Head and Neck Infections Flashcards

1
Q

What are the signs and symptoms of bacterial pharyngitis?

A

chief complaint of a “sore throat” and fever with acute onset, tender anterior cervical lymphadenopathy, tonsilar exudate => denial of cough, hoarseness, nasal congestion (i.e., only one mucus membrane)

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2
Q

What are the characteristics of viral pharyngitis?

A

sore throat and symptoms that affect > 1 mucus membrane (e.g., cough, hoarseness, congestion)

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3
Q

What are the S and S of peritonsillar abscess?

A

“hot potato voice,” uvula deviated to unaffected side, unable to swallow, trismus (unable to open mouth), drooling

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4
Q

What are the S and S of infectious mononucleosis?

A

myalgia and fatigue develop before sore throat (Epstein-Barr virus - infects and replicates in B lymphocytes), posterior lymphadenopathy (cannot clear - sits in lymphocytes/can cause Hodgkin’s lymphoma), abdominal pain (due to hepatomegaly and splenomegaly)

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5
Q

What is the worse case scenario complication with EBV infection?

A

splenomegaly leading to splenic rupture - need to sit out of sports for > 4 weeks

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6
Q

How is bacterial pharyngitis diagnosed?

A

with rapid antigen detection test - perform only for patients who meet > 1 Center Criteria => throat culture okay for kids but unnecessary for adults

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7
Q

What are the 5 Center Criteria?

A
Tonsilar exudate +1
Tender anterior cervical adenopathy +1 
Fever +1 
Absence of cough +1
Age: 
< 15 years years  +1
> 45 years - 1
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8
Q

When is blood work necessary with a sore throat?

A

when the diagnosis is infectious mononucleosis => criteria that support the diagnosis: (1) number of lymphocytes is elevated, (2) atypical lymphocytes present, and (3) liver function tests are elevated

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9
Q

What is the treatment for IM?

A

supportive (viral infection) - use of corticosteroids is controversial

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10
Q

What is the initial treatment for peritonsilar abscess?

A

clindamycin or amoxicillin

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11
Q

What are the S and S of bacterial rhinosinusitis?

A

high fever, unilateral discharge from one nostril, nasal congestion, facial pain (worse when bending over), diffuse nasal mucosal edema and erythema, lungs clear

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12
Q

What are the S and S of viral rhinitis?

A

> 1 mucus membrane ,low fever, nasal congestion, facial pain (worse when bending over)

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13
Q

What are the S and S of allergic rhinitis?

A

watery eyes, itchiness (hallmark of allergies), bilateral nasal congestion, > 1 mucus membrane, clear discharge, history of asthma/seasonal allergies, bilateral conjunctivitis, sneezing, lack of fever, allergic shiners, pale nasal mucosa

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14
Q

How is bacterial rhinosinusitis diagnosed?

A

clinically - sinus x-ray and CT scan are generally unnecessary (cannot distinguish between viral and bacterial infections)

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15
Q

When is CT scan recommended for patients with possible bacterial rhinosinusitis?

A

recurrent (>= 3/year) infections (will ID obstructive lesion – polyp or carcinoma)

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16
Q

What is the “gold standard” for diagnosing bacterial rhinosinusitis?

A

culture from sinus aspirate (NOT nasal swab) – needle aspiration of discharge => only use if PT doesn’t respond to adequate therapy

17
Q

What is the best initial therapy for bacterial rhinosinusitis?

A

watchful waiting (supportive)

18
Q

When should antibiotics be initiated in patient with bacterial rhinosinusitis?

A

only if the patient meets one of the following three criteria: (1) severe symptoms (fever > 102 or facial pain) >= 3 consecutive days, (2) any symptoms (severe or not) >= 10 days, or (3) double sickening/improvement followed by worsening

19
Q

What is the best initial Tx for patients with bacterial rhinosinusitis who require Abx?

A

Augmentin – gives both Gram+ and Gram- coverage => alternative Tx: respiratory FQ (levofloxacin or moxifloxacin) – if PT has penicillin allergy

20
Q

What are the S and S of acute otitis media?

A

acute onset, unilateral ear pain, fever, hearing loss on affected side, lack of tragal tenderness, no adenopathy, TM opaque/bulging/immobile

21
Q

What is otitis media with effusion?

A

PT will have fluid behind TM but no infection (TM more likely to be retracted due to negative pressure in the eustachian tubes – bones will be more prominently seen) => no fever or pain, will have hearing loss

22
Q

What is acute otitis externa?

A

cellulitis – more common in swimmers, painful to touch

23
Q

What is malignant otitis externa (osteomyelitis)?

A

cellulitis that spreads to bone => common in people with uncontrolled diabetes and those who are immunocompromised (S and S include severe otalgia that extends to TMJ, pain with chewing, nocturnal pain, edema, erythema of ear canal extending to pinna and mandibular area, cranial nerve/facial palsies)

24
Q

What is the initial diagnostic test for acute otitis media?

A

no diagnostic tests are needed - clinical Dx (start Tx if PT has TM effusion [bulging and/or immobility] and inflammation [pain and/or fever])

25
Q

When might you perform CT scan, culture, or tympanocentesis (aspiration of the middle ear fluid) in a patient with otalgia?

A

recurrent infection or infection non-responsive to Tx

26
Q

What is the best initial Abx Tx for PT with acute otitis media?

A

Augmentin

27
Q

What is the Tx for allergic rhinitis?

A

supportive: Sudafed for decongestion, nasal corticosteroids, and anticholinergic for discharge

28
Q

What is conductive hearing loss?

A

hearing loss due to blockage of ear canal or disorder of TM

29
Q

What is sensorineural hearing loss?

A

hearing loss only due to inner ear

30
Q

When do you perform a Weber test?

A

only in a patient with hearing loss (e.g., identified through Whisper Test) - it is NOT a screening test => helps distinguish conductive from sensorineural hearing loss

31
Q

What are the possible interpretations of the Weber test?

A

normal hearing => sound heard bilaterally (from air and skull); conductive hearing loss => sound heard better on affected side; sensorineural hearing loss => sound heard louder on unaffected side

32
Q

When do you perform a Rinne test?

A

only after a Weber test suggests conductive hearing loss - confirms the finding

33
Q

What are the possible interpretations of the Rinne test

A

normal hearing = air conduction (AC) time 2X bone conduction (BC) time; conductive hearing loss = bone conduction is heard longer than the air conduction (BC > AC); sensorineural hearing loss = AC > BC, but may not be twice as long

34
Q

What is the best initial test for infectious mononeucleosis?

A

Monospot - detects heterophil antibodies (positive in 80%) => if Monospot negative but IM still suspected, test for IgM antibodies (confirms diagnosis)

35
Q

What is the best initial treatment for Strep pharyngitis?

A

PCN VK - clarithromycin for PTs with severe penicillin allergy (hypotension and difficulty breathing) and if pregnant