ENT Infections Flashcards
What are the differentials for a sore throat?
Pharyngitis Tonsillitis Glandular fever HIV Gonococcal pharyngitis Diphtheria
What is the general management for a mild sore throat?
Regular analgesia
Adequate fluids, avoid hot drinks
Medicated lozenges
Majority are viral so do not require antibiotics
What is the most common cause of bacterial sore throat?
Group A strep (strep pyogenes)
Which antibiotics can be given for a bacterial sore throat?
Penicillin (not always required)
Are investigations indicated for a simple sore throat?
No - throat swabs not usually required in primary care
When should you be suspicious of infectious mononucleosis?
Sore throat + lethargy for > 1 week in a patient age 15-25
What are the late complications of strep sore throat?
Rheumatic fever
Glomerulonephritis
What are the features of rheumatic fever?
3 weeks post sore throat
Fever, arthritis + pancarditis
What are the features of glomerulonephritis following strep throat?
1-3 weeks post sore throat
Haematuria, proteinuria + oedema
What causes diphtheria?
Corynebacterium diphtheriae
What are the features of diphtheria?
Severe sore throat with a grey/white membrane across pharynx
Exotoxin is cardiotoxic + neurotoxic
Vaccine preventable but increasing in some countries e.g. Russia
How is diphtheria managed?
Antitoxin + supportive
Penicillin/erythromycin
Who gets infectious mononucleosis (glandular fever)?
Young adults
What is glandular fever caused by?
EBV
What are the clinical features of glandular fever?
Fever Lymphadenopathy Sore throat, pharyngitis Tonsillitis (gross enlargement + membranous exudate) Malaise, lethargy Jaundice/hepatitis, hepatosplenomegaly Rash, palatal petechiae haemorrhages
How is glandular fever diagnosed?
Atypical lymphocytes/lymphocytosis in peripheral blood
Abnormal LFTs
EBV serology IgM
Heterophile antibody - Paul-Bunnell test, monospot test
Which infections may present very similarly to glandular fever?
CMV
Toxoplasmosis
Primary HIV infection –> seroconversion illness
How is glandular fever managed?
Symptomatic
Avoid contact sports, alcohol + hepatotoxic drugs
Which drug must be avoided in glandular fever and why?
Amoxicillin –> diagnostic macular rash
What are the complications of glandular fever?
Splenic rupture
Anaemia
Thrombocytopenia
Upper airway obstruction
What does oral candida infection look like?
White patches on red, raw mucous membranes in throat/mouth
What are the causes of oral candida infection?
Post antibiotics
Inhaled steroids
Immunocompromised
Smoking
How is oral candida infection treated?
Nystatin or fluconazole
