Sore throats Flashcards
What are the two main diagnoses for an acute sore throat?
Acute pharyngitis (inflammation of the oropharynx) Tonsillitis
What is the main bacterial cause of tonsillitis?
Group A beta haemolytic streptococcus
What can help to predict if a sore throat may be bacterial?
The centor criteria
- Absence of cough
- Presence of tonsillar exudate
- History of fever
- Presence of tender anterior cervical lymphadenopathy
What centor score should be present to prescribe antibiotics for tonisllitis? Which antibiotic should be used?
A score of 3 or 4
Should be methoxyphenylpenicillin for 7 or 10 day course
What are some of the complications of tonsillitis?
Otitis media Peritonsillar abscess (quinsy) - aspiration needed parapharangeal abcess - needs drainage under GA
What are the indications for tonsilectomy?
That the sore throat is definitely due to tonsillitis
The episodes are disabling and prevent normal functioning
>7 episodes in last year
What are the complications of tonsillectomy?
Primary haemorrhage <24 hrs
Seconday haemorrhage >24hours - typically 5-10days due to infection
Both are ENT emergencies
What is the difference between stridor and stertor?
Stridor is the high pitched noise heard in inspiration from partial obstruction of the larynx or large airways
Stertor is an inspiratory snoring caused by obstruction of the pharynx
What are the signs to look for in respiratory distress?
Swallowing difficults
Accessory muscle use
cyanosis
Tracheal tug
What is the leading cause of stridor and how is it treated?
The leading cause is laryngotracheobronchitis/croup
It is a barking cough with respiratory distress
95% viral
All children should recieve a single dose of dexamethasone 0.15mg/kg
Advise usually self limiting - admit if not resolving
What are the clinical features and treatment of acute epiglottitis?
This presents with stridor and is a rapidly progressive inflammation of the epiglottis
Children are often have a pooling and drooling of saliva, they prefer to lean forwards and have a muffled voice or cry
Management:
-Keep patient upright
-do not cause distress or examine throat
-summon an anesthetist and ENT surgeon
-Diagnosis is made by largoscopy and intabated
-treated with dexamethasone and antibiotics
How do you manage acute airway obstruction in adults?
Give O2 or heliox (a mixture of helium and O2 that is less dense than air, this may make respiration easier
Nebulised adrenaline (1ml of 1:1000 with 1ml saline)
Note O2 saturation, respiratory rate, pulse and blood pressure
Call the oncall ent reg and anesthetist for help
Endotracheal intubation should be the first line of intervention, move on quickly if difficult
Emergency needle cricothyroidotomy e.g. minitrach II are temporary measures
Surgical cricothyroidotomy is quicker and easier to perfrom than emergecy tracheostomy
What causes the majority of hoarseness in patients?
A viral upper respiratory tract infection that simply settles with time
What hoarseness should be investigated and why?
> 3 weeks (esp smokers)
Chief presentation of laryngeal carcinoma
What should be the parts of your history for hoarseness?
GORD Dysphagia smoking stress singing or shouting Voice overuse is a common cause
