Diseases of the throat Flashcards
who is commonly affected by acute throat infection
children (5-10) young people (15-25)
what is the common cause of acute throat infections
viral or bacteria:
- common cold
- influenza
- strep
what are the symptoms of acute throat infections
pain at the back of the mouth
physical irritation
what is the treatment of acute throat infections
self-limiting
if an acute throat infection + lethargy persists into a 2nd week what should you consider
mono/glandular fever
what is the common cause of tonsillitis
strep pyogens (aka group A beta haemolytic strep)
what is the Centor criteria
tonsillar exudate
tender anterior cervical lymph nodes
history of fever (>38)
absence of cough
what is the modified centor criteria
tonsillar exudate tender anterior cervical lymph nodes history of fever (>38) absence of cough <15 = + 1 point >44 = -1 point
what is the fever PAIN criteria
fever (In last 24hrs) Purulence Attend rapidly (getting worse) Inflamed tonsils No cough
when would you treat tonsillitis with antibiotics
fever pain = 4 or above
centor = 2 or 3 after culture, 4 or above without culture
what antibiotic is given in tonsillitis, for how long?
phenoxymethylpenicillin
clarithromycin if allergic
10 days
what 3 criteria are used to determine the severity of tonsillitis
Centor
Modified Centor
Fever PAIN
what are the complications of tonsillitis (3)
peritonsiliar abscess
rheumatic fever
glomerulonephritis
what causes a peritonsiliar abscess
bacteria between the muscle and tonsil which produces pus
when would a peritonsiliar abscess occur after tonsillitis
3-7 days
what are the symptoms of a peritonsiliar abscess
unilateral throat pain and odynophagia
lockjaw
displacement of tonsils and uvula
loss of concavity of palate
what is the treatment of a peritonsiliar abscess
drain + antibiotics
when would rheumatic fever occur after tonsillitis
3 weeks
what are the symptoms of rheumatic fever
fever
arthritis
pancreatitis
when would glomerulonephritis occur after tonsillitis
1-3 weeks after
what are the symptoms of glomerulonephritis
haematuria
albuminuria
oedema
what is acute tonsillitis also known as
adenotonsilitis
what is the cause of acute tonsillitis
usually viral:
- EBV
- rhinovirus
- influenza/parainfluenza
- enterovirus
- adenovirus
30% bacterial
what is the treatment of acute tonsillitis
supportive
what is the treatment of recurrent acute tonsillitis
surgery
what are the symptoms of chronic tonsillitis
chronic sore throat bad breath tonsilliths peritonsillar erythema persistent cervical lymphadenopathy
what is the treatment of chronic tonsillitis
surgery (rarely offered)
what causes diphtheria
corynebaterium diphtheriae
what does corynebaterium diphtheriae produce
an exotoxin which is cardio- and neuro-toxic
what are the symptoms of diphtheria
severe sore throat
grey/white membrane across pharynx
what is the treatment of diphtheria
vaccine
antitoxin + supportive
penicillin or erythromycin
what type of vaccine is the diphtheria vaccine
toxoid vaccine
what is infectious mononucleosis also known as
mono
glandular fever
who is mainly affected by infectious mononucleosis
young adults
what causes infectious mononucleosis
EBV
what are the symptoms of infectious mononucleosis
fever enlarged lymph nodes sore throat/pharynigitis/tonsillitis tired jaundice/hepatitis palatal petechaiea haemorrhages = rash heptaosplenomegaly
what are the investigations of infectious mononucleosis
EBV IgM = paul-bunell test/+ve monospot test (heterophile antibody test)
LFTs
FBC = low CRP, leucocytosis, atypical lymphocytes
what is the treatment of infectious mononucleosis
self-limiting
severe + failing to improve = steroids
why should ampicillin NOT be prescribed in infectious mononucleosis
generalised macular rash will develop
what is the cause of candida
candida albicans
who is at risk of candida
post-antibiotics
immunosuppressed
smokers
inhaled steroids (asthma)
what are the symptoms of candida
white patches on red, raw mucous membrane in mouth or throat
pain
when would you investigate candida
if recurrent
what is the treatment of candida
1st line = nystatin
recurrent = fluconazole
describe laryngeal polyps
unilateral and pedunculated
describe laryngeal nodules
bilateral on middle 1/3 to posterior 1/3 vocal cords
who is commonly affected by laryngeal nodules
young women
what causes laryngeal nodules/polyps
change in laryngeal mucosa secondary to:
- vocal abuse
- infection
- smoking
- hypothyroidism (rare)
what is a contact ulcer, where is it usually located
benign response to injury located in posterior vocal cord
what causes contact ulcers
chronic throat clearing
voice abuse
GORD
intubation
what is squamous papilloma
rare BENIGN tumour
who is affected by squamous papilloma
<5
20-40
what causes squamous papilloma
HPV 6
HPV 11
what is squamous cell carcinoma
most common head and neck tumour
non-benign
what are the risk factors for developing squamous cell carcinoma
smoking
drinking
HPV
what is a paraganglioma
tumours arising in clusters of neuroendocrine cells dispersed throughout the body
who is usually affected by paraganglioma
> 50
what causes paragangliomas
MEN2
what are the two types of paraganglioma
chromaffin positive
non-chromaffin
where does a chromatin positive paraganglioma originate
nervous system
what does a chromatin positive paraganglioma secrete
catecholamines
what structures does a non-chromatin paraganglioma involve
carotid and aortic bodies
ganglia nodosum of vagus
clusters around oral cavity, nose, nasopharynx, larynx and orbit
what causes epiglottitis
HiB
what are the symptoms of epiglottitis
severe sore throat
drooling
fever
stridor
what is the treatment of mild epiglottitis
supportive
antibiotic
nebulised adrenaline/saline
corticosteroids
what is the treatment of severe epiglottitis
intubation and ventilation
what are the symptoms of obstructive hyperplasia in the adenoid
hypo nasal voice
snoring
AOM/OME
what are the symptoms of obstructive hyperplasia in the tonsils
muffled voice
snoring
