Throat - clinical Flashcards
(87 cards)
1
Q
What are the main types of ulceration seen in the mouth?
A
- Traumatic ulceration
- Apthous Ulceration
- Infective ulceration
2
Q
What are apthous ulcers?
A
Common mouth ulcers
3
Q
Where do apthous ulcers most commonly occur?
A
Around the edges of the toungue
4
Q
What are features of herpes simplex associated ulcers in the mouth?
A
Appearence similar to apthous ulcer, but with mild pyrexia and malaise
5
Q
What is the following?
A
Leukoplakia - white patch in the mouth, caused by hyperkeratosis of the oral mucosa
6
Q
What is important to do if you find leukoplakia?
A
Biopsy - 3% can be malignant
7
Q
What is erythroplakia?
A
Red patches in the mouth
8
Q
What is pharyngitis?
A
Inflammation of the pharynx
10
Q
What are features of acute pharyngitis?
A
- Tender anterior cervical lymph nodes
- Sore Throat
- Fever
- Inflamed tonsils
- Reddened oropharynx and soft palate
11
Q
What is the definition of acute pharyngitis?
A
Characterised by the rapid onset of sore throat and pharyngeal inflammation (with or without exudate). Absence of cough, nasal congestion, and nasal discharge distinguishes bacterial from viral aetiologies.
13
Q
What are the causes of pharyngitis?
A
- Adenovirus is most common cause
- Can be strep pneumoniae
14
Q
How would you manage pharyngitis?
A
Most are self limiting - symptomatic control
15
Q
How would you manage strep throat?
A
- Oral penicillin for 10 days, or
-
If allergic to penicillin
- Clindamycin/clarithromycin for 10 days
- Azithromycin for 5 days
16
Q
What is laryngitis?
A
Inflammation of the larynx
17
Q
What is the most common cause of laryngitis?
A
Bacterial
18
Q
What are the features of acute laryngitis?
A
- Hoarseness
- Sore throat
- Fever
- Cough
- Rhinitis
- Odynophagia/dysphagia
19
Q
How would you treat laryngitis?
A
Symptomatic management
20
Q
What is tonsilitis?
A
Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils. This definition does not include tonsillitis as part of infectious mononucleosis, although tonsillitis may occur in isolation or as part of a generalised pharyngitis. The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as “acute sore throat”
21
Q
What bacteria are implicated in acute tonsilitis?
A
- Group A beta haemolytic strep - S. Pyogenes
- H. Influenzae
- T. Pallidum
- N. Gonnorhoea
22
Q
What viruses can cause acute tonsillitis?
A
- Rhinovirus
- Coronavirus
- Adenovirus
23
Q
What are symptoms of tonsillitis?
A
- Dysphagia
- Painful Cervical lymphadenopathy
- Fever
- Rhinorrhoea
- Headache
- Abdominal pain
24
Q
What are signs of tonsillitis?
A
- Inflamed fauces/pharynx upon examination
- Enlarged tonsils
- Tonsillar exudates
- Palatal Petechia
- Enlarged cervical lymph nodes
25
Q
How might you investigate someone with tonsillitis?
A
- Swabs - Throat, Nasal
- Blood/Serology
- Blood film
26
Q
How would you treat tonsillitis?
A
- Symptomatic therapy - Ibuprofen +/- paracetamol etc
-
If CENTOR> 3/4
- If persistent - penicillin V for 10 days/macrolide 5 days if allergic
27
What are CENTOR Criteria?
Criteria which give an indication of the likelihood of a sore throat being due to bacterial infection
28
What are complications of tonsillitis in children?
* **Otitis media**
* **Sinusitis**
* **Retropharyngeal abscess**
* **Parapharyngeal/hypopharyngeal abscess**
* **Quinsy** - peritonsillar abscess
* **Febrile convulsion** - children
29
What is quinsy?
Tonsillitis infectiion spreads to the tissues lateral of the tonsil, and an abscess develops
30
What are features of a peritonsillar abscess?
* **Tonsil pushed medially**
* **Displaced uvula**
* **Unwell patient**
* **Drooling**
* **Fetor**
* **Trismus**
31
How would you manage a quinsy?
* **Aspiration/drainage**
* **Antibiotics**
32
What would be your differential diangosis for someone presenting with features of tonsilitis?
* **EBV**
* **Agranulocytosis**
* **Leukaemia**
* **Scarlet fever**
* **Diptheria**
33
What would you not give to someone to treat tonsillitis?
Amoxicillin - incase of EBV
34
What are absolute indications for a tonsillectomy?
* **Adenotonsillar hyperplasia with obstructive sleep apnea**
* **Failure to thrive, or abnormal dentofacial growth**
* **Suspicion of malignant disease**
* **Haemorrhagic tonsillitis.**
35
What are relative indications for tonsillectomy?
* **Recurent sore throat due to tonsillits**
* **Episodes of tonsillitis are disabling and prevent normal function**
* **\>/= 7 clinically significant, adequately treated sore throats in last year**
**OR**
**\>/= 5 episodes in last 2 years**
**OR**
**\>/= 3 episodes in last 3 years**
36
What is the most common complication of tonsillectomy surgery?
Bleeding
37
Where are the adenoids found?
38
What are causes of snoring and sleep apnoea?
* **Large tonsils**
* **Large adenoids**
* **Nasal obstruction**
* **Deviated septum**
* **Long palate**
* **Big tongue**
* **Small jaw**
39
What is stridor?
[https://www.youtube.com/watch?v=1Enq2BvX9aw](https://www.youtube.com/watch?v=1Enq2BvX9aw)
A muscial noise in inspiration from partial obstruction at the larynx and large airways
40
What are congenital causes of stridor?
* **Laryngomalacia**
* **Stenosis**
* **Vascular rings**
41
What are inflammatory causes of stridor?
* **Laryngitis**
* **Epiglottitis**
* **Laryngotracheobronchitis**
* **Anaphylaxis**
42
What are traumatic causes of stridor?
* **Fractured larynx**
* **Thermal - airway burns**
* **Chemical**
* **Intubation**
43
What tumours can cause stridor?
* **Hemangioma**
* **Papillomas**
44
What other signs might you look for in someone with stridor?
All grave signs, signify impending obstruction
* **Swallowing difficulties**
* **Pale/cyanosed**
* **Drooling**
* **Accessory muscle use**
* **Tracheal tug**
45
What are intrinsic causes of dysphonia?
* **Decreased lubrication**
* **Laryngoceles**
* **Granulomas**
* **Sarcoidosis**
* **TB**
* **Syphillis**
46
What are extrinsic pressure causes of stridor?
* **Goitre**
* **Carotid body tumour**
47
What are neoplastic causes fo dysphona?
* **Pancoast syndrome**
* **Larynx/thymus cancer**
* **Lymphoma**
* **Glomus tympanicum tumour**
48
What are bacterial causes of dysphonia?
* **H. flu** - epiglottits
* **Diptheria**
* **Abscess**
* **Aortitis**
49
What are CNS causes of dysphonia?
* **Vagus lesion**
* **Guillain-Barre**
* **Myasthenia**
50
What are endocrine causes of dysphonia?
* **Acromegaly**
* **Addison's**
* **Myxoedema**
51
When would you consider investigating hoarseness?
\>3 weeks
52
If someone presented with dysphonia, what would you want to ask about?
* **GORD**
* **Dysphagia**
* **Smoking**
* **Stress**
* **Singing/Shouting**
53
How would you investigate horseness?
Laryngoscopy
54
What are features of vocal cord paralysis?
* **Hoarseness with breathy voice**
* **Weak cough** - bovine
* **Repeated cough/aspiration**
* **Exertional dyspnoea**
55
What tests would you do if someone presented with features of vocal cord paralysis?
* **CXR**
* **Barium swallow**
* **MRI**
* **Panendoscopy**
56
What are malignant causes of dysphagia?
* **Oesophageal Cancer**
* **Pharyngeal cancer**
* **Gastric cancer**
* **Extrinsic pressure**
57
What are neurological causes of dysphagia?
* **Bulbar palsy**
* **Myasthenia gravis**
* **Stroke**
* **MND**
* **MS**
* **Encephalitis**
58
What is FOSIT?
Feeling of something in the throat - **Globus pharyngeus**
59
What tests would you want to do in someone presenting with dysphagia?
* **Bloods** - FBC, ESR
* **Barium Swallow**
* **Rigid Endoscopy**
* **Oesophageal motility disorders**
* **CXR**
60
If someone found it difficult to make the swallowing movement, what might you suspect as being the cause of dysphagia?
Bulbar palsy
61
What might be the problem if someone was complaining of dysphagia and a neck bulge or gurgling on drinking?
Pharyngeal pouch
62
What is a pharyngeal pouch?
Type of hernia (pulsion-type diverticulum), affecting the wall of the pharynx at its junction with the upper oesophagus
63
What age group do pharyngeal pouches most commonly occur in?
\>50 years
64
What are features of pharyngeal pouch?
* **Progressive dysphagia**
* **Regurgitation of undigested food**
* **Halitosis**
* **Gurgling emenating from neck**
65
How would you investigate suspected pharyngeal pouch?
Barium-swallow
66
What are GI causes of dysp[hagia?
* **Benign oesophageal stricture**
* **Pharyngeal pouch**
* **Achalasia**
* **Oesophagitis**
67
How would you manage a pharyngeal pouch?
Pharyngeal stapling
68
What is the following?
**Acute Sialadenitis** - acute inflammation of the parotid gland or submandibular gland
69
Who does parotitis most commonly occur in?
Old dehydrated people with poor oral hygeine
70
What are signs of parotitis?
* **Swollen gland** - parotid/submandibular
* **Tenderness**
* **Pus** - opening to parotid duct
71
What are the main criteria used in the CENTOR criteria for tonsillitis?
Presence of 3/4 suggest strep infection (positive predictive value approx 50%)
* **Presence of tonsillar exudate**
* **Presence of tender anterior cervical lymphadenopathy**
* **History of fever**
* **Absence of cough**
If all 4 absent - negative predictive value is 80%
72
If someone presented with Hoarsness lasting \>3 weeks, what would your main differentials be?
* **Laryngeal cancer**
* **Vocal cord Palsy**
* **Laryngitis**
* **Reflux laryngitis**
* **Reinke's oedema**
* **Vocal cord nodules**
73
What are symptoms of sialadenitis?
* **Painful diffuse swelling**
* **Fever**
* **Pus from gland when pressed**
74
How would you treat sialadenitis?
* **Antibiotics**
* **Good Oral hygeine**
* **Sialogogues** - lemon drops - increase salivary secretions
75
What is sialolithiasis?
**Salivary stones**
76
What are features of sialolithiasis?
* **Pain**
* **Tense swelling of gland after eating**
* **Palpable stone in mouth**
77
What imaging might you use to diagnose sialolithiasis?
* **Plain x-ray**
* **Sialogram**
78
How might you manage sialolithiasis?
* **Small stone** - may pass on their own
* **Fluids**
* **Silogogues** - lemon drop
* **Large stone** - surgical removal
79
What features of tonsillitis suggest a viral cause?
* **Headache**
* **Nasal congestion**
* **Cough**
80
What features of tonsillitis can suggest a peritonsillar abscess?
* **Trismus**
* **Change in voice quality**
81
What would you do if an individual had a CENTOR score of 2-3?
Throat culture/rapid antigen testing
82
What would be your differential diagnosis for somoene presenting with features of tonsillitis?
* **Tonsillitis**
* **Pharyngitis**
* **Oral thrush**
* **Phayngeal syphilis**
* **EBV**
* **Diptheria**
83
What might the following be?
Tonsillar/pharyngea Diptheria
84
What might the following be suggestive of in an unvaccinated child?
Diptheria - bull neck
85
What are features of diptheria?
* **Nasal** - bloody rhinorrhoea
* **Gray/white pseudomembrane over posterior pharyngeal wall/tonsils**
* **Bull neck**
* **Foul breath**
* **Myocarditis**
86
What would you do if you suspected diptheria?
* **Throat swab**
* **ECG** - check for myocarditis
* **Consider serial cardiac markers** - myocarditis
87
How would you manage diptheria?
* **Isolated ASAP**
* **Penicillin G/IV erythromycin**
* **IV diptheria antitoxin**
* **Airway support**
88
What are clinical features of diptheria caused by?
Exotoxin - IV antitoxin is cornerstone of treatment
89
Is diptheria a notifiable disease?
Yes
