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					          Throat
(Things your housemate will ask and
   things you should never miss!)
            Dr Bev Huss
                 Throat
•   Sore throats
•   Hoarseness
•   Neck lumps
•   Mouth ulcers
•   Tongue problems
             Sore Throats
• History:
• Fever, swallowing, duration, malaise,
  children may get abdo pain, coryza, cough

• Examination:
• Well/unwell, temperature, pulse, cervical
  lymph nodes, drooling/able to swallow?,
  rash
      Tonsils
• Picture normal tonsils
         Tonsils !
• Picture bilat infected tonsils
  Tonsil 
• Picture quinsy
                  Quinsy
• Unwell
• Difficulty swallowing- even saliva
• Trismus (can’t open jaw)

• REFER- needs iv ABx and poss I+D
        Sore throat- causes
• Viral 70%
• Bacterial- Group A beta haemolytic Strep
  (scarlet fever, glomerulonephritis,
  rheumatic fever)
• Glandular fever- Epstein Barr Virus (EBV)
• (Diphtheria in former Soviet Union and E
  Europe)

• 90% recover in 1week
     Sore throat- don’t forget!

DRUGS-

• Risk of neutropenia and agranulocytosis-
  chemotherapy, immunosuppressants,
  carbimazole
Tonsillar tumour
    • picture
            Tonsillar tumours
•   Unilateral tonsil swelling
•   Dysphagia
•   Sore throat
•   Earache

• REFER for biopsy -2wk wait
               Sore throat
• Antibiotics?
• Centor criteria:
  – Tonsillar exuadte
  – Swollen tender anterior cervical nodes
  – No cough
  – Fever


• ?delayed prescription
                 Sore throat
• Which anitbiotics?

  – Penicillin V, Erythromycin (if penicillin allergic)

  – NOT amoxicillin (rash if it’s EBV)
             Glandular fever
•   Teenagers/ young adults
•   Sore throat >1wk
•   Malaise, fatigue
•   Lymphadenopathy
•   Splenomegaly
•   Palatal petechiae
•   Rash 10-20%
              Glandular fever
• Investigation
  – FBC – will see atypical lymphocytes
  – Glandular fever antibodies- Paul Bunnell or Monospot
    tests
  – LFT


• Treatment
  – Rest, avoid alcohol, treat secondary infection,
  – most recover in 4wks, some have prolonged symps
Sore throat !
• Picture piercing
               Tonsillectomy
•   Recurrent tonsillitis 5+ episodes per year
•   Sleep apnoea (kissing tonsils)
•   Chronic tonsillitis 3+mth +halitosis
•   Recurrent quinsy
•   Unilateral tonsil enlargement

• Complications- haemorrhage
              Acute epiglottitis
•   Unwell, onset often just few hours
•   Drooling
•   Stridor
•   Fever
•   Sitting up leaning forward
    – (Less common since HIB imms)

• !RISK OF AIRWAY OBSTRUCTION- DO NOT
  EXAMINE!
• REFER for iv Abx, poss
  intubation/tracheostomy
              Hoarseness
• Infection- laryngitis
• Trauma- shouting, coughing, vomiting, GORD,
 ENT surgeons!
• Cancer- smokers
     hoarse>stridor>dysphagia>pain
• Neurological- CXR- apical lung ca
• Muscular
• Functional (psychological)
              Hoarseness
• Examination
• Weight- loss (ca), gain (TFT)
• Associated neck lumps

• REFER if hoarse for >3wks ?malignant
               Neck lumps
• History- infective/malignancy/other

• Examination-
• Midline
  – thyroglossal cyst- moves with tongue
  – pharyngeal pouch
  – Ranula (mucous retention cyst of floor of
    mouth)
  – cancer- larynx, trachea, oesophagus
               Neck lumps
• Lateral
  – LN- infection, malignancy (lymphoma, mets)
  – Thyroid
  – Branchial cyst
  – Salivary gland tumour

• Supraclavicular
  – GI, lung, testicular cancer metastasis
    (Virchow’s node)
        Neck lumps
• picture
Neck lumps
• Picture anatomy
   Neck lumps
• Picture branchial cyst
              Mouth ulcers
•   20% of population
•   Often FHx if recurrent
•   Freq and severity reduce with age
•   Less in smokers and ↑ when give up 
•   20% B12/folate/iron deficient

• Consider Bechets, Crohn’s, coeliac
               Mouth ulcers
• REFER if persist >3wks as risk of malignancy,
  or if persistent red or white patches

• Other causes- primary HSV (children),
  pemphigus, drugs (nicorandil, alendronate,
  chemotherapy)

• Rx- topical steroids (simple aphthous ulcers)
Mouth ulcers
• Picture aphthous
Mouth ulcers
 • Picture HSV
Mouth ulcers
• Picture syphilis
Tongue problems
 • Picture geographic
Tongue problems
 • Picture malignant
Tongue problems
 • Picture traumatic
         Tongue problems
• Non-healing ulcers REFER as ?malignant
                 Throat
•   Sore throats
•   Hoarseness
•   Neck lumps
•   Mouth ulcers
•   Tongue problems

              Any questions?

				
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