Ear patho Flashcards
Laryngitis patho
Inflammation of the larynx
Usually, the result of a virus or overuse;
Most common cause is a viral URTI.
Coughing-induced laryngitis may occur in bronchitis, pneumonia, influenza, etc..
Excessive use of the voice, allergic reactions, gastro esophageal reflux, bulimia and/or inhalation of irritants can cause acute and/or chronic laryngitis;
Bacterial laryngitis is extremely rare
Acute change in the voice, with decreased volume and hoarseness;
Unnatural change in voice Dysphonia or Aphonia;
tickling sensation, urge to clear the throat;
symptoms vary with severity of inflammation;
fever, malaise, dysphagia and throat pain may occur in more severe infections;
laryngeal edema can occur in dyspnea (rare);
Management: symptom
PHARNGITIS / TONSILLITIS
Acute viral (Rhono virus/Adenovirus/coronavirus)
Acute bacterial (Strep,gonorrhoea/chlamydia/diptheria, etc…) Group A Streptococcus (GAS) most common cause 5-15% adult cases.
Sore throat results from infection;
Most common cause is Tonsillopharyngitis acute infection of pharynx, palentine tonsils, or both (AKA Tonsillitis)
Rarely an abscess or involvement of the epiglottitis
PHARNGITIS / TONSILLITIS S/S
Severe, sudden onset of sore throat
Rarely nasal discharge and congestion
Possible fever, general aches/pains
Duration approx. 3 – 7 days (depending on cause)
Pharyngitis red flags
Stridor or other sign of respiratory distress
Drooling
Muffled, “hot potato” voice
Visible bulge in the pharynx
Involvement of Epiglottis
TONSILLITIS
High fever
Malaise
Headache
GI upset
Halitosis
muffled voice
Swollen red tonsils
Purulent exudate from tonsils
Fever (>38 ֯C)
Adenopathy
Pain with swallowing, often referred to the ears,
Palatal petechiae & exudates are more common with Group A β-hemolytic streptococcus (GABHS) than with viral
Possible scarlatiniform rash resolves in 7 days
Sinusitis Patho
Inflammation of paranasal sinuses due to viral, bacterial or fungal infections or allergic reactions
Often accompanied by rhinitis (referred to as rhinosinusitis)
3 Classifications:
Acute (duration < 4 weeks)
Sub-acute (duration 4 to 12 weeks), and
Chronic (duration > 12 weeks)
Pharyngitis/ Tonslitis treatment
Diagnostics
MO Rx: Culture Swab (Lab Requisition)
MO Rx: Rapid strep test
Centor Score
Clinical presentation
Treatment:
Warm saltwater gargles
MO Rx: Topical anesthetics (i.e. benzocaine, lidocaine, etc..)
MO Rx: Broad Spectrum ABX if indicated by Lab / Centor Score for Strep
MO Tx/Referral: Tonsillectomy only if frequent episodes
Med Tech Rx: Tylenol for pain mgmt. & fever
Med Tech Rx: Ibuprofen for inflammation
Pt dismissal: MELs or refer to higher if red flags or strep suspected.
RTC , self-monitor, increase hydration, avoid painful foods
Sinusitis S/S
purulent rhinorrhea
pressure/pain in face
Headache
nasal congestion/obstruction,
hyposomia
halitosis
productive cough (especially at night)
often pain is more severe with acute
area over sinuses may be tender swollen and erythematous
malaise may be present
fever/chills suggest infection beyond
Sinusitis red flags
Visual disturbances, especially diplopia
Periorbital swelling or erythema
Altered mental status
Sinusitis treatment
Adequate hydration
Steam inhalation 20-30min t.i.d.
Sleep with head of bed elevated
Avoid exposure to cigarette smoke, fumes.
Avoid dehydrants (caffeine and alcohol)
Med Tech Rx: Analgesics (Tylenol)
Med Tech Rx: NSAID (Ibuprofen)
Med Tech Rx: Decongestant (Pseudoephedrine) or Antihistamine (Claritin/Reactine)
Med Tech Rx: Nasal Rinse (Saline irrigation)
MO Rx: ABX indicated only when findings suggest bacterial infection
INFLUENZA Patho
Contagious Respiratory Infection
Often febrile (may induce fever)
influenza refers to illness caused by the influenza virus (A, B or C), but the term is commonly used incorrectly to refer to similar illnesses;
Influenza C does not cause typical influenza illness.
Is spread by air-borne droplets (aerosolized by coughing), person-to-person contact, or contact with contaminated items.
Incubation period: 1 to 4 days (average of 48hrs);
Infliuenza S/S
chills
fever,
coryza,
cough,
Sore throat
aches/pains
Arthralgia
Headache
malaise/prostration
Headache
initially, resp symptoms may be mild, with scratchy sore throat, substernal burning, non-productive cough and possibly coryza;
later, lower resp tract illness becomes dominant, cough can be persistent, raspy and productive. GI symptoms may occur.
Mononucleosis
Epstein-Barr (herpes virus group)
Incubation period is approx. 30 – 50 days
Transmitted in the saliva
Initially infects the epithelial cells of the oropharynx, nasopharynx and salivary glands
Infects the B- lymphocytes and spreads through the lymphatic system.
Often called the Kissing disease
Mononucleosis S?S
infection is asymptomatic.
Symptoms present more often in older children and adults
Triad: Fever, pharyngitis, adenopathy
Fatigue can last for months but is usually maximal during the first 2 to 3 wks.
Splenomegaly (Lymphatic organ)
mild hepatomegaly
hepatic percussion tenderness
periorbital edema
palatal petechiae
rarely jaundice
Mononucleosis Treatment
Med Tech Rx: Antipyretic/Analgesic acetaminophen
Med tech Rx: Anti-inflammatory: ibuprofen
Refer to MO for long term Tx Plan
MO Referral (Labs): EBV serologic & antibody
Supportive care: rest during acute phase, but can resume activity when fever, pharyngitis and malaise are less intense
MO MELS: To prevent splenic rupture, avoid heavy lifting and contact sports for 1 month after presentation and until splenomegaly resolves
MO Referral (Imagery): Ultrasound Imaging
MO RX: Corticosteroids for severe disease only (i.e. impending airway obstruction, severe thrombocytopenia, and hemolytic anemia)
