeal a. - branch of inferior thyroid a., runs with end of recurrent laryngeal n.

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34
Q

Stages of deglutition

A

• Stage 1 - voluntary, tongue pushes bolus against hard palate into oropharynx

• Stage 2 - involuntary
• Soft palate elevates to close passage into nasopharynx
• Epiglottis closes over larynx

• Stage 3 - pharyngeal constrictors sequentially contract pushing bolus into esophagus, esophagus transports bolus from pharynx to stomach

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35
Q

What is the primary function of larynx?

A

Primary- protection of lower airways
Secondary- phonation

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36
Q

Process of phonation

A

Function of the true vocal cords or glottis in adduction position, (closed)
During the exhalation of air

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37
Q

What is puberphonia
Rx

A

Adult male, having high-pitched voice
Rx- speech therapy initially, (Hey man, have guts) **Gutzmann’s manoeuvre **
For 3 to 6 months

If no improvement

*Surgical management *- type 3 thyroplasty (surgical shortening and loosening of vocal cords)

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38
Q

What is Androphonia
Rx

A

Adult female with the low pitched voice.
Rx-
direct surgical manoeuvre- type 4 thyroplasty (surgical lengthening and tightening of vocal cords)

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39
Q

What are the two vocal disorders?

A

Androphonia
Puberphonia

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40
Q

Types of laryngoscopy

A
  1. Indirect- using a straight mirror. Done in OPD.
  2. Direct- using

CURVED BLADE Macintosh in ADULTS

STRAIGHT BLADE miller in infants(peads)
Pt. Is sedated, done in OT Only. Held in non dominant hand.

  1. Flexible laryngoscope, wire thru the nose.
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41
Q

Indications for direct laryngoscopy

A

1 intubation
2 biopsy

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42
Q

Male, smoker, presents w hoarseness is voice
Dx

A

Keratosis larynx OR
Renkies edema

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43
Q

Normal lining of larynx

A

Pseudostratified ciliated, columnar epithelium

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44
Q

Normal lining of the vocal chords

A

Stratified squamous epithelium

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45
Q

What is ketosis larynx?

A

In smokers, the epithelium lining the vocal cords sheds at a faster rate. Therefore, there is hoarseness a voice, 

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46
Q

Ketosis larynx Rx

A

Decortication + quit smoking

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47
Q

Patient with complains of weak and breathy voice
Laryngoscopic examination shows keyhole gap incomplete closure of vocal cords even after complete adduction (elliptical gap)

A

Phonaesthenia

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48
Q

Phonaesthenia
Patho physio
Rx

A

Muscles of adduction- thyroarytenoid TA and interarytenoid IA weakness/ paralysis
Causing some gap
Both muscles- keyhole gap
TA only- elliptical gap

Rx- speech therapy

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49
Q

Chronic smoker
Hx of hoarseness
Laryngoscopy shows swelling of vocal cords
Dx
Rx

A

Reinke’s edema
Collection of fluid in the reinkes space of the VC.
(Space Bw the mucosa and vocal ligament)
RISK FACTOR - smoking
Rx. Of choice- decortication (same as keratosis larynx)

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50
Q

Laryngeal web
Rx

A

-Congenital anomaly
Extra tissue bw the VC
-Most common site is glottis

child with hoarse cry

RX.
- CO2 laser excision

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51
Q

Subglottic stenosis types

A

1 Congenital
Child, born with a smaller lumen

2 Acquired
Recurrent infections, causing inflammation, causing oedema, leading to stenosis

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52
Q

Subglottic stenosis grading

A

Cotton myele grading
Grade 1 and 2 (0-70)
conservative

Grade 3 and 4 (70-100)
surgical- LTR laryngotracheal reconstruction

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53
Q

Trumpet player presents to OPD with complain of neck swelling. on pressing swelling, hissing sound is noted.
X-ray soft tissue neck shows air filled swelling
CT same

A

Laryngocele

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54
Q

Hissing sound on pressing swelling

A

Bryce sign

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55
Q

Laryngocele
Dx
Rx

A

Abnormal dilation of saccule

In wind instrument players mostly or weight lifters

Do X-ray soft tissue neck with VALSALVA MANOEUVRE

Rx- surgical excision

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56
Q

Levels of neck

A
  1. Submental + submandibular
  2. Upper deep cervical
  3. Middle deep cervical
  4. Lower deep cervical
  5. Supraclavicular
  6. Prelaryngeal/pretracheal/delphian
  7. Mediastinal
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57
Q

Lymphatic drainage of supraglottis

A

Level 2 and 3

Upper and middle deep cervical lymph nodes

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58
Q

Subglottis lymph drainage

A

Level 6 LN (pretracheal)

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59
Q

Glottis lymph nodes

A

No lymphatics

Best prognosis cause no mets

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60
Q

Intoxicated pt having meal, chokes, difficulty swallowing, respiratory distress, can’t speak anything

Rx

A

Rx- heimlichs manoeuvre

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61
Q

Paediatric larynx

A

Position- high, C2-C3
Shape- funnel shaped
Narrowest part- subglottis
Edema- high due to more loose areolar tissue

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62
Q

Adult larynx

A

Position- low C3-C6
Shape- cylinder shaped
Nastiest part- glottis
Edema- low

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63
Q

Only abductor muscle of larynx (opens)

A

Posterior cricoarytenoid muscle

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64
Q

Adductor muscles of larynx

A

4

Thyroarytenoid
Interarytenoid
Lateral cricoarytenoid
Cricothyroid

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65
Q

Tensor muscles of larynx

A

Main- cricothyroid
And vocalis
(Thyroarytenoid muscle also as vocalis is the internal part of it)

Responsible for quality of voice

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66
Q

Only unpaired muscle of larynx

A

Interarytenoid muscle

Also called transverse muscle

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67
Q

Innervation of larynx- sensory

A

Glottis- SLN and RLN
Supraglottis- internal branch of SLN (ILN)
Subglottis- RLN

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68
Q

Pt underwent thyroid surgery. after surgery, He has poor quality of voice and recurrent aspiration. What is the likely cause?

A

SLN injury

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69
Q

Injury to SLN

A

Aspiration and poor voice quality

❌ external laryngeal nerve— motor nerve supply to cricothyroid muscle — poor quality of voice as it is a tensor muscle

❌ internal laryngeal nerve — sensory nerve supply to supraglottis — ❌ cough reflex leading to aspiration

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70
Q

Vocal cord paralysis

A

More commonly left sided palsy
4:1 ratio
Because left RLN has a longer course (till middle of thorax a rough arch of aorta)

MCC of unilateral palsy-
1. Ideopathic
2. Carcinoma bronchus

MCC of bilateral palsy-
1. Iatrogenic trauma (thyroidectomy)

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71
Q

Which nerve injury more common during thyroid surgery

A

SLN injury

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72
Q

Pt. W c/o hoarseness of voice and it was found left atriomegaly is causing compression of left RLN. What is Dx?

A

Ortner’s syndrome
RLN palsy

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73
Q

Pt. After thyroid surgery, having respiratory distress and stridor.
What is Dx?

A

Bilateral abductor palsy
POSTERIOR CRICOARYTENOID MUSCLE PALSY
due to bilateral RLN injury
Vocal cords are closed causing distress and strider in pt.

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74
Q

B/L RLN injury
Rx

A

Emergency- tracheostomy

Definitive- type 2 thyroplasty
(Lateralisation of vocal cords)

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75
Q

Pt. With c/o Aphonia and aspiration pneumonia
Dx.

A

Bilateral vagal paralysis
b/l RLN SLN injury causing
Bilateral ADDUCTOR palsy

Vocal cords in the cadaveric / open/ intermediate position.

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76
Q

Bilateral ADDUCTOR palsy Rx

A

Definitive only

Type 1 thyroplasty

Medialisation of vocal cords

77
Q

A neonate w c/o noisy breathing, increasing with crying or supine lying.
Picture shows omega shape OR floppy epiglottis
Dx

A

Laryngomalacia

Weakness of supraglottis

Most common congenital anomaly of larynx. And inspiratory stridor

Stridor decreases in prone position

78
Q

Most common congenital anomaly of larynx

A

Laryngomalacia

79
Q

Laryngomalacia Rx

A

Reassurance only.
Self resolving condition till 2years of age

If not improved after 2 years
SURGICAL:
supraglottoplasty
OR
epiglottopexy

80
Q

Child (school going)
in emergency
sitting bent forward (tripod position) with severe rds
and cannot swallow.
Drooling of saliva
Dysphagia.
Odynophagia
Muffled hot potato voice
Fever high grade
Dx

A

Acute epiglottitis

Bacterial infection of epiglottis/ supraglottis

81
Q

Acute epiglottitis investigation

A

First line- X-ray soft tissue neck lateral view will show characteristic thumb sign

82
Q

Most common pathogen for Acute epiglottitis?

A

Strep pneumoniae
And in non-immunised children, HIB (heamophilus influenza B)

83
Q

Acute epiglottitis Rx

A

First line management-
1. AIRWAY
Early elective intubation (high chance of stenosis) if not possible tracheostomy

  1. Antibiotics
  2. Steroids to reduce edema
  3. Nebulised epinephrine as bronchodilator
84
Q

6m- 3yr old child with low grade fever, with BARKING OR BRASSY cough
and BIPHASIC stridor
Dx

A

Croup/ Acute laryngo- tracheo- bronchitis

85
Q

Croup/ Acute laryngo- tracheo- bronchitis most common site

A

Subglottis

86
Q

Croup/ Acute laryngo- tracheo- bronchitis most common cause

A

Parainfluenza virus

87
Q

Croup/ Acute laryngo- tracheo- bronchitis investigation

A

X-ray soft tissue neck anterior view
Will show narrowing to the subglottis called the steeple sign

88
Q

Croup/ Acute laryngo- tracheo- bronchitis Rx

A

First line- Airway

-Steroids
-Bronchodilators
-Antipyretics
-Antibiotics (immunocompromised pt will have sec infection)

89
Q

School aged child, 4-6yrs, with complains of hoarseness of voice and strider
Laryngoscopy shows multiple papilla (overgrowth)
Dx

A

Juvenile pappilomatosis of larynx

90
Q

Juvenile pappilomatosis of larynx

A
  • Benign overgrowth from the stratified squamous epithelium
  • Common in children less than 18 years of age
  • Associated with HPV 6 and 11
  • Mother has genital warts during delivery
  • Viral warts present on vocal cords seen w laryngoscopy.
  • Premalignant condition
91
Q

Juvenile pappilomatosis of larynx Rx

A

MLS surgery with CO2 laser excision

92
Q

Pt w history of vocal abuse
Overgrowth in larynx
Hoarseness of voice

A

Bilateral Overgrowth in larynx less than 3mm
Vocal nodules
Teachers nodules/

unilateral Overgrowth in larynx more than 3mm
Vocal polyp

Teacher/ singer OR smoker OR with laryngopharyngeal reflux (gerd)
Overgrowth at the junction of ant 1/3rd and post 2/3rd

93
Q

Vocal nodules Rx

A

Speech therapy
Voice rest

94
Q

Vocal polyp Rx

A

MLS polyp removal
Speech therapy
Voice rest

95
Q

What characteristics feature is present in vocal polyp and absent in nodules?

A

Diplophonia (2 voices at the same time)

96
Q

Patient underwent a major surgery under general anaesthesia, and post surgery, complains of hoarseness of voice.
what is the likely diagnosis?

A

Intubation granuloma

Injury to the vocal cords while inserting the ET tube due to GA

97
Q

Intubation granuloma RX

A

MLS excision

98
Q

A 19-year-old female complains of loss of voice, (Aphonia)
Cough sound is normal
vocal cord movements are also normal. What is the best step in management?

A

Functional/ Hysterical Aphonia

Since everything is normal, pt is j being dramatic after a breakup or due to exams

Rx- sent for psychiatric consultation 👀

99
Q

Tracheostomy indications

A

Prolonged mechanical ventilation (>3 weeks) due to high risk of laryngeal edema

CICO
cant intubate cant oxygenate
Due to cervical spine fracture
OR maxilla facial injury OR B/L abductor palsy

100
Q

Best site for tracheostomy

A

Bw 2nd and 3rd tracheal ring

101
Q

Types of tracheostomy tubes

A

-on the basis of material
Metallic (cause ischemic necrosis)
silicon( Skin friendly)
Plastic (for emergency)

-cuffed (if balloon is attached) used in ICU or comatose pts w diminished reflexes to prevent aspiration.
OR uncuffed

-fenestrated (can talk)
Unfenestrated (cannot speak, ER)

-Single or
double lumen (definitive)

Shilley
portex in ER

102
Q

Complications of tracheostomy

A
  1. Main- haemorrhage
  2. Injury to lungs in children causing pneumothorax
  3. Injury to RLN
  4. Injury to thyroid gland
  5. Tracheomalacia
  6. Tube blockage
103
Q

Tracheomalacia caused by using which type of tube
Rx

A

Cuffed tube

Rx- use a high volume but low pressure cuffed tube
OR
deflate cuff for 5 minutes after every hour

104
Q

Tube blockage due to tracheostomy tube presentation
Rx

A

ICU pt in coma
Saturation started falling suddenly due to blockage of the tube by the secretions if they aren’t suctioned out properly.

Rx- immediately remove and replace tube.
Proper suctioning immediately

105
Q

CA larynx

A
  • can be of glottis, supraglottis or Subglottis
    -Most common place is glottis carcinoma
  • most common type is squamous cell carcinoma
    -risk factors: smoking, alcohol, HPV infection
  • more commonly seen in males 40-60 years of age
  • best prognosis since no lymph drainage
106
Q

Supraglottis cancer

A
  • 2nd most common
  • complaint of lump in throat
  • Throat pain
  • Hot potato voice
  • Stridor
107
Q

CA larynx treatment

A

High tracheostomy
(Bw 1st and 2nd rings)

(Usually avoid it due to subglottic stenosis risk )

108
Q

TNM staging CA larynx

A

T1a only 1 vocal cord is involved
T1b both vocal cords are involved
Vocal cords are mobile in T1

T2 more than one structure involved

T3 fixed vocal cords/ immobile

T4 extra laryngeal extension

Rx-
For T1/T2 radiotherapy

For T3/T4 total laryngectomy followed by radiotherapy with or without radical neck dissection

109
Q

What are the structures removed in radical neck dissection?

A

Level 1-5 lymph nodes

Submandibular gland
Tail of parotid gland

Sternocleidomastoid muscle
Omohyoid muscle

Accessory nerve

Internal jugular vein

110
Q

Best vocal rehabilitation device after laryngectomy in CA larynx

A
  1. TEP device
    Tracheoesophageal puncture device

surgically placed between the trachea and oesophagus, so that the air from the trachea will go to the oesophagus, and is then converted to sound
Blom singer prosthesis

  1. Electrolarynx
111
Q

Pharynx extension

A

From skull base to C6

112
Q

Pharynx parts

A

Fibromuscular tube forming
Nasopharynx
Oropharynx (epi)
Laryngopharynx (retro/ hypo)

113
Q

Most common site for Laryngopharynx malignancy?

A

Pyriform fossa/ sinus

114
Q

A middle-aged female with complains of pallor and fatigue with spoon shaped nails (koilonycia) Atrophic glossitis and post cricoid cancer.
what is appropriate diagnosis?

A

Plummer Vinson syndrome
More common in females

Classical triad:
1. Iron deficiency anemia
2. Atrophic glossaries
3. Post cricoid/ esophageal web (from which a cancer may arise)

Most common site: post cricoid area

115
Q

A seven-year-old child with complains of bilateral conductive hearing loss, poor school performance and adenoid facies.
diagnosis?

A

Adenoid hypertrophy

116
Q

Adenoid facies

A

Pinched nose, open mouth, crowded teeth, narrow palate, high palate arch

117
Q

What are Adenoids?

A

Tonsils that are present in the junction of roof and posterior wall of nasopharynx

Are present at birth, grow till 6yrs then regress and are computer gone by the age of 20.

118
Q

Most common cause for adenoid hypertrophy?

A

Recurrent upper airway infections

119
Q

Why is there b/l CHL in adenoid hypertrophy

A

Due to blockage of ET by the enlarged adenoids the pt will have B/L glue ear as secretions will not drain

120
Q

Adenoid hypertrophy Rx

A

Adenoidectomy

For CHL- myringotomy + grommet insertion

121
Q

Most common site for nasopharyngeal carcinoma

A

Fossa behind the torus tubaris called the fossa of rosenmuller

122
Q

What is anterior and posterior to the torus tubaris

A

Eustatian tube opening
Posterior is fossa of rosenmuller

123
Q

14-year-old boy comes with recurrent profuse, epistaxis and nasal mass. What is the most common appropriate investigation to make diagnosis?

A

Juvenile nasopharyngeal angiofibroma

CECT- hollman miller sign ant bowing
Angiography
MRI to check for soft tissue extension intracranially in infratemporal fossa or orbit.

124
Q

Nasopharyngeal carcinoma
Patho
Presentation

A
  • most common malignant of nasopharynx
  • arises from fossa of rosenmuller
  • Moro coming in Chinese mongols
  • commonly associated with adenovirus
  • most common clinical presentation painless cervical lymphadenopathy
  • most common CN involved is 5th CN

trotter’s triad
NPC
N neuralgia due to 5th nerve involvement
P palatial palsy due to vague nerve injury
C conductive hearing loss (unilateral)

125
Q

Nasopharyngeal carcinoma
Rx

A

Treatment of choice chemo radiation

126
Q

Oropharynx anatomy

A

Roof- hard and soft palate
Floor- base of tongue
Laterally- palatiglossal and palatopharu heal arches are present

127
Q

Palatine tonsils location

A

Bw the palatoglossal and palatopharyngeal arches
Also known as tonsillar fossa

128
Q

What is the bed of the tonsils formed by?

A

Superior constrictor muscle

Contains the 9th cranial nerve and the styloid process

129
Q

What is styalgia
Patho
Rx

A

When the styloid process is too long and irritates the cranial nerve 9, resulting in irritation of the nerve, causing pain throat and referred otalgia.
eagle syndrome
Rx- styloidectomy

130
Q

What is the most common cause of whitish membrane on tonsils?

A

Acute membranous tonsillitis

131
Q

Most common cause for acute membranous tonsillitis?

A

Group A beta haemolytic streptococci/
Streptococcus pyogenes

132
Q

Patient with bronchial asthma currently taking inhalers develops whitish patches over oral cavity. patch bleeds on removal
Dx?
Rx?

A

Oral candidiasis
Candida albicans

Rx
DOC- fluconazole

133
Q

Small child presenting with, bilateral lymphadenopathy with characteristic bulls neck and whitish membrane, extending up to the pallet from tonsils that bleeds on removal
Dx?

A

Diphtheria caused by corynebacterium dyphtheriae

134
Q

Causes of whitish membrane over palate or in oral cavity

A

-Infective mononucleosis EBV
-Vincent angina due to borelia vincenti usually after dental carries or infection
-Leukaemia
-Agranulocytosis

135
Q

Child presents w complains of fever neck swelling with dysphagia and trismus (locked jaw) examination findings show uvula pushed towards opposite side and abscess on ct
what is diagnosis?

A

Parapharyngeal abscess

136
Q

Parapharyngeal abscess
Patho
Rx

A

More common in children
Neck swelling present and visible
(Diff factors from Quincy)

Rx
External incision and drainage
antibiotics

137
Q

What is Quincy
Rx

A

Peritonsillar abscess
More common in adults
No neck swelling
Fever
Dysphagia
Hot potato voice
Most common cause is strep pneumonia

Rx
per oral incision and drainage
Antibiotics

138
Q

Trismus in Quincy occurs due to spasm of which muscle?

A

Medial pterygoid muscle

139
Q

Child brought to ER with respiratory distress, fever, muffled voice (hot potato) and dysphagia
x-ray shows collection on pus in retropharyngeal space
What is next management?

A

Acute retropharyngeal abscess

140
Q

Sequence of throat?

A
  1. Larynx
    2.Laryngopharynx
  2. Posterior wall of Laryngopharynx called buccopharyngeal fascia
  3. Retropharyngeal space
  4. Alar fascia
  5. Danger space
  6. Prevertebral fascia
  7. Cervical vertebra
141
Q

Retropharyngeal space

A

A space lying behind the pharynx between the buccopharyngeal fascia covering the pharyngeal constrictor muscles & the prevertebral fascia, extending from the base of the skull to the bifurcation of trachea. This space is divided into two lateral compartments called spaces of Gillette by a fibrous raphe.

142
Q

Lymph nodes in the retro pharyngeal space

A

retropharyngeal lymph nodes which are again divided into 2 groups:

lateral- larger, more constant, present in adults & known as node of Rouviere.

medial-present in children, disappears at 3-4yrs of age & absent in adults.

143
Q

Acute Retropharyngeal abscess symptoms

A

CLINICAL FEATURES:
• Age - <3 yrs. due to atrophy of RP lymph node in childhood.
• Sex - > in males.
• Difficulty in breathing & suckling.
• Croupy cough
• Stiffness of the neck (Torticollis)- keeping head extended
• Fever

ON EXAMINATION:
• Whole pharynx congested
• Bulging of the posterior pharyngeal wall on one side of the midline
• Oedema of the larynx

144
Q

Acute Retropharyngeal abscess investigation

A

X-Ray soft tissue neck, lateral view shows widening of the prevertebral soft tissue, straightening of the cervical vertebral column & pushing the air column forward.
Sometimes air or fluid in prevertebral area.
CT scan of the neck showing bulging of the Retropharyngeal space.

145
Q

Acute Retropharyngeal abscess treatment

A

1) Incision & drainage of the abscess without anaesthesia perorally,
patient lying supine with head low.

Vertical incision given in the most fluctuant area with the help of mouth-gag. As soon as the incision is given, patient is turned to one side & suction given to prevent aspiration.

146
Q

Chronic Retropharyngeal abscess

A

Tubercular in nature

CAUSES:
1) Caries of cervical spine due to TB usually seen centrally behind the prevertebral fascia

2) TB infection of RP lymph nodes secondary to TB of deep cervical nodes usually seen on one side of the posterior pharyngeal wall behind the buccopharyngeal fascia

147
Q

Chronic retropharyngeal abscess symptoms

A

1) Age – Adults & adolescents
2) Slow onset
3) Mild dysphagia
4) Sore throat & cough maybe present
5) Muffled voice

ON EXAMINATION:
1) Fluctuant swelling on one side in case of retropharyngeal lymph node infection & centrally in case of TB caries of cervical spine
2) Enlarged tubercular cervical lymph nodes

148
Q

Chronic retropharyngeal abscess
Rx

A

1) Incision & drainage of the abscess with a vertical incision along the anterior border of sternocleidomastoid (if low abscess) & posterior border of the sternocleidomastoid (if high abscess).

2) Antitubercular therapy for 12 months.

3) Cervical collar for 12 months till spine gets stable.

149
Q

Pre malignant lesions of Oral cavity

A

1- leukoplakia- most common

2- Erythroplakia- highest chance of malignancy

3- Oral submucous fibrosis

150
Q

Most common oral cavity cancer?

A

Squamous cell carcinoma

151
Q

Most common site for oral cavity cancer worldwide?

A

Lateral border of tongue

152
Q

Most common side for oral cavity cancer in India?

A

Gingivobuccal sulcus

153
Q

Investigation of choice for oral cavity cancer?

A

Biopsy

154
Q

Oral cavity cancer
Rc

A

Oromandibular dissection

(Commando’s operation)

155
Q

Child, with history of dental infection brought in ER with complains of respiratory distress
Mouth is completely obstructed by tongue pushed upwards
neck swelling
Dx

A

Ludwigs angina

156
Q

What is Ludwig’s angina?

A

Infection of floor of mouth
Submandibular space

Pathogen: Streptococcus viridans + anaerobes

157
Q

Ludwig’s angina
Rx

A

ER:
Airway- tracheotomy

External incision and drainage
Antibiotics.

158
Q

Acute pharyngitis
Symptoms
Investigations

A

caused by both virus and bacteria.
Adino, rhino, influenza virus
Beta haemolytic strep

Mild

Discomfort in the throat.
Low grade fever.
Earache.
No lymphadenopathy.
Congestion of pharyngeal mucosa.

Severe

Pain in the throat: severe.
Dysphagia.
Earache.
High grade fever.
Cervical lymphadenopathy.
Malaise, headache.

Investigations
Complete blood picture
Thoat swab culture

159
Q

Acute pharyngitis
Rx

A

bed rest
antipyretic
warm saline or antiseptic gargles
soft and liquid diet

Antibiotic is given if bacterial infection is suspected
Oral antibiotic against streptococci should be started immediately

160
Q

Vincent’s angina

A

-Acute ulcerative lesion, involves 1 or both tonsils, may extend to soft, palate, pillars, and gums
- Gram- fusiform Bacilli and Vincent spirochetes
- Affects young adults and middle aged
- Poor oral hygiene, carious teeth, poor diet, overcrowding.

Symptoms
-Sudden onset with marked pain in throat
-Odynophagia
-Foul breath
- Grey membrane covering tonsils
-Lymphadenopathy

Investigations
Swab test and smear

161
Q

Vincent’s angina
Rx

A

systemic antibiotics ( penicillin )
metronidazole.
Local antiseptic gargles
analgesics
antipyretics

162
Q

Thyroglossal duct cyst

A

• Failure of complete obliteration of thyroglossal duct
• Descent of thyroid gland - Foramen cecum
• Cystic midline swelling
• usually affecting children
• Rounded with a diameter of 2 - 4 cm
• presents as a draining sinus if it has burst due to infection or has been surgically drained.
• Moves with tongue protrusion Because of the attachment of thyroglossal d foramen caecum at the base of tongue
• Can occur anywhere in the course of thyroid duct

163
Q

Thyroglossl duct cyst Dx Rx

A

DIAGNOSIS
• Clinical - US/CT/MRI neck

TREATMENT
• Complete surgical excision - Sistrunk’s operation

164
Q

MC site for TDC

A

Subhyoid

165
Q

Sublingual DERMOID cyst

A

• It presents as a midline submental swelling
• does not move on protrusion of the tongue as it is not attached to foramen caecum.
• Sometimes it arises from the floor of mouth and needs differentiation from ranula.

166
Q

Sublingual dermoid cyst Rx

A

Surgical excision

167
Q

Thymic cyst

A

•Thymus develops from the third pharyngeal pouch then descends through the neck to the mediastinum

• caused by persistence of thymic remnants

•Swelling either cystic or solld

•It can occur in children or adults
presents as a neck mass anterior and deep to middle third of sternocleidomastold muscle

168
Q

Thymic cyst Rx

A

• surgical excision.
• Sternotomy is required if it also extends into the mediastinum.

169
Q

MC branchial cyst arises from which arch?

A

2nd branchial arch

  • Ant neck to tonsillar fossa
  • Common in second decade
  • Round fluctuant non tender smooth mass
  • Rx- surgical excision
170
Q

Carotid body tumour
Dx

A

• chemodectoma
•Mostly presents after 40 years
• Very slow-growing tumor
• Painless swelling
pulsatileand moves from side to side
• Bruit can be heard with a stethoscope

Dx
• Contrast-enhanced CT
MRI with gadolinium - diagnostic
• MRI angiography - Lyre’s sign
• Serum catecholamines and urinary metanephrines and VMA
• FNAC or biopsy should not be done

171
Q

Lyres sign

A

Splaying of External carotid artery and Internal carotid artery
On MRI angiography

172
Q

Cystic hygroma

A

CYSTIC HYGROMA
““Lymphangioma” or “cavernous lymphangioma”

MC- posterior triangle of the neck

• Arises from obstruction or sequestration of jugular lymph sac
• neonate, early infancy or childhood
• MC seen in the supraclavicular region, axilla and groin
* May occur in the tongue and floor of mouth
• Soft, cystic, multilocular, partially compressible and bilaterally transilluminant

Presents as
• Stridor, respiratory difficulty or feeding problems

173
Q

Cystic hygroma Rx

A

• Surgical excision with preservation of neural and vascular structures
• Bipolar diathermy
• Aspiration or tracheostomy

174
Q

Tubercular lymphadenopathy

A

• any age or sex
• single, multiple or matted LN
• Tubercular abscess may form

DIAGNOSIS
• FNAC or lymph node biopsy ( granulomatous lesion)
• Culture and sensitivity of AFB (acid fast bacillus)
• X-ray chest, skin test and work-up for other nodal group involvement

TREATMENT
• INITIAL 2 MONTHS COURSE OF FOUR DRUGS (RIFAMPICIN, ISONIARTD
PYRAZINAMIDE AND ETHAMBUTOL) FOLLOWED BY 4 MONTHS COURSE RIFAMPICIN AND ISONIAZID.

175
Q

Cleft lip results from failure of fusion of two processes. What are the names of these process-es?

A

Maxillary process and median nasal process

176
Q

Cleft lip due to?

A

Failure of fusion of palatine processes

177
Q

Aphthous ulcer

A
  • superficial small recurrent ulcers form on the mucosa of the oral cavity.
    Inner surface of the lips, buccal mucosa, floor of the mouth and soft palate are mostly involved.
  • viral, psychogenic, vitamin deficiency, hormonal and autoimmune disorders.
  • period of stress causes exacerbation.
  • Size- pinhead to 2 to 3 cms.
  • sloughing base w hyperemia

Rx- oral hygiene
Topical steroid
Local anaesthetic
Vits supplements

178
Q

Contributing Factors in Chronic Pharyngitis

A

• Heavy smoker.
• Excessive alcohol use.
• Postnasal dripping.
• Mouth breathing.
• Gums and teeth infections.
• Dry and dusty atmosphere.
• Industrial pollution. Allergy.
• Gastrooesophageal Reflux Disorder (GERD).
• Lowered resistance.

179
Q

other name for gram + ve corynebacterium diphtheriae?

A

Klebs Loeffler’s bacilli.

180
Q

A 4-year-old girl came in ER and clinically suspected to be suffering from pharyngeal diphtheria. What complications can occur if diphtheria antitoxin is not given immediately?

A

myocarditis and muscle paralysis.
Due to releases of exotoxins

181
Q

Paul Bunnell test and Monospot test

A

These are serological tests for detection of antibodies against the virus. These tests are usually positive in the first week of the disease, although around 10% of the patients never develop a positive test.

182
Q

Acute Tonsillitis types

A
  1. Acute catarrhal or superficial tonsillitis: The infection is superficial involving only the covering mucous membrane and the infection is part of generalized pharyngitis
  2. Acute follicular tonsillitis: The infection spreads into the tonsils, which are filled with infected fibrin and pus
    This leads to the characteristic spotted appearance as opening of the crypts are filled with pus.
  3. Acute parenchymatous tonsillitis: The infection spreads to the underlying lymphoid tissues and causes increase of the lymphoid follicles. The tonsils are enlarged uniformly.
  4. Acute membranous tonsillitis: This is a more severe and advanced stage where the exudation from the crypts coalesces giving the appearance of a whitish yellow false membrane on the tonsil
183
Q

Acute tonsillitis Dx
Rx

A

clinical features :
•Sore throat.
• Difficulty or pain on swallowing.
•Fever.
• Bodyache, malaise, headache. Referred earache.
• Congested and enlarged tonsils and pillars.
• Pus in the crypts or over the tonsils.
• Palpable and tender jugulodigastric lymph nodes.

Rx
broad spectrum antibiotics immediately. antibiotics like penicillin or erythromycin are the drug of choice Analgesic
antipyretic like paracetamol
bed rest,
soft diet,
proper fluid intake
Antiseptic gargle

184
Q

Tonsillectomy indications

A
  1. Recurrent tonsillitis: Tonsulectomy is indicated when there are seven attacks in one year or five attacks in a year, for two consecutive years or three attacks in a year for three consecutive years.
  2. Chronic tonsillitis
  3. Enlarged tonsils interfering with swallowing, respiration or speech.
  4. Quinsy after 4-6 weeks
  5. For biopsy
  6. After pharyngeal diphtheria,
  7. rheumatic fever, glomerulonephritis or endocarditis.
  8. Tonsillar stones
185
Q

Tonsillectomy procedure

A

under general anesthesia with nasal or oral endotracheal intubation.
supine with head extended by placing sand bag under the shoulder known as Rose’s position
mouth is opened by a Boyle Davis mouth gag which is suspended by Draffin’s suspension rods.
methods of tonsillectomy are by dissection method and diathermy method’.

The tonsil is grasped with tonsil holding forceps and pulled medially. An incision is made in the mucous membrane of the tonsil along the anterior pillar by a knife, scissors or diathermy.
Tonsil is separated from its bed by tonsillar dissector or by diathermy till the lower pole or the pedicle is reached
Pedicle can be cut by tonsillar snare, diathermy or scissors after applying

Negus forceps on its pedicle Tonsillar bed is checked for any bleeding and procedure is repeated on the other side.
Hemostasis in the tonsillar bed is achieved either by coagulation diathermy or tying with silk suture.

There are also other methods for removal of tonsils like, harmonic scalpel, diode or CO, LASER, radiofrequency ablation, microdebrider and coblation tonsillectomy

186
Q

A 9-year-old girl suffered from tonsillitis and as a complication she developed swelling and pain in multiple joints. What is the most likely microorganism responsible for this condition?

A

beta hemolytic streptococcus.

187
Q

Nerve present deep to tonsillar bed?

A

Glossopharyngea nerve

188
Q

What is the typical location of the adenoids in normal people?

A

roof and posterior wall of the nasopharynx

Ent (3 decks)

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