ENT (throat) Flashcards
What is tonsillitis?
Inflammation of the tonsils (typically the palatine tonsils)
What are the common causes of tonsillitis?
Mainly viral.
If bacterial then group A streptococcus (strep pyogens or strep pneumoniae)
Can also be caused by haemophilius influenzae, moraxella catarrhalis or staph aures.
What is waldeyer’s tonsillar ring made up of?
6 lymphoid tissues in the pharynx
- adenoid
- tubal tonsils
- palatine tonsils
- lingual tonsil
How does tonsillitis present?
Sore throat Fever Pain on swallowing On examination there is swollen, red tonsils which may have white exudate (if bacterial) Cervical lymphadenopathy
What is the FeverPAIN score used for?
The probability that tonsillitis is bacterial
What does the FeverPAIN score involve?
Fever in the last 24 hrs P - pus on tonsils A - attended within 3 days of onset of symptoms I - inflamed tonsils N - no cough
What antibiotic is first line for bacterial tonsillitis?
Penicillin V (phenoxymethylpenicillin) - 500mg qid (4 times a day) for 5 to 10 days.
or clarithromycin if allergy to penicillin.
What are some possible complications of tonsillitis?
Peritonsillar abscess - quinsy Otitis media Scarlet fever Rheumatic fever Post streptococcal glomerulonephritis Post streptococcal reactive arthritis
What are the symptoms of quinsy?
Same as tonsillitis - sore throat, painful swallowing, fever, lymphadenopathy
Sore neck
Referred ear pain
Trismus (unable to open mouth)
Change in voice (due to pharyngeal swelling)
How is quinsy managed?
Hospital admission for incision and drainage
Antibiotics (broad spec such as co-amoxiclav)
Steroids to reduce inflammation (dexamethasone)
What is quinsy?
An abscess (a collection of pus) forms between one of your tonsils and the wall of your throat. Due to the spread of the bacterial infection from the tonsil to surrounding tissues.
What is another name for quinsy?
A peritonsillar abscess
What bacteria most commonly cause tonsilitis?
Streptococcus pyogens (group A)
Staphylococcus aureus
Haemophilius influenza
What bacteria most commonly cause tonsilitis?
Streptococcus pyogens (group A)
Staphylococcus aureus
Haemophilius influenza
What is glandular fever?
A viral infection caused by the Epstein-Barr virus that commonly causes fever, lymphadenopathy and a sore throat
What is another name for glandular fever?
Infectious mononucleosis
How is glandular fever spread?
Saliva - kissing, sharing food utensils
Can also be spread through blood and semen (sexual contact)
How is glandular fever managed?
In most it is self limiting and lasts 2-4 weeks.
Pain relief and rest.
Avoid heavy lifting and intense exercise as there is risk of splenic rupture for 1 mnth after.
What are the symptoms of glandular fever?
Mainly presents in 15-24 year olds. Fever Lymphadenopathy Sore throat Fatigue
What are some of the serious complications of glandular fever?
Chronic fatigue Upper airways obstruction Splenic rupture Neutropenia If patient is immunocomprised can lead to malignancy - e.g. Hodgkins lymphoma and nasopharyngeal cancers
What are some common causes of sore throats?
Tonsilitis
Acute pharyngitis
Glandular fever
Common cold
What is glossitis?
Inflammation of the tongue
How does glossitis present?
Red, sore and swollen tongue.
The papillae atrophy giving a smooth appearance
What can cause glossitis?
Iron deficiency anaemia B12 deficiency Folate deficiency Coeliac disease Injury Irritant exposure Some infections
How is glossitis managed?
Treat underlying cause
Maintain good oral hygiene
What is oral candidiasis?
Also known as oral thrush. When the fungus, candida, overgrows in the mouth - resulting in white spots / patches that coat the tongue.
What can predispose someone to developing oral candidiasis?
Inhaled corticosteroids - not using a spacer and rinsing mouth out properly afterwards Antibiotics Diabetes Immunodeficiency Smoking Dental issues - poor hygiene, dentures
How is oral candidiasis managed?
General advise - e.g. about oral hygiene
Miconazole oral gel - 2.5ml of gel qid (4x daily) after meals for up till 7 days after symptoms disappear
Nystatin suspension - 1 ml dropped into the mouth qid (4x daily) for 7 days
Oral fluconazole - 50mg daily for 7-14 days
What is fluconazole?
An antifungal
What is leukoplakia?
White patches appear in the mouth and tongue. These are not painful, can be slightly raised and will not rub away.
What is the risk associated with leukoplakia?
Small risk of it developing into mouth cancer over time.
How can leukoplakia be managed?
Stop smoking
Reduce alcohol intake
Good oral hygiene
Operation - surgery or laser if worried about tongue cancer
What is geographic tongue?
An inflammatory condition where patches of the tongues surface lose the epithelium and papillae. This forms irregular patterns on the tongue which tends to relapse and remit (comes and goes). It commonly does not have any symptoms.
What causes geographic tongue?
No known cause
What conditions is geographic tongue associated with?
Stress and mental illnesses
Psoriasis
Atopy
Diabetes
What are the complications of geographic tongue?
Anxiety
It is benign - no link to cancer and malignancies
What conditions can strawberry tongue indicate?
Scarlet fever
Kawasaki disease
What is black hairy tongue?
A temporary, harmless condition where there is decreased shedding of keratin from the tongues surface. The papillae elongate to look like hairs. Bacteria and food then cause dark pigmentation.
What can cause black hairy tongue?
Dehydration
Dry mouth
Poor oral hygiene
Smoking
How is black hairy tongue managed?
Adequate hydration
Gentle brushing of tongue
Stopping smoking
What are the symptoms of black hair tongue?
- black, hair like appearance of the tongue
- dry mouth
- metallic taste
- bad breath
What is xerostomia?
Dry mouth
