MOUTH AND THROAT Flashcards
Acute Pharyngitis
5-15% group A streptococcus
Mostly viral cause
Acute Pharyngitis: symptoms
sore throat fever headache malaise "swollen glands" URI symptoms
Acute Pharyngitis: physical exam findings
pharyngeal erythema tonsillar hypertrophy purulent exudate tender/enlarged anterior cervical lymph nodes palatal petechiae
Acute Pharyngitis: diagnosis and treatment
diagnosis: exclude GABHS
treatment:
supportive
reassess in 5-7 d
Group A Beta Hemolytic Streptococcal Tonsillopharyngitis (GABHS): clinical presentation
sudden onset
tonsillar exudate
tender cervical adenitits
fever
rhinorrhea
cough absent
Centor Criteria
testing for GABHS
1, 4: don’t test
2, 3: test
Modified: age
(more likely in younger)
GABHS: diagnostics
rapid antigen detection testing
throat culture (for negative results)
GABHS: treatment
penicillin V 500 mg PO BID-TID x 10 days
more likely to see amoxicillin clinically
GABHS: complications
acute rheumatic fever
acute glomerulonephritis
…
Tonsillectomy Criteria
7+ episodes/year
5+episodes/year - 2 years
3+episodes/year - 3 years
Peritonsillar Abscess
most common deep neck infection in children, adolescents
Peritonsillar Abscess: etiology
polymicrobial - predominant species: streptococcus pyogenes (GABHS)
Peritonsillar Abscess: symptoms
severe sore throat
fever
muffled voice
drooling trismus neck swelling/pain ipsilateral ear pain fatigue, irritability, decreased PO intake
Peritonsillar Abscess: physical exam findings
swollen fluctuant tonsil
uvula deviation
fullness/bulging posterior soft palate
cervical LAD
Peritonsillar Abscess: treatment
monitor for airway obstruction drainage antimicrobial therapy supportive care \+/- hospitalization
Acute Laryngitis: causes
infectious:
- respiratory viruses
- bacterial respiratory infections
non-infectious
- vocal abuse
- toxic exposure
- GERD
- trauma
- vocal cord problems
Laryngitis: clinical presentation
hoarseness
URI symptoms
Laryngitis: treatment
voice rest treat underlying cause humidification hydration avoid smoking
resolves in 1-3 weeks
Epiglottitis: etiology
viral or BACTERIAL
Haemophilus influenza type B
streptococci
S. aureus
Epiglottitis: risk factors
incomplete or non-vaccination
immunodeficiency
Epiglottitis: clinical presentation
fever respiratory distress anxiety tripod/sniffing position drooling odynophagia muffled speech stridor
Epiglottitis: diagnosis
lateral plain radiograph - thumb sign (swollen epiglottis)
labs
direct laryngoscopy
fiberoptic nasolaryngoscopy
Epiglottitis: treatment
medical emergency
airway protection
hospitalization
IV antibiotics
prevention: immunization
Oral Herpes Simplex (HSV)
herpes simplex virus type 1
sudden onset
painful vesicular lesions on inflamed erythematous base
clinical diagnosis
triggers:
- sunlight
- fever
- menstruation
- stress
- trauma
HSV: treatment
antivirals
analgesics
fluid management
Herpetic gingivostomatitis
primary HSV infection
ulcerative lesions (gingiva, mucus membranes of mouth) perioral vesicular lesions
Coxsackie virus
hand foot and mouth
most common in children
coxsackie A16
clinical diagnosis
supportive treatment (resolves 2-3d)
Coxsackie virus: presentation
low grade fever
malaise
abdominal pain
URI symptoms
painful oral lesions (papules on erythematous base)
lesions on hand, feet, mouth, buttock
Herpangina
vs handfootmouth:
- higher fever
- lesions more posterior (soft palate)
