Applied Anatomy - Throat Flashcards
What is acute pharyngitis ?
Clinical presentation?
Treatment ?
- Inflammation of the part of the throat behind the soft palate (oropharynx).
- Most common cause is a viral infection
Rhinovirus, parainfluenza virus, influenza types A and B.
Clinical presentation:
Non-specific symptoms may include fever, headache, nausea, vomiting
Rhinorrhoea, nasal congestion, and cough are especially present in viral pharyngitis, but not in bacterial pharyngitis.
Management:
Give general advice for viral infection
Reasons why you think its a viral infection & why prescribing antibiotics is not suitable
Should resolve spontaneously in 7-10 days
Stay hydrated
Analgesia & antipyretics for pain and fever
Safety net
What is acute tonsilitis ?
What criteria would you use ?
Inflammation of the palatine tonsils but can extend to the adenoid and lingual tonsils
Clinical presentation:
Fever, sore throat, foul breath
Dysphagia (difficulty swallowing)
Odynophagia (painful swallowing)
Tender cervical lymph nodes
Physical examination
Mucosal inflammation
Presence of tonsillar exudates
Cervical adenitis
Use Centor Criteria to determine if likely to be bacterial (group A beta-haemolytic streptococcus (GABS)):
What is a complications of acute tonsillitis ?
Quinsy
Explain Oral Herpes Simplex
What is the management ?
A mild, self-limiting infection of the lips, cheeks, or nose (herpes labialis or ‘cold sores’) or oropharyngeal mucosa caused by the herpes simplex virus (HSV)
HSV type 1-cause in >90% of cases
HSV type 2-rare, associated with orogenital sex
Management:
Usually self limiting (7-10 days)
Give advice to prevent spread to others
Simple analgesia and topical treatments can be used- commonly Aciclovir 5% cream
Oral antiviral agents (e.g. valaciclovir) can be used if severe infection and immunocompromised
What is the clinical presentation of quinsy ?
How do you manage it ?
Clinical presentation:
Pain on swallowing (odynophagia); inability to swallow
Referred pain to the ear on the affected side (otalgia)
‘Hot-potato’ voice
Other: fever, altered mentation, signs of sepsis.
Management:
ABCDE
Refer to ENT
IV fluids for hydration
IV antibiotics, analgesia, corticosteroids
Definitive: aspiration of the abscess; may do incision & drainage (culture and sensitivity of the aspirate)
Whatr are Aphthous Ulcers
What are the variants ?
What are the possible causes ?
How to manage ?
Small, shallow lesions that develop on the soft tissues of the mouth or gums
Variants:
- Minor- less than 1 cm in diameter
- Major- usually 1–3 cm in diameter, deeply indurated
- Herpetiform- are very small (1–2 mm) grouped lesions.
Possible causes of include:
Genetic predisposition
Deficiency of iron, zinc, folic acid
Local trauma to the oral mucosa (for example, biting during chewing).
Exposure to certain foods (typically chocolate, coffee, peanuts, and/or gluten products).
Management
Most resolve without treatment within 1-2 weeks
Treat predisposing factors/conditions
First line- topical steroids and/or topical local anaesthetics and/or topical antimicrobials
Antibacterial mouthwashes prevent secondary infection
If ulcers are chronic and difficult to treat consider referral to ENT
If unexplained ulcer present for >3 weeks, refer. In adults possible oral cancer, in children to rule out other causes such as leukaemia
What is acute laryngitis ?
Treatment ?
Inflammation of the mucosal lining of the vocal folds & larynx which is less than 3 weeks
Most commonly due to an infection (viral)
Causes:
Vocal misuse, exposure to noxious agents (ie. smoking) URTI, autoimmune conditions (rare)
Treatment
Most cases are self-limiting
Voice rest, stop smoking
Hydration, reducing irritants (caffeine)
The most common etiology for acute laryngitis is an infectious source, usually a viral upper respiratory tract infection
Antibiotics for severe cases may be considered
Patients who have persistent fever (> 48 hours), purulent sputum, immunodeficiency.
What is oral candida ?
How to treat ?
Fungal infection of the mouth (aka oral thrush)
Caused by a fungus (normal commensal of the oral cavity)
Certain factors can cause it to rapidly grow & multiply within the oral cavity
Predisposing factors:
Recent antibiotic use
Elderly/ babies/neonate
Immunocompromised
Use of oral or inhaled steroid
Use of dentures
Topical treatment- miconazole gel (use nystatin if unable)
In severe infection
Adults oral fluconazole
Children refer to paediatrics
What is acute epiglottitis?
What are the signs and symptoms
This is an AIWAYWAY EMERGENCY.
Also called supraglottitis – inflammation of the supraglottic area, including epiglottis
Caused by
- Group A B-hemolyric streptocci
Steptococcus pneumoniae
-Staphylococcus aureues
- Moxella
- Reaction to chemotherapy
- trauma
Symptoms and signs
Drooling, dysphagia, distress
Shortness of breath, stridor (usually inspiratory), recession
Child looks toxic, with high fever
“Tripod” position- maximises air flow
Hoarseness, may be unable to lie flat
Acute onset and can progress rapidly
Lack of coughing compared to croup
Symptoms and signs
Drooling, dysphagia, distress
Shortness of breath, stridor (usually inspiratory), recession
Child looks toxic, with high fever
“Tripod” position- maximises air flow
Hoarseness, may be unable to lie flat
Acute onset and can progress rapidly
Lack of coughing compared to croup
Transfer to ED & inform ENT, paediatrics, anaesthetics
Assess ABCDE
Avoid intervention until senior support and emergency airway equipment available, not even examination of the throat
Broad-spectrum antibiotics, IV fluids, close monitoring for airway obstruction
Complications: Abscess formation (up to 25%), sepsis, meningitis, pneumothorax, death
