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Clinical Medicine > Infections of Throat - Lecture 8 > Flashcards

Infections of Throat - Lecture 8 Flashcards

1
Q

tonsillitis define

A

inflammation of plantains tonsil glands

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2
Q

pharyngitis define

A

inflammation of any structure of the pharynx including adenoids and lingual tonsils

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3
Q

what is the main focus of diagnosis and treatment for tonsillitis and pharyngitis?

A 
identify GABHS (Strep progenies)
-Prevent complications of rheumatic fever, post-streptococcal glomerulonephritis
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4
Q

what is the most common cause of viral tonsillitis and pharyngitis?

A

-rhinovirus

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5
Q

what is the most common cause of bacterial tonsillitis and pharyngitis?

A

Group A beta hemolytic strep

-strep progenies or Group A strep (GAS)

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6
Q

common symptoms for BOTH bacterial and viral tonsillitis and pharyngitis?

A
  • SORE THROAT
  • LYMPHADENOPATHY
  • dysphagia
  • odynophagia
  • fever
  • exudate
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7
Q

bacterial tonsillitis and pharyngitis symptoms?

A
  • NO coryza, cough or other URI sx
  • anterior LAD*
  • sudden onset sore throat
  • fever
  • petecchaie of soft palate
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8
Q

scarlet fever (GABHS) symptoms?

A
  • strawberry tongue
  • sandpaper rash that is on trunk and back
  • more common in children
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9
Q

viral tonsillitis and pharyngitis symptoms?

A
  • Coryza, cough
  • Malaise
  • Fatigue
  • Hoarseness
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10
Q

Mononucleosis symptoms

A

viral symptoms PLUS

  • posterior LAD*
  • “kissing tonsils”
  • hepatosplenomegaly - spleen starts to sequester the virus
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11
Q

diphtheria signs

A

adherent dense grey pseudomembrane covering the tonsils

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12
Q

scarlet fever (GABHS pharyngitis)

A
  • Fever
  • Strawberry tongue
  • Sandpaper-like rash to trunk and armpits
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13
Q

pharyngitis & tonsillitis dx of GABHS criteria (Symptoms)

A
  1. fever
  2. anterior cervical lymphadenopathy
  3. tonsillar exudate
  4. absence of cough
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14
Q

if have score of 4 in the pharyngitis & tonsillitis dx criteria, what do you NOT have to do?

A

don’t need to swab throat

-just treat for strep pharyngitis

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15
Q

score of 0-1 on pharyngitis & tonsillitis dx of GABHS?

A

likelihood low, no further testing

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16
Q

score of 2-3 on pharyngitis & tonsillitis dx of GABHS?

A

confirm via RAPDT

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17
Q

if Rapid strep test is positive, what do you do?

A

stop there and treat b/c 90-99% sensitive

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18
Q

throat culture for tonsillitis or pharyngitis?

A
  • Most reliable
  • 24-48 hour turn around
  • Often ordered w/RAPDT and if negative lab will do a reflex culture
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19
Q

is there dx for viral tonsillitis or pharyngitis?

A

no dx available or indicated

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20
Q

test for influenza?

A

rapid influenza

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21
Q

EBV (mono) tests to order?

A
  • Monospot (Heterophile agglutination test)
  • Anti-EBV titer
  • CBC with diff (atypical lymphs) – typically have 35% of atypical lymphs
  • Elevated LFTs
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22
Q

viral pharyngitis & tonsillitis treatment

A
  • Gargle with warm water
  • Antipyretics
  • Analgesia
  • Rest
  • +/- single dose decadron (dexamethasone)
  • +/- IVF if dehydrated
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23
Q

can people with mono play contact sports?

A

NO b/c may have hepatosplenomegaly and it can rupture if get hit

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24
Q

if patient with mono receives amoxicillin for presumptive strep pharyngitis, what can they develop?

A

a rash (NOT A DRUG ALLERGY)

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25
Q

influenza treatment

A

tamiflu

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26
Q

treatment for adult bacterial GABHS

A

Pen VK PO x 10 days

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27
Q

treatment for homeless IV drug users with bacterial GABHS

A

Pen G IM

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28
Q

treatment for children with bacterial GABHS

A

PenVK x 10 days (Gross taste)

Amoxicillin x 10 days (tastes like bubblegum)

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29
Q

treatment for pts with PCN allergies and have bacterial GABHS

A

cephalosporin or macrolide

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30
Q

complication of pharyngitis & tonsillitis

A

peritonsillar abscess (PTA)

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31
Q

peritonsillar abscess is what?

A

Collection of pus located b/w the capsule of palatine tonsil and pharyngeal muscle

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32
Q

where is peritonsillar abscess commonly located?

A

superior pole of the tonsil

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33
Q

pathogenesis of peritonsillar abscess

A

Typically preceded by tonsillitis and pharyngitis -> cellulitis -> phlegmon (in b/w cellulitis and abscess) abscess

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34
Q

is peritonsillar abscess unilateral or bilateral?

A

unilateral

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35
Q

what is the most common deep space infection of head and neck?

A

peritonsillar abscess

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36
Q

most common cause of peritonsillar abscess?

A

GABHS most common

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37
Q

symptoms of peritonsillar abscess

A
  • UNILATERAL SEVERE SORE THROAT
  • IPSILATERAL EAR PAIN
  • fatigue
  • fever
  • decreased PO intake
  • TRISMUS (can’t open mouth fully)
  • neck pain with movement
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38
Q

Classic sign of peritonsillar abscess

A

MUFFLED/”HOT POTATO VOICE”

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39
Q

other signs of peritonsillar abscess

A
  • Unilateral swollen and fluctuant tonsil with contralateral deviation of uvula
  • Pooling of saliva/drooling
  • Trismus
  • Neck swelling
  • Fever
  • Rancid or fetor breath
  • Erythema or exudate of the tonsil
40
Q

diff dx of peritonsillar abscess

A
  • Retro pharyngeal abscess
  • Recent tonsil surgery (possible complication)
  • Oral cavity malignancy
  • Strep throat
  • Mono
  • Epiglottitis
  • Ludwig’s angina (abscess that occurs under the tongue d/t dental cavity)
  • Dental infection
  • Peritonsillitis
41
Q

what is the #1 diagnostic for peritonsillar abscess

A

clinically

42
Q

diagnostics for peritonsillar abscess

A

CLINICALLY

  • CT neck w/IV contrast
  • intra-oral ultrasonography
  • lateral soft tissue
43
Q

what is the BEST imaging option for peritonsillar abscess

A

CT neck w/IV contrast

44
Q

treatment of peritonsillar abscess

A
  • secure airway
  • drainage (needle aspiration)
  • empiric
45
Q

empiric txt for peritonsillar abscess

A
  • Unsayn IV or Clindamycin IV

- Augmentin x14D

46
Q

Untreated peritonsillar abscess complications

A
  • Airway obstruction (d/t large size of peritonsillar abscess)
  • Internal jugular seeding of infection
  • Pseudo aneurysm of carotid artery
  • Septicemia
47
Q

rheumatic fever

A

delayed, non-suppurative sequelae of GABHS pharyngitis involving lesions of joints, heart, subcutaneous tissue and central nervous system

*Cardiac may be permanent

48
Q

average age for rheumatic fever?

A

5-15 y.o

49
Q

what is the leading cause of heart disease in developing countries?

A

rheumatic fever

50
Q

carditis/valvulitis rheumatic fever - what is most affected?

A

mitral valve

51
Q

carditis/valvulitis rheumatic feverself-limiting or long-term effects?

A

both

52
Q

carditis/valvulitis rheumatic fever, who is affected more, children or adults?

A

children > adults

53
Q

migratory arthritis rheumatic fever, clinical manifestations?

A

asymmetric pattern, large joints

  • knees, elbows wrists
  • in older teen/adults
54
Q

rheumatic fever dx

A
  • evidence of recent strep infection PLUS
  • 2major OR
  • 1 major and 2 minor OR
  • 3 minor (recurrent AF only)
55
Q

major symptoms for rheumatic fever

A

migratory arthritis

  • carditis/valvulitis
  • sydenham chorea
  • erythema marginatum
  • subcutaneous nodeuls
56
Q

minor symptoms for rheumatic fever

A
  • arthralgia
  • fever
  • elevated ESR or CRP
  • prolonged PR interval
57
Q

what must all patients with confirmed or suspected ARF undergo?

A

echocardiography to evaluate for carditis

58
Q

labs for rheumatic fever

A
  • Rapid strep
  • Throat culture
  • Anti-streptococcal titers
  • Antistreptolysin O or anti-DNAse B
  • C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) – may be elevated
59
Q

imaging and other procedures for rheumatic fever

A
  • EKG – prolonged PR interval
  • Chest x-ray – cardiomegaly or CHF
  • Echocardiogram – for valvulitis or carditis
60
Q

rheumatic fever acute management

A
  • PenVK (Adults and children)
  • salicylates (aspirin - not <13y.o)
  • +/- corticosteroids
  • bed rest
61
Q

secondary ppx for rheumatic fever

A
  • recurrence is possible

- PCN benzathine G IM every 4 weeks

62
Q

Post-streptococcal glomerulonephritis

A

due to skin cellulitis or strep throat

63
Q

Post-streptococcal glomerulonephritis s/sx

A
  • occur 1-3 weeks after the strep throat
  • EDEMA, HEMATURIA
  • htn, proteinuria, oliguria
64
Q

Post-streptococcal glomerulonephritis dx

A
  • urine dip and microscopy
  • streptozyme test
  • rapid strep.strep throat culture
  • renal function
  • hemolytic component (C3 decreased)
  • +/- renal biopsy
65
Q

Post-streptococcal glomerulonephritis txt

A
  • treat underlying condition (cellulitis or strep if not treated)
  • mostly symptomatic/supportive therapy
66
Q

Post-streptococcal glomerulonephritis symptomatic/supportive therapy

A
  • Restrict salt and water intake
  • +/- diuretics (edema)
  • HTN control (diuretics, CCB, ACE)
  • Limited activity
  • +/- dialysis if needed
67
Q

laryngitis

A

inflammation of larynx and vocal fold mucosa

-vocal cord edematous

68
Q

function of larynx

A

prevent aspiration of food into lungs, voice

69
Q

acute laryngitis cause?

A

VIRAL (bacterial, GERD, environmental, vocal trauma)

70
Q

acute laryngitis resolves when?

A

7-10 days

71
Q

chronic laryngitis lasts?

A

> 3 weeks

72
Q

laryngitis s/sx

A
  • preceding URI sx (cough, rhinos)
  • HOARSENESS (dysphonia)
  • odynophonia
  • odynophagia
73
Q

laryngitis dx

A
  • clinical dx based on hx and symptoms

- rarely need to visualize larynx

74
Q

laryngitis txt

A

voice rest and inhaled humidifier

75
Q

what are the 3 major salivary glands?

A

parotid, submandibular, sublingual

76
Q

function of salivary glands?

A

lubrication to aid in swallowing and digestive enzymes to break down food

77
Q

sialadenitis etiology

A

viral, bacterial, inflammatory & autoimmune (sjogre’s syndrome), stone, etc.

78
Q

parotitis is secondary to what?

A

mumps

79
Q

parotitis

A

acute-onset parotid swelling that lasts 2 days

  • exposed 2-3 weeks before onset of symptoms
  • paramyxoviral disease spread by respiratory route
80
Q

who is most affected by parotitis?

A

children (historical), now college students

81
Q

sialadenitis viral is what?

A

mumps!

82
Q

mumps is the most common what?

A

non-suppurative sialadenitis

83
Q

what type of virus is mumps?

A

paramyoxyvirus

84
Q

symptoms of mumps

A

bilateral parotid glands (parotitis) & edema

  • prodrome 48 hours before
  • a few days later (unilateral testicular swelling & tenderness)
85
Q

complications of mumps

A

deafness, orchitis, meningitis, fetal congenital abnormalities

86
Q

treatment of mumps

A

(supportive) bed rest, hydration, sialogogues (medication that promotes secretion of saliva)

87
Q

HIV sialadenitis

A
  • Parotid most common
  • Bilateral
  • Tender, erythematous
88
Q

HIV sialadenitis txt

A

antiviral & supportive therapy

89
Q

Sialadenitis work-up

A

-Physical exam
-Mumps titer – RT-PCR or serology (IGM elevated) – if indicated
-HIV RNA – if indicated
-If unclear or unimproved:
Ultrasound
CT face/neck
Sialadenoscopy

90
Q

sialadenitis bacterial etiology

A

stone -> submandibular

elderly, malnourish or post-op -> parotid

91
Q

sialadenitis bacterial s/sx

A
  • Sudden onset pain
  • Unilateral
  • Firm and tender
  • Expression of pus
92
Q

organism causing bacterial sialadenitis

A

staph aureus

93
Q

txt for bacterial sialdenitis

A
  • Antibiotics parenteral or oral (Nafcillin, dicloxacillin, Augmentin)
  • Massage of duct
  • Warm compresses
  • Sialogogues
  • Surgical drainage if abscess develops
94
Q

mumps txt

A
  • Symptom/supportive
  • Analgesia
  • Warm or cold compresses on parotid
  • Testicular pain treated with scrotal sling
95
Q

mumps prevention

A

VACCINATION

  • 2 doses of MMR (measles, mumps, rubella)
  • 12 months of age and 4-6 years of age

Clinical Medicine (11 decks)

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