L 10 Flashcards
Order from top to bottom the phyraynex
nasopharynx, oropharynx, larynx, esophagus
What is Pharyngitis? causes and epidemiology?
- Inflammation of the throat
- Caused by: viruses (e.g rhinovirus)
- Spread through direct contact of secretions
Acute sore throat most likely cause
70-90% = viral infection
Strep, glandular fever, trauma, medicines, carcinoma
Viral vs bacterial sore throat:
Age: Viral = any age, bacterial = mainly school aged
Duration: Viral AND bacterial =both 3-7 days
Cough present? Viral = common, bacterial = rare
Fever: Viral: low-grade fever, headache, but bacterial = high-grade fever
Referral of sore throat:
- Duration over 2 weeks
- High temp + swollen glands + tonsillar exudate
- Dysphagia or dysphonia (hoarse voice)
- Higher risk demographic groups (e.g māori and pacific people)
Most common or sore throats are viral or bacterial?
More than 30% or cases are viral but 72-90% patients are prescribed antibiotics.
Are antibiotics necessary for sore throats?
No, unless there are rheumatic fever complications
If a sore throat is of bacterial origin, should antibiotics be prescribed?
Not really, the immune system should clear it within a few days automatically anyway. If ongoing or serious then yes.
What is the reason for prescribing antibiotics for sore throat?
Reduce the risk of complications Diagnostic uncertainty Patients expects to be prescribed antibiotics Reduce duration of symptoms Reduce pain
Untreated sore throat bacteria can lead to further complications how many weeks after a
Untreated GAS bacteria can lead to rheumatic fever 1-5 weeks after a sore throat
Rheumatic fever can causes
Inflammation of heart, joints, brain and skin, and can causing scarring of heart valves (rheumatic heart disease)
What can we do if causing scarring of heart valves?
Heart valve replacement surgery
Rheumatic heart disease is more prevalent in … populations
30 times more prevalent is Māori and 40 times more prevalent are pacific
Antibiotics GUIDELINES are recommended for sore throat IF:
A person is at a high risk of rheumatic fever i.e:
- Family/personal/household history
- Māori and pacific ethnicity
- Living in crowded circumstances or in lower SES areas
- And aged 3-35
Or if other severe symptoms were present.
WHat is the Process of applying antibiotics for RF?
High risk patients = throat swab taken first and begin empiric antibiotics therapy . When swab test returns, patients who test negative for GAS can discontinue antibiotic use.
Which antibiotics Likely to be prescribed for a GAS sore throat (x4). Course duration =
Penicillin v for 10 days
Amoxicillin for 10 days
If allergic to penicillins:
Erythromycin, roxithromycin for 10 days
Can we use corticosteroids for symptomatic relief for sore throats: which is effective for pain reduction?
Corticosteroids might be effective but use as a single dose nor recommended for long term,
Analgesics (paracetamol/ibuprofen), aspirin gargle but needs to be taken regularly not a single dose.
Analgesics are effective for pain reduction.
Topical symptomatic therapy options for sore throats x3
Lozenges, gargles, sprays
What are the properties of an ideal sore throat treatment?
Local pain relieve Target the cause of sore throat Has prolonged duration of action Safe Effective
Issues with throat sprays
A portion of spray is immediately swallowed after application therefore reducing concentration of active ingredients present
Issues with throat gargles?
Not favoured by patients.
Gag reflex can ruin delivery to affected area
Best delivery system for sore throat. Why?
Lozenges: Release directly onto tissue. Increased saliva also helps to lubricate. Portable and convenient for patient.
Examples of antibacterial local agents for sore throats. Are they useful?
Chlorhexidine, Povidone iodine gargles.
Useless most of the time as most sore throats are viral
Examples of local anaesthetics for sore throats?
Lignocaine and benzocaine above 6yrs
Ok with pregnancy and breastfeeding mothers
Summary of local anaesthetics (who can use, duration, preg/diabetic safe?)?
Anyone 6yrs+
Short duration, 2 hourly dosing
Preg/breastfeeding/diabetic compatible
Summary of local anti-inflammatories for examples?
Benzydamine (Brand Name: Difflam)
Every 1-2 hours, ages 6yr+, pregnancy okay if early, breastfeeding okay, diabetic okay.
What we need to remember of using Flurbiprofen(NSAIDs) for sore throat:
ages over 12yr+, needs to be avoided in pregnancy esp third trimester, peptic ulcers, asthma, renal impairment, HF etc.
Dose is in Every 3-6 hours,
Probiotic lozenges good or bad?
Good for bacterial infections
What are the non pharmacological remedies for sore throat. Are they effective?
Apple cider vinegar, lemon drinks, honey drinks, alcohol, spices (e.g cinnamon or ginger), ice cubes, frozen foods.
Some are effective, but little evidence. Can provide symptomatic relief for some patients.
What does the larynx do? What processes is it integral to?
Airway protection
Maintains safe swallowing,
Integral to coughing, straining, swallowing.
What is laryngitis? + summary?
Inflammation of the larynx. Acute, common and self limiting
Symptoms of laryngitis?
Hoarseness, pain/discomfort in neck, cough, throat clearing, feeling of lump in throat
Causes of laryngitis?
Usually viral, can be bacterial but difficult to differentiate.
10% cause by Laryngeal candidiasis especially immunocompromised patients
Also can be fungal or due to reflux issues (GORD)
Treatment for laryngitis. Are antibiotics efficacious?
Urgent referral if acute airways are compromised.
Otherwise usually self-limiting.
Can do vocal hygiene like voice rest, limit caffeine intake alcohol reduction etc.
No evidence for antibiotics being useful.
Tonsillitis symptoms?
Sore throat, painful swallowing, swollen glands, bad breath, fever and chills, tiredness and headache, red and enlarged tonsils with white spots of pus.
Duration of tonsillitis?
3-4 days but can last up to 2 weeks even with treatment.
Causes of tonsillitis?
The majority are Virus > bacterial
Which bacteria are responsible for TONSILLITIS?
Streptococcus pyogenes
Treatment of tonsillitis?
Throat lozenges, rest, fluids, soft meals, analgesics.
MAYBE: corticosteroids and antibiotics if really necessary.
What are the prevention steps of Tonsillitis?
Regular and thorough washing and drying of hands
Not sharing food and utensils or drinking containers
During Coughs and sneezes cover with hand
