Lecture 10: Oropharynx and Larynx Flashcards
What is the usual cause of acute pharyngitis?
Viral
What type of virus would be less likely to cause fever in viral pharyngitis?
Respiratory viruses.
What are the two types of infections that may cause viral pharyngitis with associated ulcers?
- HSV infection
- Coxsackievirus (Herpangina)
How does Mono/EBV present in the oropharynx?
- Pharyngitis with exudate (White/purple)
- Fever
- Generalized LAN (usually post cervical)
- Splenomegaly
- HA
- Rash (can also be caused by ampicillin/amoxicillin)
How do we treat viral pharyngitis?
- 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.
What is the primary cause of strep throat?
GABHS
What findings DO NOT suggest strep throat?
- Hoarseness
- Cough
- Coryza
How does a GABHS scarletina rash appear?
- Sunburn
- Sandpaper consistency
- Diffuse erythema
What are the signs of scarlet fever?
- Scarlet rash
- Palatal petechiae
- Strawberry tongue with enlarged red papillae
How do we screen for GABHS strep?
- Rapid antigen test
- Throat culture (more sensitive but longer)
What is centor criteria for GABHStrep?
- Tonsillar exudates
- Tender anterior cervical LAN
- Fever
- Absence of cocugh
3+ highly likely, should test.
What is the first line treatment for Strep?
- Pen VK
- Amoxicillin
- Keflex (PCN allergy)/Cefdinir
- Azithromycin (Severe PCN allergy)
What is the patient education for Strep throat?
- 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.
What are the complications associated with Strep?
- Rheumatic fever
- Valvular heart disease
- Poststreptococcal glomerulonephritis
How do we check if strep may have complications?
Antistreptolysin O (ASO) titer will be elevated after a recent strep infection.
What is a symptom typically not seen in strep throat?
Cough
What is a quinsy?
Peritonsillar abscess
Why is peritonsillar abscess concerning?
MC deep neck infection in children and adolescents.
What are the 2 MCC of peritonsillar abscess?
- Strep pyogenes (MC)
- Staph Aureus
What are the clinical findings of peritonsillar abscess?
- Hot potato voice (Muffled voice)
- Drooling
- Odynophagia
- Trismus
- Neck swelling and pain
- Referred ear pain
What are the PE findings expected of peritonsillar abscess?
- Extremely swollen and fluctuant tonsil
- Deviation of the uvula to the OPPOSITE SIDE
How is peritonsillar abscess diagnosed?
Aspiration of pus from abscess.
What is the imaging of choice for peritonsillar abscess?
CT w/ IV contrast
checks for complications
What is a lateral neck radiograph used for in peritonsillar abscess?
R/O epiglottitis or retropharyngeal abscess
How is a peritonsillar abscess managed?
- Airway
- Consult ENT
- Needle aspiration or I&D
- ABX (IV Unasyn +/- vanco) until afebrile
- ABX (oral for 14 days total, augmentin +/- clinda)
Where does a retropharyngeal abscess tend to occur between?
- Prevertebral fascia and constrictor muscles
- Posterior wall of esophagus and anterior cervical fascia
What clinical findings might suggest Retropharyngeal abscess?
- Neck swelling/mass/LAN
- Spiking fever
- Neck pain
- Odynophagia
- Dysphagia
What is the imaging of choice for a retropharyngeal abscess?
CT w/ IV contrast
Ring enhancing lesion in retropharyngeal space.
Loss of definition between anatomic spaces in the neck.
How do we manage a retropharyngeal abscess?
- Airway
- Empiric IV ABX (Unasyn or rocephin+metro or clinda + levofloxacin)
- Drainage
- Improvement within 24-48h
- Switch to oral metro or levofloxacin
What is acute laryngitis?
Inflammation of the larynx.
MCC of hoarseness.
What are some noninfectious causes of laryngitis?
- Vocal strain/cyst
- Vocal cord polyps
- Reflux