Pharyngitis Flashcards
Where is pharyngitis inflammation is located?
Where is tonsillitis located?
- posterior oral cavity (between tonsils & larynx)
- hyperemic tonsils
Primary cause of Pharyngitis/tonsillitis
Viral- most common
- Group A Streph (kiddos 5-15) Primary 75% likely strep
- Staph Pyogenes=5-15%
- other viruses rhino, corona, flu, aden, HSV, coxsackie, EBV, CMV
Clinical Presentations of Pharyngitis/tonsillitis if caused by Rhino/Coronavirus ?
= coryzal symptoms
Clinical Presentations of Pharyngitis/tonsillitis if by EBV/CMV ?
fatigue fever "shaggy" exudate general adenopathy splenomegaly 1/3 may have secondary strep
Clinical Presentations of Pharyngitis/tonsillitis if caused by Flu?
- fatigue
- myalgias
- headache
- cough
Clinical Presentations of Pharyngitis/tonsillitis if caused by adenovirus?
conjunctivitis
Clinical Presentations of Pharyngitis/tonsillitis if caused by HSV?
exudate
vesicles
ulcers on palate
Clinical Presentations of Pharyngitis/tonsillitis if caused by coxsackie?
vesicles on soft palate/uvula
rupture to white ulcers
Clinical Presentations of Pharyngitis/tonsillitis if caused by strep?
Centor Criteria= fever tonsillar exudate tender cervical lymphadenopathy no URI/cough symptoms
scarlatiniform rash
Work up/ labs for Pharyngitis/tonsillitis ?
- Centor Criteria
- Throat Swab - rapid strep/ Culture
- Labs; CBC (usually not helpful), mono spot (helpful, but can have false negatives)
Tx of Pharyngitis/tonsillitis ?
Viral–> so supportive care (pain meds/gargling)
Strep–> Penicillin= first line tx
other abx=amoxil (pedes)
cephalosporin
Macrolide
What bacterial profile found in Peritonsillar Abscess?
Same as tonsillitis, with the addition of Fusobacterium
***Staph pyogenese most common
isolated tonsillar enlargement resulting from a bacterial infection that has penetrated the tonsillar capsule and perhaps the surrounding tissues describes what?
Peritonsillar Abscess
HX/ Exam of Peritonsillar Abscess?
increased pain,
trismus (inability to open mouth)
deviation of soft palate/uvula
hot potato voice
Work up for Peritonsillar Abscess?
manual exam
labs
ultrasound
CT
Tx of Peritonsillar Abscess
aspiration I&D (be careful of vessels/nerves in back of mouth) IV abx pain meds steroids (to decrease swelling)
Where is a retropharygeal abscess located?
- retropharyngeal space between pharynx/cervical vertebrae
- extends from base of the skull to mediastinum
How do retropharyngeal abscesses present?
- stiff neck
What microbes are responsible for retropharygeal abscess ?
strep, staph, H. Flu, Klebsiella
Work up/ labs retropharygeal abscess?
soft tissue neck x-ray (>1/2 width of adjacent vertebral body)
consider labs
consider CT
Tx of retropharyngeal Abscess?
IV abx (cephalosporin + amp-sulbactam or clinda)
ENT consult
Aspiration
I&D
What are the etiologies of Ludwigs Angina?
More common…
- Poor dentition
- Deep tissue infection of the submandibular space
What bacteria common in Ludwigs Angina?
-Staph
-Strep
Bacteroides
Fusobacterium
Hx/Exam of Ludwigs Angina?
submental/sublingual swelling, drooling fever
Workup/labs for Ludwigs Angina?
CT
ultrasound (both assess for cellulitis vs abscess)
soft tissue xray= may show STS or gas
tx of Ludwigs Angina?
IV abx
surgical I&D
dental F/U after resolved
Complications of Ludwigs Angina?
- airway compromise
- thrombophlebitis of IJV (Lemierre Syndrome)
- associated w headache
- septic pulmonary emboli
