CNS/HN - Sorethroat Flashcards
Differential Diagnosis of Sorethroat
- Infectious Mononucleosis
- Infectious Mononucleosis - counselling
- Gonococcal Pharyngitis
- Quinsy
- Viral tonsillitis
Differential Diagnosis
- Tonsillitis
- Pharyngitis
- Viral URTI
- EBV
- Laryngitis
- Quinsy
Key History - Sore Throat
Key history
- First determine whether the patient has a sore throat, a deep pain in the throat or neck pain.
- Enquire about relevant associated symptoms such as a metallic taste in the mouth, fever, upper respiratory infection, postnasal drip, sinusitis, cough and other pain such as ear pain.
- Note whether the patient is an asthmatic and uses a steroid inhaler or is a smoker or exposed to environmental irritants.
Key Physical Examination - Sore Throat
Key examination
•On inspection note the general appearance,
- look for toxicity,
- the anaemic pallor of leukaemia,
- the nasal stuffiness of infectious mononucleosis or - the halitosis of a streptococcal throat
•Palpate the neck for
- soreness and
- lymphadenopathy and
- check the sinus area
•Then inspect the
- oral cavity and pharynx
Key Investigation - Sore Throat
Key investigations Consider: •throat swab •FBE •mononucleosis test •blood sugar •biopsy of suspicious lesions.
Key Diagnostic Tip - Sore Throat
Diagnostic tips
•Tonsillitis with a covering membrane may be caused by Epstein–Barr mononucleosis.
•Admit if any suspicion of epiglottitis—and do not examine the throat.
•The triad-hoarseness, pain on swallowing and referred ear pain → pharyngeal cancer
Differential Diagnosis - Infectious Mononucleosis
fever, sorethroat, rash, cervical LAD, hepatosplenomegaly
Differential Diagnosis
- EBV
- CMV/toxoplasmosis
- HIV
- Streptococcus pharyngitis (tonsillitis)
- Lymphoma/leukemia
- Hepatitis
- Rickettsia/leptospirosis
- Rubella
- Disseminated gonococcal disease (DIC)
- Kawasaki (kids)
History - Infectious Mononucleosis
History
- HOPI
- Fever
- how high? continuous or on and off? rigors and chills?
- Sorethroat - SIQORAA
- difficulty and pain in swallowing
- deep pain in throat or neck pain?
- Rash
- where? when? itchy? discharge? blanch? allergy? meds?
ASSOCIATED SYMPTOMS
- runny nose
- cough and colds
- facial pain (sinusitis)
- ear pain
- neck pain
- nausea and vomiting
- water works and bowel works
- yellowish discoloration of skin?
- LOA, LOW, LBBB, Night sweats
- Body weakness
- Joint pains
Complications questions:
- any difficulty opening your mouth? (trismus)
- any shortness of breath?
RISK FACTORS
- Travel
- Occupation
- Pets/Carpets - Asthma> steroid inhaler
- Exposure> someone with same condition>pollution > smoke?
- Sexual history
- PMH
- SADMA
Physical Examination - Infectious Mononucleosis
Examination:
- GA - Pallor, Icterus, Lymphadenopathy, Dehydration, Rash
- VS - Temp
- Focused EENT
- Nose - hyperemia, discharge
- Throat - white coating of tongue and tonsils? Tonsil enlargement and exudates, hyperemia,
- Neck - redness, swelling, tenderness, cervical lymphadenopathy
- RS
- CVS
- Abd - visible distension, tenderness, hepatosplenomegaly, bowel sound
- OT - UDS, BSL
Investigation - Infectious Mononucleosis
- Investigation o Blood film (atypical lymphocytes) o Monospot test/Paul Bunnel test (antibodies and specific EBV nuclear antigen) § False positives: - hepatitis, - HL, - acute leukemia
o EBV antibodies
Diagnosis - Infectious Mononucleosis
CONDITION:
- Viral infection - illness similar to influenza - Sometimes called " the kissing disease" - Transmitted through mouth, coughing and sharing food - Spread to blood and lymphatic causing swelling of spleen, liver and lymph glands and cause fever (glandular fever)
COMMON
- Common in children and young adults
CLINICAL FEATURES / SYMPTOMS
The symptoms are similar to those of the flu: fever, headache,
blocked nose, nausea, mouth breathing, sore throat (you may have tonsillitis) and a general sense of feeling ‘out of sorts’.
The patient may be aware of having swollen, tender glands (lymph nodes) in the neck, armpits and groin. Less common symptoms include a rash and jaundice.
- Major symptoms lasts within 2-3 weeks
- Occasionally lethargy can last for many months
- Chronic glandular fever –> chronic fatigue syndrome
COMPLICATIONS
What are the risks?
It is not a dangerous disease, but can make you feel extremely sick if it causes hepatitis. It can lead to chronic fatigue for several months. You may have a relapse during the course of the first year after contracting it. However, it eventually settles completely and the body returns to normal.
o Antibiotic-induced rash o Hepatitis o Depression o Chronic fatigue syndrome Rare: myocarditis, hemolytic anemia, splenic rupture, cranial nerve paralysis, GBS
Management - Infectious Mononucleosis
MANAGEMENT:
What is the treatment?
Because glandular fever is a viral infection, antibiotics will
not help. The illness must simply run its course.
Do:
- take paracetamol (in modest doses) to relieve discomfort or pain, but not if the liver is affected - rest (the best treatment), preferably at home and indoors - drink plenty of fluids such as water and fruit juices - gargle soluble aspirin or 30% glucose to soothe the throat - disinfect articles soiled with nose and throat discharges, such as handkerchiefs.
Don’t:
- drink alcohol or eat fatty foods - push yourself to perform tasks - attempt to return to your normal daily routine until advised to do so by your doctor (about 4 weeks after the illness starts) - participate in contact sports until at least 4–6 weeks after complete recovery (an abdominal injury may cause the swollen spleen to rupture) - share drinking containers.
Finally, it is common to feel depressed during the illness and in the recovery phase because you may feel tired and lethargic. Report any such problems to your doctor.
History - Gonococcal Pharyngitis
History
- HOPI
- Sorethroat - SIQORAA
- difficulty and pain in swallowing
- deep pain in throat or neck pain?
ASSOCIATED SYMPTOMS
- Fever
- Rash
- runny nose
- cough and colds
- facial pain (sinusitis)
- ear pain
- neck pain
- nausea and vomiting
- water works and bowel works
- yellowish discoloration of skin?
- LOA, LOW, LBBB, Night sweats
- Body weakness
- Joint pains
Complications questions:
- any difficulty opening your mouth? (trismus)
- any shortness of breath?
RISK FACTORS
- Travel
- Occupation
- Pets/Carpets - Asthma> steroid inhaler
- Exposure> someone with same condition>pollution > smoke?
- Sexual history
- PMH
- SADMA
Physical Examination - Gonococcal Pharyngitis
Physical Examination
- General appearance: Healthy looking
- V/S: Temp 37.6
- ENT: Ear and nose looks ok!
- Pharynx is red, tonsils seem inflamed. There’s no pus.
- No LN enlargement
- Genital examination: all good.
- OT - Urine dip stick and BSL normal
Investigation - Gonococcal Pharyngitis
- Throat swab for Gram staining,
- FBE and
- blood culture,
- Urine microscopy and culture (1st pass urine),
- STD screening
- HIV
- Syphilis and
- Chlamydia
Diagnosis - Gonococcal Pharyngitis
Condition -
Gonococcal Pharyngitis. It is the inflammation of your throat
Common
Cause
caused by a bug call Neisseria gonorrhea. Its known to be a STD infection. Most likely you got it from unprotected sex. But it’s a good idea you have come.
Clinical feature
Complication
- Less likely, the complications are:
- disseminated gonococcal infection
- conjunctivitis
- epididymo-orchitis
- prostitis.
But these are the conditions if you don’t have treatment.
