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Foundations II Exam 1 > Mouth 1 > Flashcards

Mouth 1 Flashcards

1
Q

Less common etiology of Laryngitis?

A

Bacterial Respiratory infections:

  • Strep
  • M. catarrhalis
  • H. influenza
  • S. aureus
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2
Q

When should acute pharyngitis improve? In other words, when should you re-assess?

A

5 - 7 days

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3
Q

What is your goal when evaluating acute pharyngitis?

Rule in what?

R/o what?

A

Rule in: Group A Beta Hemolytic Strep Tonsillopharyngitis (GABHS)

Rule out: Epiglottitis, peritonsillar abscess, Ludwig’s Retropharyng infections, primary HIV

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4
Q
  • Pharyngeal erythema
  • Tonsillar hypertrophy
  • Purulent exudates
  • Tender/enlarged ant. cerv lymph nodes
A

Acute Pharyngitis PE findings

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5
Q
  • IV abx w/ 3rd generation cephalosporin and antistaphylococcal (vancomycin)
  • +/- Dexamethasone (steroids)
A

Tx for epiglottits

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6
Q

What organism causes a peritonsilar abscess?

A

Streptoccus pyogenes (GABHS)

*polymicrobial species

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7
Q

2nd most important complication for GABHS?

A

Acute glomerulonephritis (but treating strep does not completely prevent this)

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8
Q

What are the 4 Centor Criteria for determining bacterial cause of sore throat?

A
  1. Tonsillar exudate
  2. Tender cervical adenitis
  3. Fever
  4. Cough absent
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9
Q

Tx for Laryngitis

A
  • Tx underlying cause (abx for bacterial or supportive for viral)
  • Humidifier
  • Complete voice rest (no whispering)
  • Hydrate
  • No smoking
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10
Q
  • Unilateral sore throat
  • Fever
  • “hot potato” or muffled voice
  • Drooling
  • Trismus (lock jaw due to swelling)
A

Peritonsilar abscess

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11
Q

What is the sensitivity of RADT for GABHS?

A

70 - 90% (chance that pt who has strep is TP)

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12
Q

Palatal petechia

A

More strongly associated w/ strep compared to viral

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13
Q
  • Sore throat
  • Fever
  • HA
  • Malaise
  • Adenopathy
  • URI sxs
A

Sxs of Acute Pharyngitis

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14
Q

How do you prevent Epiglottitis?

A

Immunizations (for HiB)

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15
Q

Tx for acute viral pharyngitis?

A

Supportive tx (fluids/rest/salt water gargle)

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16
Q
  • Mouth open
  • Neck/Chin extended
  • Leaning forward

What condition? Why are they sitting like this?

A

Epiglottitis

Pt is having airway issues and is subconsciously trying to open their airway

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17
Q

Throat culture for GABHS:

  • sensitivity
  • specificity
  • How long does it take for results?
A
  • 90 - 95% sensitivity
  • 95 - 99 specificity
  • 24 - 48 hours
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18
Q

For ENT referral for tonsillectomy, the episodes must include 1 of the 4 things. What are they?

A
  1. Sore throat w/ fever >100.9F
  2. Tonsillar exudates
  3. Ant. cerv adenopathy
    • culture for GABHS

(pt also needs appropriate abx therapy)

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19
Q

Etiologies:

  • Viral or bacterial
  • Strep
  • S. aureus
A

Epiglottitis

20
Q
  • Swollen, fluctuant tonsil
  • Deviation of uvula to opposite side
  • Fullness/bulging of posterior soft palate
  • Cervical LAD
A

PE findings of peritonsilar abscess

21
Q

Most common DEEP NECK infection in children/adolescents

A

Peritonsilar abscess

22
Q

Erythematous, sandpaper rash. What dx is it associated with?

A

Scarlet fever (a complication of GABHS)

23
Q
  • Fever
  • Resp distress
  • Anxiety from Resp distress
  • “Tripod position”
  • Drooling
  • Odynophagia (pain out of proportion)
  • Stridor
  • Muffled speech
A

Clinical presentation of Epiglottitis

24
Q
  • When should laryngitis resolve by?
  • When should you get concerned and refer to ENT?
  • Why should you be concerned?
A
  • 1 - 3 weeks
  • > 3 weeks
  • Could be cancer, pt may need laryngoscopy perfomed by ENT
25
Q
  • Vocal abuse
  • Intubation/Trauma
  • Toxic exposure (smoking)
  • GERD
  • Vocal cord nodules
  • Vocal cord cancer/paralysis
A

Non-infectious causes of Laryngitis

26
Q

Most common etiology of Laryngitis?

A

Respiratory Viruses:

  • Rhinovirus
  • Influenza
  • Adenovirus
  • Coxsackie
  • RSV
27
Q
  • Monitor airway obstruction
  • Drain (w/ needle aspiration, I&D, tonsillectomy)
A

Tx for Peritonsilar Abscess

28
Q

What is the specificity of RADT for diagnosing GABHS?

A

90 - 100% (correctly identifies those w/o disease)

If +, can be pretty certain pt has strep as there are not many false +

29
Q
  • 12 million visits annually
  • 5 - 15% cases caused by Group A Strep
  • Mostly viral etiology
  • Other etiologies: smoking, STI, allergies
A

Acute Pharyngitis

30
Q

What % are carriers for strep? (always have it, but don’t show sxs)

A

15% of pediatric patients

31
Q
  • 1st line tx for GABHS?
  • Most common Rx for GABHS. Why?
  • What is given to pt if concern for non-compliance? (children)
A
  • Penicillin 500mg PO BID/TID 10 days
  • Amoxicillin 500mg BID 10 days
    • more common bc/ better compliance w/ only BID instead of TID, tastes better
  • IM penicillin for non-compliance
32
Q

Risk factors:

  • Incomplete or no vaccines
  • Immunodeficiency
A

Epiglottitis (bc/ there are vaccines for HiB)

33
Q

“The 3 D’s”

What are they?

What condition?

A
  1. Distress
  2. Drooling
  3. Dysphagia

Epiglottitis

34
Q
  • Sudden onset sore throat
  • tonsillar exudate
  • tender cerv adenitis
  • fever
  • NO rhinorrhea/cough
A

GABHS tonsillopharyngitis

35
Q

On PE, throat is not impressive, but pain is out of proportion. What is the condition?

A

Epiglottitis

(the throat exam is normal bc/ area involved is not visualized)

36
Q

1 cause of Acute Epiglottitis

A

Haemophilus influenzae type B (HiB)

*bacterial

37
Q

Why do we tx strep w/ abx? What is our main concern? What is our time frame for tx before it can pose a problem?

A
  • Acute rheumatic fever
  • Tx within 2 weeks for prevention
38
Q

Labs:

  • Leukocytosis on CBC
  • Electrolytes
  • Throat culture

Imaging

  • CT w/ IV contrast
A

Diagnostics of Peritonsilar Abscess

(Can also get culture of abscess fluid)

39
Q

The American Academy of Otolaryngology - Head/Neck Surgery have guidelines for tonsillectomy in pts w/ GABHS recurrences.

-What are the 3 circumstances?

A
  1. 7 episodes in last year
  2. 5 episodes in each of past 2 years (10)
  3. 3 episodes in each of past 3 years (9)
40
Q

Dx for epiglottitis/ Tx plan

A
  • Lateral plain x-ray to look for “thumb sign”
  • If valid concern, send to ED
  • ENT: laryngoscopy or fiberoptic nasolaryngoscopy
  • When airway secured: get labs (CBC, blood culture, epiglottal culture if intubated)
41
Q

If pt has penicillin allergy, what do you Rx for GABHS?

A

Macrolides

  • erythromycin
  • clarithromycin
  • azithromycin
42
Q

With which condition do you need to be super careful with examination? Why?

A

Epiglottitis. Bc/ the airway could be compromised. Be careful, especially w/ children becoming anxious during examination (have intubation ready).

*laryngeal spasm

*laying down obstructs airway

43
Q

With which Centor criteria # should you order and not order RADT? (rapid antigen detection test)

A

Order: 2 or 3

DO NOT order: 1 and 4

44
Q

Abx therapy for which condition?

  • Parenteral (via IV): ampicillin-sulbactam or clinda, consider vanco
  • Oral: Augmentin or Clinda for 14 days
  • Supportive care
  • +/- Hospitalization (depending on presentation)
A

Tx for Peritonsilar Abscess

45
Q
  • Hoarseness or Complete voice loss
  • URI sxs
    • rhinorrhea, nasal cong, cough, ST
A

Clinical presentation of Laryngitis

Foundations II Exam 1 (25 decks)

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