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ENT > Acute sore throat presentation > Flashcards

Acute sore throat presentation Flashcards

1
Q

history in acute sore throat presentation

A
  • PAIN hx – SOCRATES
  • Associated sx: cough, dysphagia, rash, stridor, fever, feeling systemically unwell
  • Key associated sympoms: otalgia, coryzal, cough, night sweats, odynophagia, SOB
  • Drooling, leaning forward, high temp = epiglottitis.
  • Key signs: Fever (degree of), tachycardia, weight loss, dysphagia, drooling, stridor
  • Any self-medication/OTC medications
  • PMH – other comorbidities, prev risk factors/past infections
  • DH and allergies - glandular fever reaction with amoxicillin
  • FH anyone else affected
  • SH - smoker, occupation
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2
Q

examination in acute sore throat presentation

A

Look = neck swelling, asymmetry, rash, uvula deviation, tongue, throat examination
Erythema, enlarged tonsils, presence of exudates

Feel = cervical lymphadenopathy

Move = neck movement, mouth opening, any trismus

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3
Q

Investigations in acute sore throat presentation

A
  • Usually unnecessary
  • Throat swabs – not advised for routine but may be helpful in high-risk groups, or where there is treatment failure
  • FBC, LFT & monospot test – if glandular fever suspected
  • Antistreptolysin O (ASO) titres – may be useful in excluding recent strep infection in patients who are systemically unwell/ have prolonged sx
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4
Q

viral infections & acute sore throat presentation + management

A

rhinoviruses, coronavirus,respiratory syncytial virus,parainfluenza virus – 80%

Adenovirus
Orthomyxoviridae-influenza
Epstein-Barr virus
Herpes simplex virus
Measles

Mx:

  • Reassurance – self-limiting within 1 week
  • Analgesia
  • Fluids
  • Symptomatic relief
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5
Q

Glandular fever: presentation and signs

A 
Presentation:
Sore throat
pyrexia
malaise
anorexia

Signs:

  • Posterior cervical lymphadenopathy
  • splenomegaly
  • hepatitis
  • haemolysis
  • diffuse rash
  • soft palate petechiae
  • exudative tonsils

80–90% of patients with acuteEpstein–Barr virusinfection treated with antibiotics develop a red, diffuse rash.

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6
Q

Glandular fever: diagnosis and management

A

Diagnosis:

  • WCC - 50% lymphocytes with >10% atypical lymphocytes, raised ALT
  • monospot - specific but not sensitive: (100% specific, 85% sensitive) – 1-2 weeks for ve+ results
  • EBV Titre

Management:

  • Supportive therapy (analgesia, fluids)
  • Steroids

Delayed

  • Safety advice – avoid contact sports for 6 weeks
  • GP to re-check derranged LFTs on discharge
  • ENT review if persistent symptoms
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7
Q

laryngitis: presentation, aetiology and management

A

Presentation:
Fever, Dysphonia

Aetiology:
Trauma (chemical/physical),
Infection (viral)

Management:
Voice rest
Humidification
Steroids

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8
Q

Epiglottitis (Supraglottitis): target group & presentation

A

Target group: children (epiglottitis), adults (supraglottitis), immunosuppressed; 1-4:100,000

Presentation:
Sore throat
difficulty speaking
drooling
leaning forward
fever
difficulty swallowing
fast heart rate
difficulty in breathing
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9
Q

Epiglottitis (Supraglottitis): aetiology

A

Aetiology:
Streptococcus pneumoniae, Haemophilus parainfluenzae,

Adult: Haemophilus influenza (25%); Strep pneumoniae; Group A Strep
Paeds: Hameophilus influenzae type B (Hib) is less common; Group A beta-haemolytic strep ; step penumoniae

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10
Q

Epiglottitis (Supraglottitis): management

A 
Management:
AIRWAY-E assessment 
broad spectrum antibiotics
Steroids
Secure airway
- Adrenaline nebs
- IV dexamethasone
- Intubate
- Cricothyroidotmy vs Tracheosotomy

Sore throat but normal looking tonsils = FNE

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11
Q

FNE

A

fiberoptic nasoendoscopy, commonly used in the treatment of epistaxis in assessing the nasal cavity after removal of nasal packs

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12
Q

bacterial infections & acute sore throat presentation

A

Strep sore throat - Streptococcus pyogenes (group A beta-hemolytic streptococcus)

Scarlet fever - erythrogenic toxin producing strains ofStreptococcus pyogenes

Diphtheria is caused by an exotoxin-producing gram-positive rod,Corynebacterium diphtheriae

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13
Q

(Pharyngo)tonsillitis presentation & aetiology

A

Presentation:
severe pain on swallowing, fever, toxic

GABS – anterior cervical and submandibular lymphadenopathy on examination

Aetiology:
Streptococcus pyogenes,
Staphylococcus aureus,
Haemophilus influenzae

Viral: 50-80%, 1-10% Epstein-Barr Virus
Bacterial: Group A B-haeomolytic strep (exudate)

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14
Q

(Pharyngo)tonsillitis management

A

Management:
-Antibiotics:
Phenoxymethylpenicillin for 5-10 days (clarithomycin in pen allergy)
Avoid amoxiciilin – cause rash in glandular fever
-Rehydration
-Analgesia

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15
Q

Centor criteria:

A 
Centor criteria:
Tonsillar exudate
Tender anterior cervical LNs
Absence of cough
Hx of fever (>38)
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16
Q

score for Centor criteria

A

Score 3-4: 32-56% presence of GABS = Abx may be beneficial

Score 0,1 or 2: 3-17%

17
Q

Fever Pain criteria

A
  • Fever (last 24 hours)
  • Pus on tonsils
  • Attend rapidly (within 3 days after onset of Sx)
  • Severely Inflammed tonsils
  • No cough/coryzal sx
18
Q

Fever Pain criteria score

A

Score 0-1: 13-18% of isolating streptococcus
2-3: 34-40%
4-5: 62-64%, give antibiotics

19
Q

When to refer

A 
Urgent same day:
Stridor or respiratory difficulty
Dehydration
Quinsy
Severe systemic illness
Suspected kawasaki disease or epiglotitis
20
Q

Routine referral for consideration tonsillectomy:

A
  • More than 7 episodes in 1 year
  • 5 per year for 2 years
  • 3 per year for 3 years

*Bacterial infections, abx use, affecting school/work/debilitating sx

21
Q

Complications of tonsillitis

A
  • Quinsy (peritonsillar abscess)
  • Scarlet fever
  • Strep toxic shock syndrome
  • Lemierre’s syndrome (rare – acute septicaemia & jugular vein thrombosis secondary to infection with fusobacterium spp.)
  • Rheumatic fever
  • Post-strep glomerulonephritis
    Guttate psoriaris
22
Q

Peritonsillar abscess (Quinsy): presentation and aetiology

A

Presentation:

  • Severe unilateral pain
  • Pyrexia
  • Unilateral Earache
  • Odynophagia
  • Trismus
  • muffled voice “hot potato” voice
  • Foetor oris
  • Halitosis
  • deviated uvula

Aetiology:
aerobic:
Streptococcus pyogenes, Staphylococcus aureus

Occurs in space between tonsil and pharyngeal wall

as a complication of untreated tonsillitis

23
Q

Peritonsillar abscess (Quinsy): investigations & management

A

Investigations: ENT opinion needed, Bloods (FBC, U+E, CRP, LFTs, monospot, clotting)

Management:
broad spectrum antibiotics – BenPen
- IV steroids - dexamethasone
- Rehydration
- Analgesia
- Needle aspiration, may require incision and drainage
24
Q

scarlet fever presentation

A

Notifiable disease

Prodromal sx: sore throat, fever, headache, myalgia

Rash – coarse texture ‘sandpaper’. Typically neck first  chest & scapular regions trunk & legs

White Strawberry tongue – red papillae seen through a white ‘fur’  red, raw (desquamation)

Throat swab

25
Q

management of scarlet fever

A

Mx: penicillin based for 10 days

Exclusion from school – can return after 24h of abx

26
Q

Measles presentation, aetiology and complications

A
  • RNA virus of the family Paramyxoviridae
  • Contagious infection diseases – notifiable disease

Prodrome sx:
fever
cough
coryzal sx
conjuctivitis
Koplik’s spots – pathognomonic – opposite 2nd molar teeth – small, red spots, with a bluish-white speck
Morbiliform rash – forehead, neck trunks limbs

Complications: pneumonia, encephalitis

27
Q

Pharyngitis: symptoms and aetiology

A
  • Common
  • Target Group: Child-Adult

symptoms:
- sore throat
- cough
- coryza
- oltalgia
- pyrexia
cervical lymphadenopathy

Causes
Viral: rhinovirus, adenovirus, para-influenza
Bacterial: Group A B-haeomolytic strep (exudate)
Fungal: candida (white spots)

28
Q

pharyngitis: Investigations & management

A

Investigations:

  • Examination,
  • ECG if tachy
  • CXR if persistent cough
  • bloods if concerned other pathology - monospot for glandular fever etc

Management:

  • Reassure
  • Oral fluids
  • analgesia
  • antibiotics if bacterial infection suspected (penicillin V vs amoxicillin)

ENT (7 decks)

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