Throat Conditions Flashcards by Roshan Patel

What is a retropharyngeal abscess?

Neck infection involving abscess in the space between the pre-vertebral fascia and constrictor muscles

Most commonly seen in children

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What causes retropharyngeal abscesses?

Complication of URTI from:

strep viridans
strep epidermis
staph aureus

Can also be trauma or foreign body

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How do retropharyngeal abscesses present?

Spiking fever
Neck pain - especially on movement
Torticollis
Dysphagia and odynophagia –> drooling

!Airway compromise!

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What is torticollis?

Abnormal, asymmetrical, twisted head position

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What may be seen on examination with a retropharyngeal abscess?

Tonsillar swelling

Lymphadenopathy

Oropharyngeal swelling

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What investigation may you carry out for a suspected retropharyngeal abscess and what would it show?

CT with contrast - ring enhancing lesion in retropharyngeal space

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What are the risk factors associated with retropharyngeal abscess?

Diabetes
Dental Infection
FB ingestion
Trauma

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What complications can arise from retropharyngeal abscesses?

Airway compromise
Mediastinitis
Pericarditis
CN9 + 12 palsy

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How is a retropharyngeal abscess managed?

IV dexamethasone + nebulised adrenaline

IV Abx - ampicillin

Surgical drainage

Supportive therapy

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What is Ludwig’s angina?

Cellulitis of the floor of the mouth

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What causes Ludwig’s angina?

Follow dental infection in 90% of cases

Parapharyngeal abscess

Mandibular fracture

Cut/piercing in mouth

Submandibular salivary stones

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How does Ludwig’s angina present?

Progress over hours
Drooling - dysphagia
Bilateral lower face swelling - mandible and neck
Elevation of the floor of the mouth
Posterior displacement of the tongue - can compromise airway
Painful neck area

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How would you investigate Ludwig’s angina?

CT with contrast

+ dental x rays and chest imaging

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How is Ludwig’s angina managed?

Airway management
Empirical IV Abx (Benpen + metronidazole)
Surgical incision and drainage

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Give some differential diagnoses for neck lumps

Reactive lymphadenopathy
Lymphoma
Thyroid swelling
Thyroglossal cyst
Pharyngeal pouch
Cystic hygroma
Branchial cyst
Cervical Rib
Carotid aneurysm
Sebaceous cyst
Lipoma
Salivary gland problems

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If a patient presents with a history of general malaise but has a neck lump, what would be your primary differential?

Reactive lymphadenopathy

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What history would indicate a neck lump is a lymphoma?

Rubbery painless lymphadenopathy

+- night sweats and splenomegaly

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What feature of a neck lump would indicate it is a thyroid swelling?

Moves upwards on swallowing

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What history would indicate a thyroglossal cyst?

Painful - if infected
Midline (between isthmus of thyroid and hyoid)
Move up with protrusion of tongue
Commonly <20yo

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What history may indicate a neck lump is a pharyngeal pouch?

HALITOSIS

Usually older men
Represent herniation between thyropharyngeus and cricopharynxgeus
Gurgle on palpation
Usually not seen but if large then midline
Dysphagia, regurgitation, aspiration, chronic cough

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How would a cystic hygroma appear?

Left side

Congenital lesion - most evident at birth, 90% before 2yo

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What history indicates a branchial cyst?

Oval, mobile, cystic mass
Pain and redness
Between SCM and pharynx
Usually early adulthood

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What is often noted about cervical rib?

More common in adult females

10% develop thoracic outlet syndrome

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How may a carotid aneurysm appear?

Pulsatile lateral neck mass

Doesn’t move on swallowing

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How does a sebaceous cyst appear?

Intradermal - quite superficial | Central punctum

What may make you think a neck lump is due to salivary gland issues?

Associated with eating Fluctuant in size May cross mandibular angle

What questions do you ask about for a neck lump?

``` Fever Malaise Night Sweats? Weight Loss? Swallowing okay? Voice change? Smoker Travel? ```

What investigations would you request for a neck lump?

FBC and ESR - generalised lymphadenopathy Thyroid function tests CXR - supraclavicular and >40yo USS and fine needle aspiration if diagnosis unclear - NOT IF PULSATILE

What is the most common head and neck cancer? What cancers do "head and neck" cancers include?

Squamous cell carcinoma Oral cavity Pharynx Larynx

What are the red flags for head and neck cancers?

``` Neck lumps Hoarse voice Oral Ulcer > 3 weeks Red/white oral patch Lip lump Stridor Dysphagia or odynophagia >3 weeks Unilateral throat discomfort >4 weeks Tooth mobility ```

What are the main risk factors for head and neck cancers/

``` Smoking Alcohol Poor dentition Poor diet - limited fruit, veg and fish GORD HPV16 ```

How are head and neck cancers investigated?

Fine needle aspiration cytology

How are head and neck cancers staged?

TNM staging

Whats the difference between a thyroid nodule and goitre?

Goitre - enlargement of the thyroid gland - can be multiple nodules Lump - can be in a normal thyroid gland or a goitre. - can be cystic, colloid, hyperplastic, malignant or oedematous

What TFT's would you expect to see in a non-toxic goitre?

Normal

What thyroid conditions can cause raised TFT's?

Grave's disease Toxic multi nodular goitre

What happens in toxic multi nodular goitres?

Autonomously functioning thyroid nodules secrete excess hormone

What thyroid conditions can cause low TFT's?

Hashimoto's De Quervain's thyroiditis Riedel's thyroiditis

What history would indicate de quervain's thyroiditis?

Painful goitre Raised ESR Following URTI

What happens in acute suppurative thyroiditis?

Infection causing an abscess

What history may indicate Riedel's thyroiditis?

Painless goitre | Fibrous tissue replace thyroid parenchyma

What are the red flags for thyroid lumps?

``` Stridor - same day referral In a child Voice changes Rapid enlargement over weeks Cervical lymphadenopathy History of radiation exposure ```

How would you investigate a thyroid lump?

Thyroid function tests US guided fine needle aspiration Hemithyroidectomy if in diagnostic doubt

What are the types of thyroid neoplasms?

``` Benign - adenoma (follicular cells) Malignant: - Papillary adenocarcinoma (70%) - Follicular carcinoma (20%) - Medullary carcinoma (5%) - Anaplastic carcinoma (5%) ```

What history is common in papillary adenocarcinoma of the thyroid?

Most common type of malignant thyroid neoplasm Younger patients History of neck irradiation

What may indicate a thyroid cancer is a follicular carcinoma?

Metastasise to bones and lungs

What is important to know about medullary carcinoma's of the thyroid?

Neoplasm of C Cells - regulate calcitonin Typically seen in MEN syndromes - screen other organs Genetic component

What is important to know about anaplastic thyroid carcinoma?

Typically older patients | Poor prognosis - weeks/months by time of diagnosis

How are non neoplastic thyroid nodules managed?

Conservatively Hemithyroidectomy if airway compression, patient preference or cosmetic reasons Avoid thyroidectomy due to complications and lifelong thyroxine req.

How are neoplastic thyroid nodules managed?

Adenoma - diagnostic hemithyroidectomy Carcinoma - total thyroidectomy

What complications are associated with thyroid surgery?

Post-operative haemorrhage Airway obstruction - haemorrhage or vocal cord palsy Vocal cord palsy Hypocalcaemia

What are the salivary glands?

Parotid Sublingual Submandibular

Which salivary gland is normally affected by calculi?

Submandibular - 80%

What makes up most salivary calculi?

Calcium phosphate or calcium carbonate 70% radioopaque

How does sialiolithiasis usually present?

Colicky pain and post prandial swelling of the gland

How is sialolithiasis diagnosed?

Sialography - demonstrate site of obstruction

How is sialolithiasis managed?

Distal aspect of Wharton's duct - remove orally Other stones and chronic inflammation - gland excision

What ducts are connected to each salivary gland?

Parotid - Stensons duct Submandibular - Wharton's duct Sublingual - duct of Rivinus

What is sialadenitis?

Infection of the salivary glands Usually due to staph aureus tracking from oral cavity

What risk factors are associated with sialadenitis?

``` Decreased saliva or obstruction Dehydration Malnourishment Radiotherapy Drugs - antihistamines, beta blockers, diuretics ```

How is sialadenitis managed?

Abx - fluclox and metronidazole Warm compress - encourage flow Hydration

How does sialadnitis present?

``` Reduced saliva Bad taste in mouth - pus Pain Swelling Redness of skin ```

What is Sjogrens syndrome?

Autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces May be primary or secondary to rheumatoid arthritis/other connective tissue disorders

Who is Sjogren's more common in?

Females

What does Sjogren's increase risk of ?

Lymphoid malignancy - 40-60fold increase

What are the main features of Sjogrens?

``` Dry eyes dry mouth vaginal dryness arthralgia Raynaud's Myalgia Sensory polyneuropathy Recurrent parotitis Renal tubular acidosis - usually subclinical ```

What antibodies are associated with Sjogrens

Rheumatoid Factor - nearly 100% of patients ANA - 70% Anti-Ro - 70% with primary sjogrens Anti-La - 30% of primary sjogrens

What other investigations are indicated for suspected Sjogrens?

Schirmers test - filter paper near conjunctival sac to measure tear formation Histology - focal lymphocytic infiltration Hypergammaglobulinaemia

How is Sjogren's managed?

Artificial saliva and tears | Pilocarpine - may stimulate saliva production

Throat Conditions Flashcards

(69 cards)