Throat Pathologies

Question 1

Should throat swabs be carried out routinely in primary care?

Answer 1

No

Question 2

A bacterial tonsillitis is most commonly due to what organism?

Answer 2

Strep pyogenes (GAS)

Question 3

What are the 4 main features of the Centor criter?

Answer 3

Fever > 38 degrees, no cough, tender anterior cervical lymphadenopathy, tonsillar swelling or exudate

Question 4

An extra point is gained on the Centor criteria if the individual is what age?

Answer 4

3-14 years

Question 5

An point is lost on the Centor criteria if the individual is what age?

Answer 5

> 44 years

Question 6

What is the management of tonsillitis with a Centor score of 0-1?

Answer 6

Supportive care only

Question 7

What is the management of tonsillitis with a Centor score of 2-3?

Answer 7

Supportive care and a delayed prescription of antibiotics for if symptoms persist

Question 8

What is the management of tonsillitis with a Centor score of 4-5?

Answer 8

Supportive care and antibiotics

Question 9

What is the first line antibiotic treatment for tonsillitis and how long is it given for?

Answer 9

Oral penicillin V for 5 days

Question 10

What is the second line antibiotic treatment for tonsillitis and how long is it given for?

Answer 10

Oral clarithromycin for 5 days

Question 11

What are some potential late complications of a streptococcal tonsillitis?

Answer 11

Rheumatic fever or glomerulonephritis

Question 12

How many episodes of tonsillitis is one year would be considered criteria for tonsillectomy?

Answer 12

7 episodes

Question 13

What is the most significant risk of tonsillectomy?

Answer 13

Bleeding

Question 14

Unilateral throat pain and odynophagia following an acute tonsillitis is most suggestive of what diagnosis?

Answer 14

Quinsy (peritonsillar abscess)

Question 15

How is quinsy treated?

Answer 15

Hospital admission for aspiration, IV antibiotics and a one-off dose of IV dexamethasone

Question 16

A sore throat and lethargy persisting for over one week should raise suspicion of what diagnosis?

Answer 16

Glandular fever

Question 17

What organism is responsible for causing infectious mononucleosis (glandular fever)?

Answer 17

EBV

Question 18

What is the classic triad of glandular fever?

Answer 18

Fever, enlarged cervical lymph nodes and a sore throat

Question 19

A rash which becomes more prominent if amoxicillin is prescribed occurs in what condition?

Answer 19

Glandular fever

Question 20

How is glandular fever diagnosed?

Answer 20

EBV serology and Monospot test

Question 21

What are the most important blood tests to perform for someone with suspected glandular fever?

Answer 21

FBC and LFTs

Question 22

How is glandular fever treated?

Answer 22

Supportive treatment only

Question 23

Following glandular fever, contact sports should be avoided for how long and why?

Answer 23

6 weeks to avoid splenic rupture

Question 24

A severe sore throat with a grey/white membrane across the pharynx is suggestive of what diagnosis?

Answer 24

Diphtheria

Question 25

A teardrop sign on CT is suggestive of what diagnosis?

Answer 25

Orbital floor fracture

Question 26

What are the major risk factors for SCC in elderly patients?

Answer 26

Smoking and alcohol

Question 27

What is the major risk factor for SCC in younger patients?

Answer 27

HPV infection (commonly type 16)

Question 28

Chewing of betel nuts is a risk factor for what pathology?

Answer 28

Oral cancer

Question 29

Hardwood exposure, commonly seen in joiners, is a risk factor for what pathology?

Answer 29

Malignancies of the paranasal sinuses

Question 30

What is the investigation of choice for all neck lumps?

Answer 30

Ultrasound

Question 31

Most HPV associated squamous cell carcinomas are located where?

Answer 31

The tonsils or tongue base

Question 32

What is the initial investigation of choice for suspected laryngeal cancer?

Answer 32

Direct laryngoscopy

Question 33

If there is any uncertainty over whether or not a reactive lymph node is malignant or not, what is the investigation of choice?

Answer 33

Ultrasound guided FNA

Question 34

Masses located where will move upwards with swallowing?

Answer 34

Masses located in the thyroid

Question 35

A lump between the isthmus of the thyroid gland and the hyoid bone which moves upwards on protrusion of the tongue is most likely to be what?

Answer 35

Thyroglossal duct cyst

Question 36

What is usually the cause of a lump on the left side of the neck in the first 2 years of life?

Answer 36

Cystic hygroma

Question 37

Where is a branchial cyst usually located?

Answer 37

Between the sternocleidomastoid muscle and the pharynx

Question 38

When does a branchial cyst usually present?

Answer 38

Early adulthood

Question 39

An FNA showing an acellular fluid with cholesterol crystals is suggestive of what diagnosis?

Answer 39

Branchial cyst

Question 40

What is the investigation of choice for suspected pharyngeal pouch?

Answer 40

Barium swallow

Question 41

A salivary gland stone is most likely to occur in which gland?

Answer 41

Submandibular gland

Question 42

Pain and swelling in the mouth after eating is suggestive of what diagnosis?

Answer 42

Salivary gland stone

Question 43

Which salivary gland is the most common site for tumours?

Answer 43

Parotid gland

Question 44

What is the most common salivary gland tumour, usually seen in females aged > 60 in the parotid gland?

Answer 44

Pleomorphic adenoma

Question 45

What type of salivary gland tumour is typically seen in the parotid gland in males aged > 50 and have a strong association with smoking?

Answer 45

Warthin's tumour

Question 46

What is the most common malignant salivary gland tumour in the UK?

Answer 46

Adenoid cystic carcinoma

Question 47

What diagnosis is usually made when an individual is investigated for hoarseness but no underlying cause is identified?

Answer 47

Silent reflux

Question 48

How is silent reflux treated?

Answer 48

Lifestyle advice and a PPI

Question 49

An intermittent sensation of a lump in the throat with a normal examination is most suggestive of what diagnosis?

Answer 49

Globus pharyngeus