ENT infections (throat) Flashcards
What are the main causes of throat infections ?
Viral and bacterial - with 2/3rds being viral (hence most don’t need antibiotics)
What is the most common bacterial cause of sore throats ?
Group A strep - specifically Strep.pyogenes
What are 2 of the main causes of pain in the back of your mouth?
Acute pharyngitis and tonsillitis
What are some of the complications which can occur due to infections of the throat and pharynx?
- Otitis media (most common)
- Peri-tonsillar abscess (quinsy)
- Parapharyngeal abscess
- And mastoiditis
What should not be routinely used to diagnose throat infections ?
Throat swabs
What are the more common causes of sore throats ?
Common cold, influenza, streptococcal infection
What are the less common causes of sore throats ?
HIV, gonococcal pharyngitis, and diphtheria.
What are the common signs of tonsillitis ?
- Pain on swallowing
- Swollen tonsils
- Dysphonia
- Fever
- Tonsillar exudate
- Risk factors - most common in 5-15 yr olds
If sore throat and lethargy persist into the second week in 15-25 year olds what should be suspected ?
Infectious mononucleosis
What criteria is used to decide wether or not to give someone with a sore throat antibiotics ?
The FeverPain score or the centor criteria
List the FeverPain criteria which suggests bacterial infection of the throat
- Presence of tonsillar exudate.
- Presence of tender anterior cervical lymphadenopathy or lymphadenitis.
- History of fever.
- Absence of cough.
List the FeverPain criteria and state the score which is used to determine if antibiotics are given or not for tonsillitis in tayside
- Fever (during previous 24 hours)
- Purulence (pus on tonsils)
- Attended rapidly (within 3 days of symptom onset)
- Severely Inflamed tonsils
- No cough or coryza
A score of ≥ 4 = 62 – 65% chance of isolating sterptococcus ==> give Antibiotics
What is the first and second line antibiotic treatmeant for sore throats ?
(This is talking about all of tonsillitis/pharyngitis/sore throat)
- 1st line - Penicillin V
- 2nd line (if penicillin allergic) - Clarithromycin
What complication of tonsillitis can develop ?
Peri-tonsillar abscess (quinsy)
What additional signs would suggest development of a quinsy ?
- Unilateral bulging above & lateral to the affected tonsil
- Uvula is displaced away from the quisy
What is the treatment of a quinsy?
Anitbiotics + drainage + consideration of tonsillectomy in 6 weeks
What is the 1st and 2nd line antibiotics used to treat a quinsy?
- 1st line = IV benzylpenicillin or PO Penicillin V if able to swallow (+ mentronidazole if not resolving after 48hrs)
- 2nd line = PO clindamycin or IV if unable to swallow (dont need to add metronidazole here)
What are the 2 main late serious complications of a streptococcal throat infection and there signs?
- Rheumatic fever - 3 weeks post infection, fever, arthritis and pancarditis
- Glomerulonephritis - 1-3 weeks post infection, haematuria, albuminuria and oedema
What is the criteria someone must meet for consideration of doing a tonsillectomy for recurrent tonsillitis ?
- Sore throats are definitley due to tonsillitis (i.e. not recurrent URTI’s)
- Has five or more episodes of sore throat per year
- Symptoms have been occurring for at least a year
- The episodes of sore throat are disabling and prevent normal functioning
What are the main complications of a tonsillectomy and what is done to treat these complications ?
- Pain - analgesia
- Haemorrhage; 1. Primary = haemorrhage usually in the first 6-8hrs. Treat this with immediate return to theatre as it could be masking a larger bleed! 2. Secondary = usually occurs 5-10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics.
What is the causative organism of diphtheria ?
Corynebacterium diphtheriae
Describe the clinical presentation of diphtheria
Severe sore throat with a grey white membrane across the pharynx.
What is the treatment of diphtheria ?
- Antitoxin, supportive care
- And penicillin / erythromycin
What is the cause of oral candida/thrush?
Candida albicans
What is the clinical presentation of oral candida/thrush ?
White patches on red, raw mucous membranes in throat/ mouth
What is the treatment of oral candida/thrush ?
- Nystatin in lecuture but
- Miconazole on antibiotic man
What is infectious mononucleosis caused by ?
EBV
Describe the clinical presentation of infectious mononucleosis
- Fever
- Enlarged lymph nodes
- Sore throat, pharyngitis, tonsillitis
- Malaise, lethargy
- Spelnomegaly
- Most common aged 15-25
May cause - rash, jaundice etc
What are some of the complications of infectious mononucleosis ?
- Anaemia, thrombocytopenia
- Splenic rupture
- Upper airway obstruction (stridor)
- Increased risk of lymphoma
What is the treatment of infectious mononucleosis ?
- 1st line - supportive care
- e.g. Bed rest, Paracetamol, Avoid sport
Corticosteroids may be used if theres signs of upper resp obstruction etc
How is infectious mononucleosis diagnosed ?
- 1st line - monospot test
- 2nd line (if monspot negatve but still suspect IM) - Epstein-Barr virus IgM
Describe what epiglottitis is
- It is a condition in which there is inflammation of the epiglottis.
- It may also affect the soft tissues surrounding the epiglottis, particularly in affected adults - hence the term supraglottitis.
- It is potentially life-threatening if complete obstruction of the airway occurs.
What is the cause of epiglottitis ?
- Classically - H.influenxa type B
- But since the Hib vaccine other bacteria have been more common causes e.g. strep penumonia or pyogenes or staph aureus
What are the presenting features of epiglottitis ?
Rapid onset:
- Sore throat
- Stridor
- Odynophagia
- Inability to swallow causing drooling
- Muffled voice - ‘hot potato’ voice
- Fever & generally unwell
How is epiglottis diagnosed ?
Laryngoscopy in operating theatre
What is the treatment of epiglottitis ?
1st line = ceftriaxone & secure the airway with ET tube
Define what the common cold (corzya) is
The common cold is an acute, self-limiting, viral inflammation of the mucosa of the upper respiratory tract.
What are the causes of the common cold ?
It is caused by a vast array of different viruses, some of which include:
- Adenovirus
- Rhinovirus
- Respiratory syncytial virus
- Coronavirus
On average how common is the common cold?
- Adults get 2-3 per year
- Children get 5-6 per year
What are the main presenting features of the common cold ?
- Nasal discahrge
- Nasal obstruction
- Sneezing
- Sore thorat
- General malaise
- Cough
Note - Headache & fever are less common
What is the treatment of the common cold ?
It is self-limiting, so supportive
