ENT Flashcards
What criteria do you use to diagnose Group A Strep Pharyngitis?
TTAA
Centor Criteria (TTAA)
- Tonsilar swelling and exudate
- Temperature >38
- Anterior or cervical lymphadenopathy (tender)
- Absence of cough
Only 1-2 present = 80% likely to be not strep.
3-4 present = 40-60% likely to be GABH Strep
Common in 5-15 year old
When does Group A Strep generally improve?
How to Ix?
Generally improves by Day 5
Throat swab of purulent exudate
Treatment of choice for Group A Strep?
Phenoxymethylpenicillin for 10 days + Panadol.
If allergic: roxithromycin.
Signs of peritonillar abscess/ quinsy?
3 pain symptoms + 3 others
- Severe unilateral sore throat
- ipsilateral ear pain
-Increasing dysphagia/ odynophagia
Drooling
Trismus (inability to open mouth)
High fever
Investigation for quinsy?
Lateral neck X ray - to rule out retropharyngeal abscess
Treatment for quinsy
IV Benzylpenicillin + IV metronidazole
Refer to ENT for surgical drainage
What are signs SPECIFIC to EBV/ EBM/ Mono?
Malaise, lethargy
Anorexia, myalgia
FATIGUE
RASH !
- Primary (5%)
- Secondary rash with amoxicillin.
Ddx for Ebstein Barr Virus
CMV, toxoplasmosis, HIV< lymphoma.
Examination of Ebstein Barr throat will show:
Petechiae on palate
Enlarged + white exudates
Looks WORSE than strep throat.
RETICULAR like pattern
Examination of Ebstein Barr patient will show:
Peri-orbital oedema
POSTERIOR cervical lymphadenopathy
Splenomegaly (50%)
Jaundice + hepatomegaly (5-10%)
Investigation of EBV (4)
Throat swab testing for:
-EBV serology
-Blood film - ATYPICAL MONONUCLEAR CELLS, Downey Cells.
- WCC - ABSOLUTE LYMPHOCYTOSIS
- Monospot - antibody test
Main differentials for a sore throat (5)
Pharyngitis - viral
Tonsillitis - viral/bacterial
Glandular fever
Quinsy
Aphthous ulcer
