Neck triangle borders:
- Anterior: Sup, Lat, Med
- Posterior: Ant, Post, Infer
Sup: inferior margin of mandible
Lat: ant border of sternocleidomastoid
Med: midline of neck
Ant: post border of sam
Post: ant border of trapezius
Inf: middle 1/3 of clavicle
Neck lumps:
causes
- reactive lymphad (infection, inflammation)
- lymphoma
- thyroid swelling - moves upwards when swallowing
- thyroglossal cyst: painless smooth mass, moves when tongue protrusion + swallowing
- pharyngeal pouch - dysphagia, regurg, aspiration, chronic cough
- cystic hygroma - congen lesion on left
- brachial cyst - left side, mobile cyst between scm + pharynx
- cervical rib
- carotid aneurysm - pulsatile, doesnt move on swallowing
Retropharyngeal abscesses:
- Causative organisms
- Risk factors (4)
- Symptoms
- Investigations
Retropharyngeal abscesses:
- Causative organisms: strep pyogenes, aures - can cause mediastinitis
- Risk factors (4): ot media, pharyngitis, sinusitis, immunosuppression
- Symptoms : neck upright + rigid, sys unwell, dysph, odynop, drooling, fever
- Investigations : lateral xray (widening space), ct neck if
Ludwig’s angina:
- Definition
- Symptoms (5)
- Investigations
- Management
Ludwig’s angina:
- Definition : submandib space infection- cellulitis of floor of mouth
- Symptoms (5): preceding dental infection, swelling of floor + neck, dysphagia, fever, protruding tongue, airway comp, drooling
- Investigations: orthopantomogram
- Management : airway support, iv abx, drainage
Parapharyngeal abscess:
- Definition
- Symptoms
Parapharyngeal abscess:
- Definition : via tonsillitis, dental infections
- Symptoms: similar to quinsy
Thyroid nodules
- Symptoms
- Causes (4)
- Investigations
- Complications of surgery (3)
- What is non neoplastic thyroid nodule + management
- What is goitre
- Risk factors for thyroid cancer
- Types of benign thyroid neoplasms + management
- Types of malignant thyroid neoplasms (4)
- Management for malignant thyroid cancer
Thyroid nodules
- Symptoms : hyperthy symptoms, malig signs (hoarse, dysphagia, dyspnoea)
- Causes (4): thyroid hyperplasia, thyroid cyst, thyroiditis, tumour
- Investigations: uss, tfts, uss guided fna (hemithyroidectomy if suspect ca)
- Complications of surgery (3): damage to parathyroid glands so hypocalc, recurrent laryngeal nerve damage, bleeding leading to laryngeal oedema, thyroid storm
- What is non neoplastic thyroid nodule + management: conserv unless compressive/cosmetic issues then hemithy
- What is goitre: enlarged thyroid gland - diffuse or nodular (single or multinod)
- Risk factors for thyroid cancer: irradiation, smoking , fx
- Types of benign thyroid neoplasms + management : follicular adenoma
- Types of malignant thyroid neoplasms (4): papillary, follicular, medullary (MEN), anaplastic
- Management for malignant thyroid cancer: total thyroidectomy, radioiodine after surgery, check ca levels post for hypocalc + yearly thyroglobulin
Acute sialadenitis:
- Definition
- Causes - bacterial, viral
- Symptoms
- Investigations
- Management
Acute sialadenitis:
- Definition: inflamm of saliv glands
- Causes - bacterial, viral : staph aures, paramyxovirus mumps
- Symptoms : rapid onset pain/swelling, dysphagia, fever, pus
- Investigations: mc+s, facial xray
- Management: abx, rehyd
Sialolithiasis:
- Definition
- Which gland is it most common in
- What are they composed of
- Symptoms
- Investigations
- Management
Sialolithiasis:
- Definition : stones in salivary gland
- Which gland is it most common in ? submandibular
- What are they composed of: ca carbonate or ca phosphate
- Symptoms: colicky pain, swelling, ludwigs angina if becomes infected
- Investigations : sialography
- Management : if in whartons duct can remove orally if not gland excision
Laryngopharyngeal reflux:
- definition
- symptoms
- mx
Laryngopharyngeal reflux:
- definition: GOR resulting in inflammatory changes to larynx/pharynx
- symptoms: lump in throat worse when swallowing saliva, hoarse, cough, dysphagia, heartburn, erythematous post pharynx
- mx: lifestyle (dec fatty, caffeine, chocolate, alc), ppi, gaviscon
Parotid pleomorphic adenoma:
- definition
- symptoms
- mx
Parotid pleomorphic adenoma:
- parotid (serous mostly tumours), submandib (mixed, most stones), sublingual (mucous)
- definition: benign tumour parotid gland, 40-60yrs
- symptoms: slow growing painless unilat swelling, non fixed
- mx: surgical excision (parotidectomy) as risk of cn7 palsy + malig transformation if not removed (adenocarc)
Tonsillitis:
- definition
- causes
- symptoms
- ix
- mx
- complications
Tonsillitis:
- definition: inflamm of palatine tonsils
- causes: bacterial (strep pyogenes, haem influ, pneum, ecoli), viral (rhinovirus, enterovirus, adenov, ebv)
- symptoms: odynophagia, dysphagia, cough, fever, reduced intake, snoring, red inflammed tonsils with maybe white exudate, cervical lymphad
- ix: fbc/crp/lfts (gland?), U+es
fever pain: fever in last 24 hours, purulence, attends rapidly, inflammed tonsils, no cough
centor: exudate, lymphad, fever, no cough
- mx: paracet, delayed prescription oral penicillin 5 5-10 days, difflam (benzyldramine), tonsillectomy if sign criteria (>7 1 yr, 5> per year in 2, >3 per year in 3 years) (prim haemorrhage if <8 hours post take back to theatre or secondary between 5-10 days where admit + abx)
- complications: scarring, otitis media, quinsy (severe pain, uvula deviation, trismus), para/retropharngeal space infection, glomerulonephritis
Head and neck ca
- types
- symptoms
- referral
Head and neck ca
- types: oral cavity, cancers of pharynx, larynx
- symptoms: neck lump, horse, sore throat, persis ulcer
- referral
laryngeal: >45 weeks persis horse or unexpl lump
oral: >3 weeks ulcer, persis lump, erythroplakia, erythroleukoplakia
thyroid: unexp thyroid lump
Hoarse
- causes
voice overuse
smoking
viral illness
hypothy
gord
laryngeal ca
lung can
EBV (infectious mononucleosis):
- symptoms
- ix
- mx
- complications
- causes: human herpes 4
- symptoms: fever, sore throat, fatigue, lymphad, tonsillar enlargement, splenomegaly
- ix: monospot test (after 2 weeks for heterophiles ab to appear), or IBM/igG ab
- mx: self limiting 2-3 weeks but fatigue for several months. avoid alc/ contact spots for 4 weeks
- complic: spleen rupture, glomerulonephritis, haemolytic anaemia, thrombocytopenia, cancer (burkitts, Hodgkins, nasopharyngeal)
