Mouth & Throat Disorders Flashcards
What is the main objective when diagnosing Acute Pharyngitis?
Whether to rule out GABHS- 5-15%
Criterion Center for Stept Throat?
- Fever
- Absence of Cough
- Exudates
- Cervical adenitis
Criteria needed to perform a RADT or throat culture
3 or more symptoms
Main antibiotic for Acute Pharyngitis?
Penicillin V 500 mg or Amoxicillin 500 mg
If allergic to Penicillin:
-Give macrolides (erythromycin, clarithromycin, azithromycin)
What are complications that are associated with GABHS?
Acute rheumatic fever
Acute Glomerulonephritis
Paradise Criteria for Tonillectomy?
How long should these guidelines be observed
- At least 7 episodes in the last year
OR at least 5 episodes in 2 years
OR 3 episodes in the last 3 years
- 12 month observation period
Who does Peritonsillar Abscess mostly occur in?
- Most common deep neck infection in children or adolescents
Predominant species for Peritonsillar Abscess?
GABHS (Steptococcus pyogenes)
Common symptoms with Peritonsillar Abscess?
- Severe sore throat
- Fever
- “Hot potato” or muffled voice
- Drooling “painful to swallow”
- Trismus “lock jaw”
- Ipsilateral ear pain
Physical exam findings for Peritonsillar abscess
- Swollen, fluctuate tonsils
- Deviation of uvula
- Bulding of the posterior soft palate
Imaging preferred for Peritonsillar Abscess?
CT with IV contrast
Treatment for Peritonsillar Abscess
- Clear airway obstruction
- Drainage (needle aspiration)
- Antimicrobial Therapy
- Parenteral: ampicillin-sulbactam or clindamycin
- Oral: amoxicillin-cluvulanate or clindamycin x 14 days
For a Tonsillectomy what does an episode of Acute pharyngitis consists of?
- Sore throat + Fever
- OR tonsillar exudate
- OR Anterior cervical adenopathy
- Culture confirmed GABHS
What are the infectious causes of Laryngitis
- Respiratory Viral
2. Low chance of Bacterial
Labs for Peritonsillar Abscess
CBC
Electrolytes
Throat culture
Culture of abscess fluid
How is Laryngitis clinically presented?
- Hoarseness
- URI symptoms
- Rhinorrhea, nasal congestion, cough, sore throat
Non infections causes of Laryngitis
Vocal abuse
GERD and more
Treatment for Laryngitis
- Treat underlying cause (virus)
- Humidification
- Voice rest (no whispering)
- Hydration
- Avoid smoking
Usually resolves in 1-3 weeks. Anything beyond that refer to ENT for possible cancer
Ddx for Laryngitis
slide 27
Etiology for Epiglottitis
Who is most at risk?
Viral or BACTERIAL
- Most common is H. Influenza
Risk: Non vaccinated, Immunodeficiency
Clinical presentations for Epiglottis?
3 D’s
Dyphagia
Drooling
Distress
Along with Tripod position
What is a common sign seen in imaging for Epiglottitis?
Lateral “thumb sign”
Treatment for Epiglottitis?
- Airway protection
- Hopsitalization/ER
- IV antibiotics
- Educate on Prevention/Immunization
Presentation for Oral herpes simplex or Herpetic gingivostomatitis
Sudden onset Painful vesicular lesions lasting between 10-14 days
Treatment for Herpetic gingivostomatitis
Antivirals
analgesics
Fluids
Etiology of Oral candidiasis
Candida albicans
Signs of Oral candidiasis
- Painful, creamy-white curd-like patches
- Easily scraped off “thrush will brush”
- Cotton mouth
- Loss of taste
How do you diagnose Oral candidiasis?
- Clinical
- KOH wet prep under a microscope
- budding yeast with or w/o pseudophyphe
Treatment for Oral candidiasis
Antifungal treatments
3 Causes of Head and Neck cancers?
- HPV 16, 18, 31, = Squamous Cell carcinomas
- Nasopharyngeal Carcinomas
- P53 Tumor suppressor gene
How does Squamous cell carcinomas appear?
What are the risk factors associated?
Oral cavity cancers with ulcers or masses that DO NOT heal
What is the preferred way to diagnose Squamous Cell carcinoma
ENT referral for biopsy
Infection that arises from tooth roots and within the neck
Ludwigs angina
What are the preventions of Ludwig’s angina
- Swelling of the neck
- Air way compression
- Fever
What are the treatments for Ludwig’s angina?
- Secure & monitor airway
- Hospitalize
- IV antibiotics
- Acute infection of the parotid gland
- Firm, erythematous swelling or pre and post auricular areas down to the mandible
Suppurative Parotitis
What will lab studies show in someone with Suppurative Parotitis
Elevated amylase
Stone and inflammation in the salivary glands or ducts?
Silolithiasis - most stones occur in Wharton duct