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CM 1B: ID/EENT > Lecture 10: Oropharynx and Larynx > Flashcards

Lecture 10: Oropharynx and Larynx Flashcards

1
Q

What is the usual cause of acute pharyngitis?

A

Viral

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2
Q

What finding in pharyngitis heavily suggests viral origin?

A

Ulcers

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2
Q

What type of virus would be less likely to cause fever in viral pharyngitis?

A

Respiratory viruses.

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3
Q

What are the two types of infections that may cause viral pharyngitis with associated ulcers?

A
  • HSV infection
  • Coxsackievirus (Herpangina)
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4
Q

How does Mono/EBV present in the oropharynx?

A
  • Pharyngitis with exudate (White/purple)
  • Fever
  • Generalized LAN (usually post cervical)
  • Splenomegaly
  • HA
  • Rash (can also be caused by ampicillin/amoxicillin)
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5
Q

How do we screen for viral pharyngitis?

A
  • Rapid test
  • Monospot
  • Serum EBV specific antibodies
  • NP swab
  • Labs (lymphocytosis, atypical lymphocytosis, WBC > 12k, Elevated LFTs)
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5
Q

How do we treat viral pharyngitis?

A
  • Supportive care for all.
  • Influenza: tamiflu within 48hrs
  • HSV: acyclovir/valacyclovir
  • EBV/Mono: Avoid contact spots for 4 weeks. Oral prednisone for significant tonsillar swelling.
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6
Q

What is the primary cause of strep throat?

A

GABHS

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7
Q

What findings DO NOT suggest strep throat?

A
  • Hoarseness
  • Cough
  • Coryza
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8
Q

How does a GABHS scarletina rash appear?

A
  • Sunburn
  • Sandpaper consistency
  • Diffuse erythema
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9
Q

What are the signs of scarlet fever?

A
  • Scarlet rash
  • Palatal petechiae
  • Strawberry tongue with enlarged red papillae
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10
Q

How do we screen for GABHS strep?

A
  • Rapid antigen test
  • Throat culture (more sensitive but longer)
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11
Q

What is centor criteria for GABHStrep?

A
  • Tonsillar exudates
  • Tender anterior cervical LAN
  • Fever
  • Absence of cocugh

3+ highly likely, should test.

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12
Q

What is the first line treatment for Strep?

A
  • Pen VK
  • Amoxicillin
  • Keflex (PCN allergy)/Cefdinir
  • Azithromycin (Severe PCN allergy)
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13
Q

What is the patient education for Strep throat?

A
  • Change toothbrush after 24h
  • Not contagious after 24h of treatment
  • ABX are not mandatory
  • Contagious for 2-3 weeks post symptoms if no ABX use.
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14
Q

What are the complications associated with Strep?

A
  • Rheumatic fever
  • Valvular heart disease
  • Poststreptococcal glomerulonephritis
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15
Q

How do we check if strep may have complications?

A

Antistreptolysin O (ASO) titer will be elevated after a recent strep infection.

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16
Q

What is a symptom typically not seen in strep throat?

A

Cough

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17
Q

A 12 y/o patient presents to the office with a sore throat. Mom states pt has had a fever of 101F as well but is not coughing or congested. You notice tender cervical lymph nodes that are enlarged, as well as tonsillar exudate. What is your next step?
a. Rapid strep screen and culture
b. Immediately treat
c. Do nothing and say it’s viral

A

A. Rapid strep screen and culture

Meets all centor criteria.

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17
Q

What is a quinsy?

A

Peritonsillar abscess

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18
Q

Why is peritonsillar abscess concerning?

A

MC deep neck infection in children and adolescents.

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19
Q

What are the 2 MCC of peritonsillar abscess?

A
  1. Strep pyogenes (MC)
  2. Staph Aureus
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20
Q

What are the clinical findings of peritonsillar abscess?

A
  • Hot potato voice (Muffled voice)
  • Drooling
  • Odynophagia
  • Trismus
  • Neck swelling and pain
  • Referred ear pain
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21
Q

What are the PE findings expected of peritonsillar abscess?

A
  • Extremely swollen and fluctuant tonsil
  • Deviation of the uvula to the OPPOSITE SIDE
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22
Q

How is peritonsillar abscess diagnosed?

A

Aspiration of pus from abscess.

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23
Q

What is the imaging of choice for peritonsillar abscess?

A

CT w/ IV contrast

checks for complications

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24
Q

What is a lateral neck radiograph used for in peritonsillar abscess?

A

R/O epiglottitis or retropharyngeal abscess

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25
Q

How is a peritonsillar abscess managed?

A
  • Airway
  • Consult ENT
  • Needle aspiration or I&D
  • ABX (IV Unasyn +/- vanco) until afebrile
  • ABX (oral for 14 days total, augmentin +/- clinda)
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26
Q

Where does a retropharyngeal abscess tend to occur between?

A
  • Prevertebral fascia and constrictor muscles
  • Posterior wall of esophagus and anterior cervical fascia
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27
Q

Who is a retropharyngeal abscess MC in? Why?

A

Children, due to their more frequent URIs.

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27
Q

What clinical findings might suggest Retropharyngeal abscess?

A
  • Neck swelling/mass/LAN
  • Spiking fever
  • Neck pain
  • Odynophagia
  • Dysphagia
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28
Q

What is the imaging of choice for a retropharyngeal abscess?

A

CT w/ IV contrast

Ring enhancing lesion in retropharyngeal space.
Loss of definition between anatomic spaces in the neck.

29
Q

How do we manage a retropharyngeal abscess?

A
  • Airway
  • Empiric IV ABX (Unasyn or rocephin+metro or clinda + levofloxacin)
  • Drainage
  • Improvement within 24-48h
  • Switch to oral metro or levofloxacin
30
Q

What is acute laryngitis?

A

Inflammation of the larynx.
MCC of hoarseness.

31
Q

What are some noninfectious causes of laryngitis?

A
  • Vocal strain/cyst
  • Vocal cord polyps
  • Reflux
32
Q

What might suggest bacterial laryngitis?

A

Exudative tonsillopharyngitis with fever and cervical LAN.

33
Q

What are the MC bacterial causes of laryngitis?

A
  • GABHS
  • Diphtheria
  • M cat
34
Q

If someone is a singer/actor with laryngitis, what treatment can they be given to improve their recovery speed?

A

Oral steroids or erythromycin.

35
Q

What kind of laryngitis would suggest an ENT referral?

A

Laryngitis W/O URI symptoms persisting > 2 weeks and are smokers/drinkers.

36
Q

What is the treatment for viral laryngitis? Bacterial?

A
  • Viral: voice rest and hydration.
  • Bacterial: PCN, erythromycin, supportive care
37
Q

What is Croup?

A
  • Laryngotracheobronchitis
  • Age specific VIRAL syndrome with acute laryngeal and subglottic swelling.
38
Q

What is the MCC of Croup?

A

Parainfluenza (1 & 3)

39
Q

When does Croup typically occur?

A

Late Fall (Sep-Dec)

Sometimes spring

40
Q

What are the hallmark signs of Croup?

A
  • Use of accessory muscles (Retractions)
  • Barking, seal-like cough
  • Inspiratory stridor
  • Prodromal URI for 1-2 days
41
Q

What sign might be seen on a neck XRAY for Croup?

A

Steeple sign (subglottic narrowing)

42
Q

How is Croup diagnosed?

A

Clinically

43
Q

What qualifies as mild Croup?

A
  • Lack of stridor
  • Barky cough
  • Hoarse cry
  • Lack of chest wall retractions
44
Q

What patient education should be provided to a parent with Croup?

A
  • Extended stridor = worsening
  • Difficulty breathing = worsening
  • Worsening
  • Minimal handling of child
  • Crying and anxiety will worsen presentation
45
Q

How is OP Croup treated?

A
  • Dexamethasone shot
  • Oral prednisolone (1 dose)
46
Q

What qualifies as moderate Croup? Tx?

A
  • Stridor at rest
  • Mild to moderate retractions
  • Send to ER (dexamethasone, nebulized epi)
47
Q

What qualifies as severe Croup?

A
  • Stridor at rest
  • Marked retractions with agitations
  • Lethargy or cyanosis
48
Q

What is the most common pathogen associated with croup?
a. RSV
b. Parainfluenza virus 1 and 3
c. Adenovirus

A

B. Parainfluenza virus 1 & 3

48
Q

A 1 year old child presents to the clinic with a barking cough. The mom stated it started in the middle of the night. The mom describes the cough as “seal like.”

Mom states she also has a low grade fever and mild runny nose. She denies any trouble breathing. She brings him to the office for evaluation and the patient coughs, which sounds like a seal bark. What is your treatment for this patient?

A

Mild presentation.
Can be given dexamethasone or oral prednisolone (1 dose)

48
Q

What is epiglottitis?

A

Cellulitis of the supraglottitis and surrounding structures.

48
Q

What is the MCC of epiglottitis?

A

H flu type B

AKA VACCINATE

49
Q

What are the clinical findings that suggest epiglottitis?

A
  • Dysphagia, drooling, distress
  • Tripod position
  • Sudden onset of high fever
  • Extreme odynophagia
  • Toxic appearance
50
Q

Why is epiglottitis concerning?

A

Can progress to rapid obstruction of the airway.

51
Q

How is epiglottitis diagnosed?

A

Direct visualization of an erythematous, edematous, epiglottitis during laryngoscopy.

52
Q

What sign might differentiate epiglottis from Croup?

A

Neck XRay showing THUMBPRINT sign

Anterior neck
Croup is a steeple sign, C for church steeple

53
Q

When should we consider epiglottitis?

A

A sore throat with odynophagia that appears only mild on examination.

54
Q

What is the treatment for epiglottitis?

A
  • IP admission for Empiric ABX (Rocephin + Vanco) or (Rocephin + Clinda) for 7-10 days
  • Antipyretics
  • Steroids (maybe)
54
Q

What is the treatment for epiglottitis?

A
  • IP admission for Empiric ABX (Rocephin + Vanco) or (Rocephin + Clinda) for 7-10 days
  • Antipyretics
  • Steroids (maybe)

Need culture prior to abx!

54
Q

What is ludwig’s angina?

A
  • Bilateral cellulitis of the sublingual, submandibular, and submental spaces.
54
Q

What are the MCC of ludwig’s angina?

A
  • Lower 2nd/3rd molar infection by strep viridans post extraction.
54
Q

What are the concerns with ludwig’s angina?

A
  • Aggressive, rapidly spreading.
  • No marked LAN
  • Airway obstruction
54
Q

What are the 4 descriptive characteristics of Ludwig’s angina?

A
  • Floor of mouth has a woody/brawny cellulitis
  • Rapidly spreading without LAN
  • Sublingual and submaxillary spaces involved
  • Bilateral
54
Q

What clinical findings are expected in Ludwig’s angina?

A
  • Dysphagia, odynophagia
  • Edema and erythema of the sublingual region
  • Tongue displacement (back and up)
  • Drooling, stiff neck
  • Bull neck
  • DEEP NECK ABSCESSES are emergencies!
55
Q

How do we treat Ludwig’s Angina?

A
  • Admit
  • CT with IV contrast
  • Close monitoring of airway
  • Empiric IV ABX (Unasyn alone or rocephin + metro)
  • Culture
  • Drainage (if needed)
56
Q

A 3 year old male presents to the clinic with a severely sore throat. Mom states he has to sit in a specific way in order to not have trouble breathing. On PE, you notice the patient is drooling and looks to be in pain. You later learn in the encounter the patient is on a delayed vaccine schedule. What is your diagnosis?

A

Epiglottitis, which is most commonly caused by H flu.

57
Q

What are the types of laryngeal tumors?

A
  • Nodules: benign, due to vocal abuse.
  • Polyps: caused by abuse, smoking, or chemical irritants.
  • Squamous cell carcinoma: smoking/alcohol
58
Q

What is the first symptom of squamous cell carcinoma in the larynx?

A

Hoarseness.

59
Q

What causes vocal cord paralysis?

A

Lesion or damage to the recurrent laryngeal or vagus nerve!

Any surgery in that area, esp thyroid, has a risk for this.

60
Q

What is the first step in treating vocal cord paralysis?

A

Determining the cause.
* Laryngoscopy
* Bronchoscopy
* Esophagoscopy
* Neuro exam
* CT Scan
* Thyroid scan

61
Q

What are the grades for hypertrophic tonsils?

A
  • Grade 0: surgically removed
  • Grade 1: hidden behind pillars
  • Grade 2: extending to pillars
  • Grade 3: Visible beyond pillars
  • Grade 4: enlarged to midline
62
Q

When are hypertrophic tonsils recommended for removal?

A
  • OSA (obstructive sleep apnea)
  • Recurrent throat infection (3+ in 3 yrs or 5 in 2, or 7+ in 1)
63
Q

What qualifies as a throat infection episode for hypertrophic tonsils?

A
  • Oral temp >= 101F/38.3C
  • Enlarged (> 2cm) or tender anterior LAN
  • Tonsillar exudate
  • Positive culture for GABHS

At least 1 of the above.

64
Q

Which nerves are damaged in vocal cord paralysis?
a. CN III and recurrent laryngeal
b. CN X only
c. CN X and recurrent laryngeal nerve

A

C: CN X and recurrent laryngeal nerve

65
Q

What is the most common type of cancer that causes malignant tumors of the larynx?

A

Squamous Cell Carcinoma

66
Q

Are vocal cord polyps concerning for malignancy? What is their MC cause?

A

Not normally.
MCC: vocal strain/abuse

CM 1B: ID/EENT (27 decks)

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