ENT 4 Flashcards
pharyngitis
inflammation of the pharynx, caused by viral, bacterial, or fungal source or occasionally allergies
inflammation of the pharynx, caused by viral, bacterial, or fungal source or occasionally allergies
pharyngitis
peritonsillar abscess
infection of the posterior pharynx with a collection of purulent material around tonsils
infection of the posterior pharynx with a collection of purulent material around tonsils
peritonsillar abscess
pharyngitis - sx
3
- fever
- sore throat
- pain or difficulty swallowing
pharyngitis - symptoms peak when?
peak 3-5 days from onset
peritonsillar abscess - sx
4
- fever
- throat pain
- trismus (lock jaw)
- +/- difficulty swallowing
peritonsillar abscess - pain is usually where
one side of throat
peritonsillar abscess - physical exam
3
- look for inferior and medial displacement of infected tonsil w/ contralateral deviation of uvula away from affected tonsil
- +/- drooling and muffled, “hot potato” voice
- cervical lymphadenopathy
pharyngitis - physical exam viral
2
- pharyngeal erythema
- tonsillar hypertrophy
pharyngitis - physical exam bacterial
3
- tonsillar exudates (exudate may suggest mono)
- palatal petechiae
- anterior cervical lymphadenopathy
pharyngitis - exudate may suggest what
mono
pharyngitis - physical exam fungal
2
- angular cheilitis
- curd like plaques in oropharynx
quick scale to use when suspecting strept pharyngitis
CENTOR
CENTOR scale includes
7
- fever 1
- tonsillar exudate 1
- absence of cough 1
- anterior cervical lymphadenopathy 1
- age 3-14 1
- age 15-44 0
- age 45 and older -1
CENTOR score recs
1 or less - no culture, no abx
2-3 - RADT or throat culture
4 or more - abx tx
pharyngitis - viral 4 and bacterial etiologies 2
viral - adenovirus, coxsachievirus, HSV, EBV/mono
bact - group A strep, N. gonorrhoeae
viral pharyngitis - tx
3
symptomatic tx
NSAIDs
warm saline gargling
lozenges
pharyngitis - suspected mono tx
3
- symptomatic tx
- abstain from contact sports 6-8 weeks d/t risk of splenic rupture
- amoxicillin can lead to diffuse rash - not an allergy, no tx required
bacterial pharyngitis - adult tx
5
- benzathine PNC G 1.2 million units IM once (if concerned for low compliance)
- amoxicillin 500 mg PO BID or 1000 mg PO once daily for 10 days
- cephalexin 500 mg BID for 10 days
- azithromycin 500 mg PO once daily for 5 days
- severe pnc allergy - clindamycin 300 mg PO q8H for 10 days
bacterial pharyngitis - peds tx
5
- benzathine pnc G - <27 kg: 600000units IM once, >27 kg: 1.2 million units IM once
- amoxicillin 25 mg/kg PO BIG or 50 mg/kg PO once daily for 10 days
- cephalexin 20 mg/kg PO BID for 10 days
- azithromycin 12 mg/kg PO once daily for 5 days
- severe pcn allergy - clindamycin 10mg/kg PO q8h for 10 days
bacterial pharyngitis - symptomatic tx
3
- topical anesthetics (OTC sore throat spray, chloreseptic; prescription lidocaine solution for adults - q3h prn)
- NSAIDs
- steroids for pain relief (dexamethasone 0.6 mg/kg PO once, or 10 mg once for adults PO or IM)
peritonsillar abscess - tx
3
- needle aspiration or I&D (need to be done by ER or better an ENT specialist w/ prophylactic abx given)
- Augmentin 875 (P 45 mg/kg) PO BID for 10-14 days
- clindamycin 450 mg (P 10 mg/kg) PO q8h for 10-14 days
peritonsillar abscess - when to refer to ER
when considering US or CT imaging
