Head and Neck Infections Flashcards
What are the signs and symptoms of bacterial pharyngitis?
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)
What are the characteristics of viral pharyngitis?
sore throat and symptoms that affect > 1 mucus membrane (e.g., cough, hoarseness, congestion)
What are the S and S of peritonsillar abscess?
“hot potato voice,” uvula deviated to unaffected side, unable to swallow, trismus (unable to open mouth), drooling
What are the S and S of infectious mononucleosis?
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)
What is the worse case scenario complication with EBV infection?
splenomegaly leading to splenic rupture - need to sit out of sports for > 4 weeks
How is bacterial pharyngitis diagnosed?
with rapid antigen detection test - perform only for patients who meet > 1 Center Criteria => throat culture okay for kids but unnecessary for adults
What are the 5 Center Criteria?
Tonsilar exudate +1 Tender anterior cervical adenopathy +1 Fever +1 Absence of cough +1 Age: < 15 years years +1 > 45 years - 1
When is blood work necessary with a sore throat?
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
What is the treatment for IM?
supportive (viral infection) - use of corticosteroids is controversial
What is the initial treatment for peritonsilar abscess?
clindamycin or amoxicillin
What are the S and S of bacterial rhinosinusitis?
high fever, unilateral discharge from one nostril, nasal congestion, facial pain (worse when bending over), diffuse nasal mucosal edema and erythema, lungs clear
What are the S and S of viral rhinitis?
> 1 mucus membrane ,low fever, nasal congestion, facial pain (worse when bending over)
What are the S and S of allergic rhinitis?
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
How is bacterial rhinosinusitis diagnosed?
clinically - sinus x-ray and CT scan are generally unnecessary (cannot distinguish between viral and bacterial infections)
When is CT scan recommended for patients with possible bacterial rhinosinusitis?
recurrent (>= 3/year) infections (will ID obstructive lesion – polyp or carcinoma)
What is the “gold standard” for diagnosing bacterial rhinosinusitis?
culture from sinus aspirate (NOT nasal swab) – needle aspiration of discharge => only use if PT doesn’t respond to adequate therapy
What is the best initial therapy for bacterial rhinosinusitis?
watchful waiting (supportive)
When should antibiotics be initiated in patient with bacterial rhinosinusitis?
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
What is the best initial Tx for patients with bacterial rhinosinusitis who require Abx?
Augmentin – gives both Gram+ and Gram- coverage => alternative Tx: respiratory FQ (levofloxacin or moxifloxacin) – if PT has penicillin allergy
What are the S and S of acute otitis media?
acute onset, unilateral ear pain, fever, hearing loss on affected side, lack of tragal tenderness, no adenopathy, TM opaque/bulging/immobile
What is otitis media with effusion?
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
What is acute otitis externa?
cellulitis – more common in swimmers, painful to touch
What is malignant otitis externa (osteomyelitis)?
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)
What is the initial diagnostic test for acute otitis media?
no diagnostic tests are needed - clinical Dx (start Tx if PT has TM effusion [bulging and/or immobility] and inflammation [pain and/or fever])
When might you perform CT scan, culture, or tympanocentesis (aspiration of the middle ear fluid) in a patient with otalgia?
recurrent infection or infection non-responsive to Tx
What is the best initial Abx Tx for PT with acute otitis media?
Augmentin
What is the Tx for allergic rhinitis?
supportive: Sudafed for decongestion, nasal corticosteroids, and anticholinergic for discharge
What is conductive hearing loss?
hearing loss due to blockage of ear canal or disorder of TM
What is sensorineural hearing loss?
hearing loss only due to inner ear
When do you perform a Weber test?
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
What are the possible interpretations of the Weber test?
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
When do you perform a Rinne test?
only after a Weber test suggests conductive hearing loss - confirms the finding
What are the possible interpretations of the Rinne test
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
What is the best initial test for infectious mononeucleosis?
Monospot - detects heterophil antibodies (positive in 80%) => if Monospot negative but IM still suspected, test for IgM antibodies (confirms diagnosis)
What is the best initial treatment for Strep pharyngitis?
PCN VK - clarithromycin for PTs with severe penicillin allergy (hypotension and difficulty breathing) and if pregnant
