Intro to HENT, URIs, Pharyn&Tonsil Flashcards
what two hearing systems are integrated in the cerebellum?
pitch reception and vestibular system (balance)
what is pitch reception?
sound pressure moves the stapes –> oval window–>electrical energy –> neural energy
what is the vestibular system?
center of balance. otoliths in the SemiCircular canals move and bend hair cells to create electrical signals
what is mucociliary clearance?
the way by which the sinuses maintain a sterile enviornment. Infection is secondary to impaired mucociliary clearance
what is mastoiditis?
this boney sponge (mastoid bone) behind the ear can be infected by the middle ear, this can lead to a brain infection
what is important about head and neck lymphatics from a clinical standpoint?
you need to think about what is going on under the surface. Concern if they are enlarged… where do places typically drain to? AKA Where does the inflamed lymph get drainage from?
manifestations of URIs in the nose? tonsils? pharynx?
nose: rhinitis, rhinosinusitis
tonsils: tonsilitis
pharynx: pharyngitis
what causes URIs?
bacterial: S. pneumo > H.Flu> M. Cat
viral: make up 90% of cases. come from “cold viruses” (adenovirus, rhinovirus, etc) and influenza
how are viral URIs transmitted
air, hand to face
Txt of URIs : abx?
since >90% viral : NO Abx
- maybe bacterial IF symptoms not improving >7days
- only consider Abx <7days if suspected Strep
Txt of URIs: meds for each symptom…
runny nose: OTC antiH
congestion (swelling): decongestant (will keep you awake)
thick secretions: guaifenesin
- single dose steroid
allergies vs URI
allergies: most common non-infectious cause of URI
- similar to a cold but gradual onset and last longer, no fever
waldeyers ring
adenoids
palatine tonsils
lingual tonsils (tongue)
-ring of lymphoid tissues that reacts to infection
tonsils and adenoids are what kind of lymph tissue? what do they secrete?
secondary- (there are lots of backups to the immune system)- so if you remove them its ok.
secrete topical IgA
IgG IgM into the blood
at what age are T&A most active?
4-10
circumvalle papillae
normal taste buds
stomatitis, what is it? what are two types?
infections of the mouth, usually viral (apthous ulcers (viral), herpangina, herpes simplex)
thrush (fungal)
how do apthous ulcers present? how long do they stay?
white ulcer on red base, come suddenly and go in a few weeks
oral thrush, what organism causes it? how does it present?
candida, reddish base w/ stuck-on white plaques that can not be scraped off
-raw and irritated
what is herpangina?
coxsackievirus A
- fever, sore throat, rash/ulcers on palate
- -small vesicles w/ red base that BECOME ulcers
- -severe pain
txt: stomatitis cocktail (didn’t say in class… but it is benadryl liquid and maddox swish)
pharyngitis- how does it present? what is the most likely cause and associated symptoms w/ this cause (symp not super important)?
red lateral walls or cobblestoned posteriorly
-90% cases are viral w/ symptoms runny nose, cough, conjunctivitis and diarrhea
2 non-infectious causes of pharyngitis.. how they present, good to know but not imperative
snoring= red uvula larnygeal acid reflux= -chronic/recurrent pharyngitis/laryngitis -cough @ night -globus sensation in throat
4 symptoms of tonsillitis
- odynophagia (pain w/ swallowing)
- dysphagia (difficulty swallowing)
- fever
- enlarged, tender lymph nodes in upper neck w/ possible exudate/tonsilloliths (stones from hardened pus- from bacteria).
* “cervical adenopathy” =lymph nodes disease
complications if tonsillitis is untreated
missed school/work
- dehydration
- abscess (peritonsillar or deep neck)
- systemic complications (w/ strep)
3 causes of tonsillitis
- viral: adenovirus, rhinovirus, flu, etc.
- bacteria: usually w/ exudate (not diagnositc)
- mono EBV: w/ exudate
what organism is “strep”?
group A beta-hemolytic streptococcus
other strep species can cause infection though
what is chronic strep caused by?
group A strep, actinomyces (another type of bacteria)
3 rare causes of bacterial tonsillitis
gonorrhea, clamydia, diptheria
Dx of strep
sudden onset sore throat and fever, headache or nausea, swollen LNs, >3days sore throat
-rapid and culture
3 types of group A txt
- PCN (amox)
- erythromycin if allergic to PCN
- 2nd line: amox/clav, cephalosporins, Clindamycin
why treat strep if it self-limited and most would go away without abx?
local complications (peritonsillar or deep neck abscess, lymphadenitis)
systemic complications
contagious nature of it
- *what is a peritonsillar abscess?
* *what are 5 S&S to look for?
walled off collection of pus, outside the tonsil
- unilateral
- uvula medially deviated
- bulging soft palate
- trismus: inability to fully open jaw
- dysphagia (hot potato voice)
peritonsillar abscess txt
if < 3 days and mild: Abx w/ close f/u
if worse, needle aspiration, I&D,
maybe quinsy tonsillectomy (didnt expand on what this is)
2 complications of peritonsillar abscess
spread (retropharyngeal or pharyngeal abscess)
–(deep throat to chest= high morbidity)
airway obstruction
** 3 systemic complications of group A strep
- rheumatic fever (infects heart valves)
- scarlet fever- toxin produced, widespread rash, strawberry tongue
- glomerulonephritis: “coca cola” urine (strep antiBs depositting in uring)
when to treat carriers of asymp. strep?
when theyre “ping-ponging” the infection among family
what is diptheria?
RARE: vaccinate against
gray psuedomembrane (thick membrane covering back of throat)- can cause pain, difficulty breathing
systemic toxins- damage cardiac & neurologic
txt for diptheria
erythromycin or PCN, antitoxin
how long does mono last?
1-3+ months
Dx of mono? how many also have strep?
symptoms >1 wk
tonsil, LN, posterior neck node enlargement
usually w/ tonsil exudate (thick, white, cant remove. confluated (continous- not spotty)
20-30% also have strep
3 complications of mono
- splenomegaly
- hepatomegaly
- hepatosplenomegaly (2nd-4th week)
3 ways to Dx mono
- monospot- rapid (only 60% pos. after 2 wks, 90% after 1 month)
- WBC elevated, lots of atypical lymphs (monocytes)
- mono panel- IgM (elevated in acute), IgG
txt of mono
- Abx if coinfected (not amox, it will give a rash)
2. limits to activity (spleen)
adenoid hypertrophy can cause?
they can block eustachian tubes and back of nose
-otitis media, mouth-breathing, chronic rhinorrhea, “nasal speech”
tonsil hypertrophy can cause (especially in young kids)?
sleep apnea, bedwetting, hard to wake, behavior problems
what is epiglottitis? does it present?
AIRWAY EMERGENCY
epiglottis and supraglottis (above vocal cords) swelling
presents:
1.sitting forward, drooling, can’t swallow
2.inspiratory stridor (noise)
3.fever, “toxic”
what causes epiglottitis?
bacteria: Hemophilus influenza type B
(HIB vaccine against)
-risk: immunocompromised adults (alcoholics)
**txt of epiglottitis
DO NOT use tongue depressor or scope
- IV steroids, Abx, racemic epi
- urgent anesthesia, ENT eval
- may need intubation vs trach.
torus palatini
common bony growth on palate or mandible
