Pharynx & Larynx Flashcards
Describe the etiology/risk factors of acute viral pharyngitis
- most common PC visit
- EBV, mpox, rhinovirus, coronavirus, influenza, adenovirus
- common in children, those in close contact
Describe the clinical presentation of influenza related acute viral pharyngitis
- cough
- myalgia
- headache
- fever
- “hit by a truck”
Describe the clinical presentation of EBV related acute viral pharyngitis
- persistent fatigue
- possible hepato/splenomegaly
- tender posterior cervical nodes
Describe the clinical presentation of HSV related acute viral pharyngitis
- vesicles
- shallow ulcers
- diffuse on palate
Describe the clinical presentation of adenovirus related acute viral pharyngitis
- conjunctivitis
- preauricular LAD
What are the bacterial causes of pharyngitis
- GABH
- strep
- gonorrhea
- diphtheria
- mycoplasma
- cornybacterium diphtheria
Describe the PE and diagnostic testing for acute viral pharyngitis
- always include abdominal exam
- +/- tonsillar exudates
- cervical LAD not typically prominent or tender
- negative RST/confirmatory test
- heterophile Ab
- flu test
Describe the treatment for acute viral pharyngitis
Usually self limited or supportive treatment
- antivirals with flu to shorten the course/lessen the symptoms (Tamiflu, baloxavir)
Describe the etiology/risk factors for mononucleosis
- EBV aka HHV-4
- saliva or close personal contact
Describe the clinical presentation of mononucleosis
persistent (1-2 mos) malaise, fatigue, HA, fever, sore throat
- milder forms can go undiagnosed
Describe the PE/diagnostic testing for mononucleosis
- exudative tonsils
- hepatosplenomegaly
- posterior cervical lymphadenopathy
- palatal petechiae
- axillary, inguinal, generalized LAD
- IgM heterophile Ab seen in 2nd week
- EBV specific Ab testing
- CBC w/ diff shows lymphocytosis
- peripheral smear shows atypical lymphocytes
Describe the treatment for mononucleosis
- treat symptoms: analgesics, corticosteroids for 4+ painful tonsils
- may have secondary strep
- avoid strenuous activity x21 days d/t risk of splenic rupture
- rare risk of CNS infection
What happens if PCN/ampicillin is given in mononucleosis
rash
Describe the clinical presentation of bacterial pharyngitis
Worse in adults
- sore throat
- odynophagia
- rever
- HA
- scarlatina rash (scarlet fever)
- kids may have dysphagia, irritability, n/v
- cough/rhinorrhea absent
- fever >100.4
- beefy red tonsils/oropharynx with exudates
- tonsillar hypertrophy/edema
- halitosis
- tender anterior cervical nodes
- strawberry tongue
Describe the diagnostic criteria for bacterial pharyngitis
GABHS Centor Criteria
- fever >100.4
- tender anterior cervical adenopathy
- no cough
- pharyngotonsillar exudates
Describe the diagnostic testing for bacterial pharyngitis
- **RST
- POCT**
- relfex to culture or PCR if RST neg
Describe the treatment for bacterial pharyngitis
- treat symptoms
- Amoxicillin or PCN VK PO BID x10 days
- cephalexin, azithromycin, clindamycin, PCN G IM x1
- **peds dosing: 50mg/kg/day divided BID x10 days
- 50mg/kg once daily
- max dose 1,000mg/day**
Describe the etiology/risk factors for rheumatic fever
can develop 1-5 weeks after strep infection
Describe the clinical criteria/presentation for rheumatic fever
Major
- J: joints (polyarthritis, hot/swollen)
- <3: heart (carditis, valve damage)
- N: Nodules (subq, extensor surfaces)
- E: Erythema marginatum (painless rash)
- S: Sydenham chorea (flinching movement disorder)
Minor
- P: Previous rheumatic fever
- E: ECG with PR prolongation
- A: Arthralgias
- C: CRP/ESR elevated
- E: elevated temp
Describe the diagnostic testing for rheumatic fever
- ECG with PR prolongation
- elevated ESR/CRP
- history of recent strep infection with presence of 2 major criteria or 1 major and 2 minor critera
Describe the etiology/risk factors for peritonsillar abscess
- can develop after strep infection (or staph)
- MC in adolescents/young adults
- usually unilateral
Describe the clinical presentation of peritonsillar abscess
gradually progressive: severe sore throat, dysphagia, fever, trismus, hot potato voice, fever
Describe the diagnostic testing/PE for peritonsillar abscess
- medial displacement of tonsil
- lateral displacement of uvula
- purulent abscess
- dehydration
- needle aspiration or I&D
Describe the treatment of peritonsillar abscess
- admit to hosp
- IV abx and hydration
- close follow up a day later d/t recurrence risk
Describe the etiology/risk factors of retropharyngeal abscess
- kids 0-6
- trauma/sharp object, post-pharyngitis, sinusitis, otitis