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Otolaryngology > Sore throats > Flashcards

Sore throats Flashcards

1
Q

What is acute tonsillitis?

A

Acute tonsillitis is an inflammation of the tonsils

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2
Q

What is pharyngitis?

A

inflammation of the pharynx (Sore throat)

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3
Q

What is the most common cause of acute tonsillitis and pharyngitis?

A

Viral infection

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4
Q

What are some viral causes of acute tonsillitis and pharyngitis?

A

EBV
RhinovirusI
Influenza
Parainfluenza
Enterovirus
Adenovirus

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5
Q

What are some bacterial causes of acute tonsillitis and pharyngitis?

A

Strep. pyogenes (Most common)
H. influenza
Staph. aureus
Strep. pneumoniae

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6
Q

What are some non-infectious causes of pharyngitis?

A

Physical irritation from GORD or chronic irritation from cigarette smoke

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7
Q

What is shown?

A

Acute tonsillitis

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8
Q

What is shown?

A

Acute pharyngitis

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9
Q

What are some symptoms of viral tonsillitis?

A
  • Malaise
  • Sore throat, mild analgesia requirement
  • Temperature
  • Able to undertake near normal activity
  • Possible lymphadenopathy
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10
Q

What are some symptoms of bacterial tonsillitis?

A
  • Systemic upset
  • Fever
  • Odynophagia
  • Halitosis
  • Unable to work/school
  • Lymphadenopathy
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11
Q

How long will viral tonsillitis usually last?

A

3-4 days

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12
Q

How long will bacterial tonsillitis usually last?

A

Around 1 week

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13
Q

What are some pieces of self-care advice that should be given in acute tonsillitis and pharyngitis?

A
  • Eat and drink, rest
  • Regular analgesia (paracetamol/ibuprofen)
  • Medicated lozenges
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14
Q

What scoring system is used to determine whether tonsillitis requires antibiotics?

A

FeverPAIN

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15
Q

What does FeverPAIN stand for?

A

Fever
P - Purulence (Pus on tonsils)
A - Attended rapidly within 3 days
I - Inflamed tonsils
N - No cough or coryza (Inflammation of mucus membranes in the nose)

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16
Q

What does a FeverPAIN score of 0-1 suggest?

A

Low association of isolating streptococcus
No need for antibiotics

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17
Q

What does a FeverPAIN score of 2-3 suggest?

A

Moderate association with streptotoccus Consider delayed presentation for antibiotics

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18
Q

What does a FeverPAIN score of 4-5 suggest?

A

Highest association (62-65% likelihood of streptococcus)
Treat with antibiotic

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19
Q

What is the first line antibiotic used in treatment of Strep. pyogenes in acute tonsillitis?

A

Penicillin (Clarithromycin if allergic)

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20
Q

When should a patient with tonsillitis be admitted or referred?

A
  • Stridor
  • Breathing difficulty
  • Clinical dehydration
  • Systemically unwell
  • Persistent sore throat lasting 3-4 weeks (± Neck mass)
  • Red or white patches lasting over 3 weeks
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21
Q

How is acute tonsillitis managed in hospital?

A

IV fluids, antibiotics and steroids

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22
Q

How is infection control achieved in acute Strep. pyogenes (GAS) infection in hospital?

A
  • Isolation for the first 48 hours of treatment
  • Standard infection control precautions
  • Contact precautions
  • Risk assess need for droplet precautions
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23
Q

When is surgery indicated in tonsillitis?

A

Recommended for recurrent severe sore throat due to acute tonsillitis in adults

‘Watchful waiting’ more appropriate than tonsillectomy for children with mild sore throats

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24
Q

What are some complications of acute tonsillitis?

A
  • Otitis media (most common)
  • Peritonsillar abscess (quincy)
  • Parapharyngeal abscess
  • Lemierre symdrome (suppurative thrombophlebitis of jugular vein)
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25
Q

What are some late complications of Strep. pyogenes infection?

A
  • Rheumatic fever - fever, arthritis and pancarditis 3 weeks post sore throat
  • Glomerulonepthritis - haematuria, albuminuria and oedema 1-3 weeks post sore throat
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26
Q

What causes quinsy (Peritonsillar abscess)?

A

Bacteria between the muscle and the tonsil produce pus

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27
Q

How does quinsy present?

A
  • Unilateral throat pain and odynophagia
  • Trismus (Pain opening mouth)
  • 3-7 days of preceding acute tonsillitis
  • Medial displacement of tonsil and uvula
  • Concavity of palate lost
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28
Q

What is shown?

A

Quinsy (Peritonsillar abscess)

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29
Q

How is quinsy managed?

A

Aspiration and antibiotics

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30
Q

What is chronic tonsillitis?

A

Persistent infection of the tonsils - symptoms that persist beyond two weeks

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31
Q

What are some bacterial causes of chronic tonsillitis?

A

S. pyogenes (GAS), H. influenza, S. aureus, S. pneumoniae

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32
Q

How is chronic tonsillitis managed?

A
  • Surgery rarely offered
  • Manage with simple dental mouthwash, will settle by itself but may take some time
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33
Q

What are some causes of neutropenia?

A

DMARDs
Carbimazole
Chemotherapy
Leukaemia
Asplenia
Anaplastic anaemia
HIV with low CD4+

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34
Q

What should be done in patient who is on a DMARD presents with rash, oral ulceration, nausea/vomiting, diarrhoea, dry cough, or new onset/increasing dyspnea?

A

DMARD should be stopped and specialised advice taken

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35
Q

What should be done in a patient who is on a DMARD in the event of a severe sore throat or abnormal bruising?

A

Treatment should be withheld, an urgent FBC taken and any blood test abnormalities discussed with specialist team

  • Provide symptomatic relief
  • Consider prescribing an antibiotic, taking into account potential interactions with DMARDs
36
Q

What is diphtheria?

A

Potentially fatal contagious bacterial infection that mainly affects the nose and throat

37
Q

What bacteria causes diphtheria?

A

Corynebacterium diphtheria

38
Q

Why is diphtheria potentially fatal?

A

The organism produces a potent exotoxin which is cardiotoxic and neurotoxic

39
Q

How does diphtheria present?

A

Severe sore throat with a grey-white membrane across the pharynx (pseudomembrane)

40
Q

What is shown?

A

Diphtheria

41
Q

What is shown?

A

Diphtheria - Pseudomembrane in the posterior pharynx

42
Q

How is diphtheria managed?

A
  • Antibiotic (penicillin/erythromycin)
  • Antibiotic and diptheria antitoxin for severe cases
43
Q

How is diphtheria prevented?

A

Toxoid vaccine - made from a cell-free purified toxin extracted from a strain of C. dipththeriae

44
Q

What is infectious mononucleosis (Glandular fever)?

A

A disease of young adults caused by the Ebstein-Barr virus

45
Q

How does EBV cause infectious mononucleosis?

A

EBV is a virus of the Herpes family which establishes a persistent infection in epithelial cells, notably in the pharynx

46
Q

In who does infectious mononucleosis more commonly occur?

A
  • Primary infection in early childhood rarely results in infectious mononeucleosis
  • Primary infection in those >10 years often causes infectious mononucleosis
47
Q

How does glandular fever present?

A

Triad:
- Fever
- Pharyngitis
- Lymphadenopathy
Also:
- Malaise and lethargy

48
Q

What are some clinical signs of infectious mononucleosis?

A
  • Gross tonsillar enlargement with membranous exudates
  • Marked cervical lymphadenopathy
  • Generalised lymphadenopathy
  • Palatal petchial haemorrahages
  • Hepatosplenomegaly, jaundice, hepatitis
  • Rash
49
Q

What is shown?

A

Glandular fever

50
Q

What is shown?

A

Glandular fever

51
Q

What are some investigations required in glandular fever?

A
  • Blood count and film - atypical lymphocytes/lymphocytosis in peripheral blood
  • EVB serology is the most accurate test, antibody tests (monospot or Paul-Bunnel test) are sometimes used
  • Low CRP
  • Deranged liver function tests
52
Q

How is glandular fever managed?

A

Self-limiting illness so symptomatic treatment:
- Bed rest
- Paracetamol
- Avoid sport for 6 weeks to avoid splenic rupture

53
Q

What is the role of antibiotics in management of infectious mononucleosis?

A

Prevention of secondary infection

54
Q

What antibiotics should never be given in tonsillitis and glandular fever?

A

Ampicillin / Amoxicillin

55
Q

What will occur is amoxicillin is given in glandular fever?

A

Diagnostic generalised macular rash will result

56
Q

What is given is severe, unrelenting glandular fever?

A

Systemic steroids

57
Q

What are some complications of glandular fever?

A
  • Anaemia, thrombocytopenia
  • Splenic rupture
  • Upper airway obstruction
  • Increased risk of lymphoma, especially in immunosuppressed
58
Q

What are laryngeal nodes and polyps?

A

Non-inflammatory response to laryngeal injury usually caused by vocal cord abuse and irritation

59
Q

What are some causes of laryngeal nodes and polyps?

A

Vocal abuse
Infection
Smoking can all damage the mucosa of the larynx leading to the formation of polyps
Hypothyroidism (Rare)

60
Q

Where do laryngeal nodules form?

A

Young women
Located bilaterally on middle 1/3 to posterior 1/3 on the vocal cord

61
Q

Where do laryngeal polyps form?

A

Unilateral and pedunculated

62
Q

How do laryngeal nodes and polyps present?

A
  • Voice changes - hoarseness, raspy voice
  • Pain
  • Frequent coughing/throat clearing
63
Q

How will laryngeal nodes and polyps show on biopsy?

A
  • Stratified squamous epithelium
  • Stroma oedematous/fibrous/myxoid
64
Q

How are laryngeal nodes and polyps managed?

A
  • Voice therapy
  • Some cases require surgery to remove the growths
65
Q

What is a contact ulcer of the throat?

A

Raw sores on the mucous membrane covering the cartilage to which the vocal cords are attached

66
Q

What causes a laryngeal contact ulcer?

A

Benign response to injury to the posterior vocal cord:
- Chronic throat clearing
- Voice abuse
- GORD
- Intubation

67
Q

How will a laryngeal contact ulcer present?

A
  • Mild pain while speaking or swallowing
  • Varying degrees of hoarseness
68
Q

How is a laryngeal contact ulcer managed?

A
  • Rest
  • Voice therapy
69
Q

What is epiglottis?

A

Inflammation of the epiglottis

70
Q

What are some bacterial causes of epiglottis?

A

Streptococcus pneumoniae
Streptococcus pyogenes
Staphylococcus aureus
Historically H. influenza but vaccines have diminished cases

71
Q

What are some symptoms of epiglottis?

A
  • Severe sore throat
  • Drooling saliva
  • Pyrexia
72
Q

What are some clinical signs of epiglottis?

A
  • Examination of oral cavity is normal - no inflammation of tonsils
  • May have stridor
73
Q

How is a diagnosis of epiglottis made?

A
  • Clinical diagnosis
  • Only attempt examination if prepared for intubation
74
Q

How is mild epiglottis managed?

A
  • Supportive
  • Antibiotics
  • Nebulisers (adrenaline/saline)
  • Corticosteroids
75
Q

How is severe epiglottis managed?

A
  • Antibiotics
  • Intubation and ventilation
  • Tracheostomy
76
Q

What is Reinke’s oedema?

A

Swelling of the vocal cords due to fluid collected within the Reinke’s space

77
Q

What is the most common cause of Reinke’s oedema?

A

Smoking is the most common cause

78
Q

How will Reinke’s oedema present?

A
  • Hoarse voice
  • Dysphonia
  • Throat discomfort
79
Q

What is shown?

A

Reinke’s oedema

80
Q

How is Reinke’s oedema managed?

A
  • Management of risk factors e.g. smoking cessation
  • Voice therapy
  • If the elimination of risk factors is not sufficient to improve the patient’s symptoms, surgery may be required
81
Q

What is subglottic stenosis?

A

Narrowing of the airway below the vocal cords (subglottis) and above the trachea

82
Q

What causes subglottic stenosis?

A
  • Idiopathic
  • Vasculitis
83
Q

How will subglottic stenosis managed?

A

Progressive breathing difficulty, often exacerbated by exertion

84
Q

How is subglottic stenosis managed?

A
  • Division of the stenosis
  • If recurrent - resection and reconstruction
85
Q
A

Otolaryngology (23 decks)

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