Throat conditions Flashcards
(87 cards)
1
Q
Stridor - examination
A
Attempts to examine the throat should be avoided
2
Q
Sore throat - cause
A
Viral infection (most common) Bacterial infection
3
Q
Viral sore throat - management
A
Self limiting
4
Q
Bacterial sore throat - causative organism
A
Strep pyogenes (group A strep)
5
Q
Bacterial sore throat - clinical presentation
A
Acute follicular tonsillitis
6
Q
Bacterial sore throat - Management
A
Penicillin
7
Q
Bacterial sore throat - late complications
A
Rheumatic fever
Glomerulonephritis
8
Q
Diphtheria - who gets it
A
Rarely seen in UK due to vaccine
9
Q
Diphtheria - clinical features
A
Severe sore throat
Grey-white membrane across the pharynx
10
Q
Diphtheria - management
A
Antitoxin
11
Q
Oral thrush - causative organism
A
Candida albicans
12
Q
Oral thrush - who gets it
A
People who recently had antibiotics
Immunosuppressed
13
Q
Oral thrush - clinical features
A
White patches on red, raw mucous membranes
14
Q
Oral thrush - management
A
Nystatin
15
Q
Infectious Mononucleosis - definition
A
Glandular fever
Think of mono as in (union)
16
Q
Infectious Mononucleosis - cause
A
Epstein Barr Virus (EBV)
- virus of the herpes family
- transmitted by kissing
17
Q
Infectious Mononucleosis - who gets it?
A
Young adults
18
Q
Infectious Mononucleosis - Clinical features
A
Gradual onset over a few days Sore throat Enlarged tonsils - white exudate often coats tonsils Fever Enlarged cervical lymph nodes Malaise Lethargy Jaundice Rash Hepatosplenomegaly Palatal petechiae (pin point bruising) Oedematous uvula
19
Q
Infectious Mononucleosis - when to suspect
A
If suspected tonsillitis persists despite antibiotic treatment
20
Q
Infectious Mononucleosis - investigations
A
Bloods - atypical lymphocytes - atypical mononuclear cells - low CRP (this is surprising) EBV virus IgM Paul Bunnell test Monospot test Hetrophile antibody +ve
21
Q
Infectious Mononucleosis - management
A
Bed rest
Paracetamol
Severe cases: corticosteroids (i.e. if upper airway obstruction)
Antibiotics
- try not to give as can get generalised macular rash from amoxicillin
22
Q
Infectious Mononucleosis - complications
A
Anaemia
Thrombocytopenia
Splenic rupture
Upper airway obstruction
23
Q
Laryngeal polyps - definition
A
There is a reactive change in the laryngeal mucosa
This results in unilateral and pedunculated polyp
24
Q
Laryngeal polyps - cause
A
Vocal abuse
Infection
Smoking
25
Contact ulcer - definition
Inflammatory response to trauma or abuse of vocal cords
26
Contact ulcer - causes
Chronic throat
Voice abuse
GORD
27
Squamous papilloma - definition
Type 6 and 11
Causes benign disease
Warts
28
Squamous papilloma - who gets it
Children under 5
| Adults age 20-40
29
Squamous papilloma - pathology
Finger like projections
30
Paraganglioma - definition
Tumour arising in clusters of neuroendocrine cells
31
Paraganglioma - types
Chromaffin positive
| Chromaffin negative
32
Paraganglioma - where are chromaffin positive usually?
Below the diaphragm
| - sympathetic nervous system can secrete catecholamines (adrenaline)
33
Paraganglioma - where are chromaffin negative usually?
Above the diaphragm
| - don't produce adrenaline
34
Paraganglioma - associated conditions
MEN 2
35
Tonsilitis - definition
Inflammation of the tonsils
36
Tonsilitis - 2 main causes
```
Viral infection (most common)
Bacterial infection
```
37
Tonsilitis - viral causes
EBV
Rhinovirus
Adenovirus
Influenza
38
Tonsilitis - bacterial causes
Strep pyogenes (GABHS)
Staph aureus
Strep pneumoniae
39
Tonsilitis - clinical features (viral)
Malaise
Sore throat
Temperature
Lasts 3-4 days
40
Tonsilitis - clinical features (bacterial)
```
Systemic upset
Fever
Odynophagia
Hallitosis
May mimic earache (referred pain)
```
41
Tonsilitis - examination
Lymphadenopathy
42
Tonsilitis - investigations
Throat swab is not recommended
| - core species do not always correlate with commensal surface bacteria
43
Tonsilitis - which set of criteria differentiates bacterial from viral tonsillitis?
Centor criteria
44
Tonsilitis - centor criteria
```
1 point for each of the following:
History of fever
Tonsillar exudates (white/yellow)
Tender anterior cervical adenopathy
Absence of cough
```
45
Tonsilitis - centor criteria 0-1 points
No antibiotics
| Likely to be viral infection
46
Tonsilitis - centor criteria 2 or 3 points
Should receive antibiotic if symptoms progress
47
Tonsilitis - centor criteria 4 or 5 points
Treat empirically with an antibiotic as there is high risk of bacterial infection
48
Tonsilitis - management viral
Supportive treatment
49
Tonsilitis - management bacterial
Antibiotics
- penicillin 500mg QDS for 10 days
- clarithromycin if penicillin allergic
Surgery
50
Tonsilitis - when is surgery indicated
7 or more well documented clinically significant adequately treated sore throats in the preceding year
51
Tonsilitis - complications
Peritonsilar abscess
| Unilateral tonsil enlargement
52
Peritonsilar abscess - definition
Complication of acute bacterial tonsillitis
Bacteria between the muscle and tonsil produce pus
The pus expands and drags the tonsil away from its attachments
53
Peritonsilar abscess - clinical features
Hx of preceding tonsillitis then
unilateral throat pain
odynophagia
lock jaw (trismus)
54
Peritonsilar abscess - examination
Uvula pushed to one side
| Medial displacement of tonsil and uvula
55
Peritonsilar abscess - management
Aspiration
- drainage of abscess gives instant relief
Antibiotics
56
Recurrent respiratory papillomatosis - definition
Warty growth in the upper airway which can cause obstruction
57
Recurrent respiratory papillomatosis - cause
HPV
- type 16 or 18 = malignant risk
- type 6 or 11 = benign
58
Recurrent respiratory papillomatosis - clinical features
Stridor
Dyspnoea
Hoarseness
59
Subglottic stenosis - definition
Narrowing of subglottis which causes airway obstruction
60
Subglottic stenosis - cause
Small vessel vasculitis
61
Throat cancer - clinical features
```
Persistent sore throat (3/4 weeks)
Odynophagia
Dysphagia
Stridor
Hoarseness / voice change
Neck mass
```
62
Glottic tumours - where do they usually present?
Most present on the vocal cords and stay there (doesn't metastasise)
63
Squamous cell carcinoma - types
HPV related
| Smoking and alcohol related
64
Squamous cell carcinoma - HPV related
HPV makes E6 and E7 proteins which disrupt p53 and RB pathways repectively leading to cellular immortality
65
HPV Squamous cell carcinoma - who gets it?
Young people who are relatively fit and healthy
66
HPV squamous cell carcinoma - clinical features
Lump in the neck region
67
HPV squamous cell carcinoma - management
Chemotherapy and radiotherapy
| - patietns tend to do really well with this
68
What is the most common site for a salivary gland tumour?
Parotid gland
69
Tumours in the parotid gland are usually more malignant than tumours of submandibular/sublingual glands. True or false?
False
| - tumours in smaller glands are more likely to be malignant
70
Salivary gland tumour - clinical features
Young person with a painful mass
71
Pleomorphic adenoma - definition
Most common benign salivary tumour
| Mainly in parotid glands
72
Pleomorphic adenoma - who gets it
Females
| Old
73
Warthins tumour - definition
Mainly occurs in parotid glands
74
Warthins tumour - risk factors
Smoking
75
Warthins tumour - pathology
Bilateral
| Multicentric
76
Most common malignant salivary gland tumour worldwide?
Mucoepidermoid carcinoma
77
Globus pharyngeus - clinical features
Patient complains on a lump in the midline of the throat when swallowing saliva
This lump disappears when ingesting foods or liquids
78
Globus pharyngeus - there is no abnormality on examination or investigations. True or false?
True
79
Laryngomalacia - definition
Soft larynx
| Larynx collapses during breathing
80
Laryngomalacia - who gets it
Young infants
81
Laryngomalacia - clinical features
Chronic stridor
| Noisy breathing
82
Commonest cause of bacterial tonsillitis?
beta haemolytic strep
| strep pyogenes
83
What is quinsy?
Peri-tonsillar abscess
84
OSA is an indication for tonsillectomy? True or false
True
85
Quinsy in a pt with recurrent tonsillitis is an indication for tonsillectomy? true or false?
True
86
Laryngeal nodules are always bilateral and commoner in females ?
True
87
Which questionnaire is used to discriminate snoring from OSA ?
Epworth
