Test 5 Flashcards
preventing the common
good hygiene and preventing transmission
- mask
- don’t need antibacterial soap
healthy diet
lactobacillus: reduce respiratory infections
breastfeeding
low stress
active lifestyle
echinacea and vit C: vit c is good for children, cross-contry skiers or out in cold
Vit D
Fish oil
DHA: associated with delayed onset and reduced incidence of URIs and common allergic diseases up to 3 years of age
hydrotherapy: sauna, ending cold might not be helpful
Non-Allergic Rhinitis with Eosinophil Syndrome/Perennial Non-Allergic Rhinitis TX
Address co-morbid conditions: fibromyalgia, CFS, IBS
Assess thyroid status
Trial with graded aerobic exercise, cognitive behavioral therapy and depression protocols (B-vitamins, Omega-3 fatty acids, 5-http, St John’s wort)
Consider functional adrenal testing (ASI) and treat accordingly
Treat dry nares with saline sprays, Vitamin E gels.
Capsaicin is an option for non-allergic rhinitis, it appears to have beneficial effects on overall nasal symptoms
Rhinosinusitis TX
- Nasal vasoconstrictors - Neo-Synephrine
- Antibiotics
- Surgical drainage in chronic cases or acute abscess
- Prevention - treat hay fever & viral URIs sufficiently
- Maintain open drainage of sinus ostia, thin secretions with hydration
- Decrease inflammation
- Improve tissue integrity
- Address causative factors, known risk factors
- Keep bowels moving, use bitter bowel alterative herbs if needed
- Diet: Same as general diet for URI, add garlic (Allium sativum) Horse Radish (Armoracia rusticana) and Ginger (Zingiber officinale) ad libitum as seasoning for immune support, mucolytic and anti-inflammatory effects
- botanicals: Achillea, Amoracea, euphrasia or Amenopsis (Yerba mansa), Hydtastis, baptisia (sicker), echinacea (sicker), Gentian root, Primula flower, Sorrel herb, Elder flower
- supplements: Vit A, beta carotene, Vit C, Vit E, Zinc, bromelain
- Short wave diathermy
- bilateral nasal specific: chronic more
- hydrotherapy
- Acupuncture, Chinese herbs, acupressure
- Antibiotics: not recommended
- HP: silica, mercurius, nux vomica, kali bichromium, arsenicum album
Rhinosinusitis TX chronic
- anti-inflammatory diet
- treat inhalant allergy
- improve digestion: Bieler’s broth
- probiotics
- Vitamins C and A
- Selenium
- Vitamin E
- Myer’s cocktail
- N-Acetyl Cysteine
- Bioflavonoids
- Beta carotene
- Vit B 5 (Pantothenic acid)
- Echinacea, Larix
- Glycyrrhiza, Astragalus, Lomatium isolate
- Hoxey-like formula, thymus extract
- Vitamin D: 25OHD levels are inversely associated with ARS
- Stress reduction - especially breathing exercises
- nasal specifics
- craniosacral
- nasal lavage
- humming
indication for urgent referral with rhinosinusitis
- high fevers and severe headache warrant immediate evaluation and probable imaging.
- Abnormal vision (diplopia, blindness)
- Change in mental status
- Periorbital edema
- Cranial Nerve abnormalities (CNs 2,3,4,6)
Fungal sinusitis TX
Nystatin “sniff”
Sprayed Manuka honey 50/50 mixture of honey-saline solution once a day at night for 30 days
Anterior Epistaxis population
children and young adults
Anterior epistaxis RF
< winter due to sudden temperature changes and exposure to dry air
increased URI (nose blowing)
trauma
picking
Anterior epistaxis sx
nose bleeding
Anterior epistaxis tx
vit C
bioflavonoids
HP: phosphorus
Posterior epistaxis pop
older adults, men, fifth decade of life with HTN and arteriolosclerosis
Posterior epistaxis pop
older adults, men, fifth decade of life with HTN and arteriolosclerosis
Posterior epistaxis RF
Hypertension (prolongs bleeding) coagulopathies, Warfarin Sodium, or ASA > 325 mg/day, liver disease, alcoholism
Posterior epistaxis PE
Assess for hemodynamic stability, look for bleeding site
Posterior epistaxis TX
refer to EENT and ED
Vestibulitis cause
Bacterial infection at the nasal vestibule. Usually Staph Aureus
Vestibulitis tx
Treat with warm compresses, poultice of hydrastis, Commiphora and Arctium powdered herb
topical or an antibiotic such as Mupirocin (Bactroban)
Uncomplicated Acute Pharyngitis pop
5-15
Uncomplicated Acute Pharyngitis cause
Group A b-hemolytic Streptococcus pyogenes
Uncomplicated Acute Pharyngitis PE
- heart
- lung
- eyes
- ears
- head
- throat
- skin
Uncomplicated Acute Pharyngitis Dx
centor, rapid antigen detection test, throat cultures if RADT is negative, ASO titer
Uncomplicated Acute Pharyngitis complication
Scarlet/rheumatic fever
peritonsillar abscess
retropharyngeal abscess
glomerular nephritis
guttate psoriasis
erythema nodosum
PANDAS
acute rheumatic fever
Uncomplicated Acute Pharyngitis TX
antibiotics, oral steroids
Strep Carrier
those that have strep as their normal flora
positive culture, negative ASO titer
Pneumonia pop
school-aged children and college students
Pneumonia cause
Mycoplasma pneumoniae
Pneumonia sx
cough
pharyngitis
rhinorrhea
ear pain
Pneumonia dx
multiplex PCR
xray
Hand, Foot, Mouth Disease pop
children
Hand, Foot, Mouth Disease cause
Coxsackie virus
Hand, Foot, Mouth Disease sx
Painful lesions on tongue, mouth, possible hands and feet; self-limiting, but very contagious
Aphthous Ulcers cause
autoimmune condition
Aphthous Ulcers sx
multiple painful oral ulcers
Small round or oval white ulcer 1-5 mm in size surrounded by halo of reddened mucosa
Single or multiple ulcers may coalesce.
May form on any of oral mucus membranes.
Sore throat can be caused when ulcer is in posterior 1/3rd of the tongue, innervated by the glossopharyngeal nerve (CN 9)
Resolves spontaneously in 1-2 weeks.
Oral Candidiasis cause
Candidiasis
HIV
diabetes
Oral Candidiasis RF
inhaled corticosteroids
Mononucleosis pop
teenagers
Mononucleosis cause
Epstein Bar Virus (EBV) infection
Mononucleosis RF
Sexual activity and kissing
Mononucleosis sx
sore throat persisting for > week
Posterior cervical and discreet tender nodes may have adenopathy in groin and axilla
substantial functional impairment with myalgia
tonsil exudate
petechiae on back of pharynx.
hepatomegaly
jaundice
splenomegaly
fatigue
Mononucleosis work up
abdominal exam
peripheral smear
monospot positive
mild elevated transaminase levels
Mononucleosis complication
severe airway obstruction
splenic rupture
hemolytic anemia
thrombocytopenia
malignancy: Burkitt’s lymphoma, nasopharyngeal carcinoma and B cell lymphomas.
Necrotizing Gingivitis cause
Bacterial infection
Necrotizing Gingivitis sx
papillary gingiva are gray; fever and very foul breath; cervical nodes enlarged
Necrotizing Gingivitis RF
smoking, poor hygiene; teenagers most susceptible
Non-Strep Pharyngitis cause
viral or other bacteria
Non-Strep Pharyngitis TX
botanicals
- echinacea
- andrographis paniculata
- glycyrrhiza
- liguticum
- usnea
- ginger
- propolis
- achillea
- garlic
- thyme oil
- myrrh
- sage:
- stillingia
- mycoshield
Physical medicine
- saline gargles
- warming throat compress
- lymphatic massage
- carrot ginger poultices
- cervical manipulation
HP
- Positive study for homeopathy and viral pharyngitis RCT N=30.
Gonococcal Pharyngitis Cause
Neisseria gonorrhoeae
Gonococcal Pharyngitis sx
- Sore throat
- Difficulty swallowing
- Redness and swelling in the back of the throat
- White or yellow pus-like discharge from the tonsils
- Swollen lymph nodes in the neck
Gonococcal Pharyngitis Dx
swab of the throat, DNA probe
Gonococcal Pharyngitis TX
antibiotics
Peritonsillar abscess pop
young adults
Peritonsillar abscess cause
bacterial infection, caused by untreated tonsillitis or other throat infections.
Streptococcus G and Staph A, respiratory anaerobes (including Fusobacteria, Prevotella, and Veillonella species) often polymicrobial
Peritonsillar abscess RF
acute tonsillitis
pharyngitis
periodontal disease
diabetes
smoking
NSAIDs
Peritonsillar abscess SX
sore throat
difficulty swallowing
fever
Unilaterally enlarged tonsil, displaced medially and inferiorly, with contralateral displaced uvula
drooling
Tender cervical nodes on ipsilateral side
Trismus - Spasm of facial and jaw muscles and unable to open mouth fully
muffled (hot potato) voice
may also experience ear pain and difficulty opening their mouth fully.
In severe cases, the infection can spread to other parts of the body and cause serious complications.
Peritonsillar abscess DX
CT scans or ultrasounds
needle aspiration
Peritonsillar abscess TX
draining the abscess through a small incision
antibiotics
Peritonsillar abscess complications
- death
- Airway obstruction
- Aspiration pneumonia if the abscess ruptures into the airway
- Septicemia
- Lemierre Syndrome (internal jugular vein thrombophlebitis and sepsis)
- Carotid artery rupture
- Mediastinitis
- Necrotizing fasciitis
- rheumatic fever, heart disease, glomerulonephritis
Peritonsillar abscess prevention
practicing good oral hygiene
avoiding smoking
excessive alcohol consumption
Diphtheria cause
Corynebacterium diphtheria
Diphtheria sx
Tip-off is blue white membrane adhered to posterior pharynx
cardiac depression
Diphtheria TX
antitoxin
In severe cases, hospitalization may be necessary for respiratory support and other treatments.
Retropharyngeal abscess cause
bacterial infections due to
- Dental infections
- Upper respiratory infections
- Pharyngitis
- Tonsillitis
- Ear infections
Retropharyngeal abscess SX
- Sore throat
- Painful and difficult swallowing
- Difficulty breathing
- Swollen lymph nodes in the neck
- Fever
- Headache
- Neck stiffness
- Drooling in children
- hot potato voice
Retropharyngeal abscess dx
CT scan or an MRI
Retropharyngeal abscess
draining the abscess and administering antibiotics to treat the infection
ED
Ludwig’s Angina cause
bacterial infection, most commonly arising from dental infections or dental procedures,
Ludwig’s Angina SX
fever, difficulty swallowing, drooling, swelling of the neck and mouth, and difficulty breathing.
spread rapidly to the surrounding tissues, including the tongue, throat, and chest
Ludwig’s Angina complication
airway obstruction and sepsis
Ludwig’s Angina TX
administration of antibiotics
surgical drainage
airway management
Necrotizing Fascitis cause
bacterial infection that can destroy skin, fat, and the tissue covering the muscles within a very short amount of time enter the body through surgical wounds, puncture wounds, and insect bites.
Necrotizing Fascitis RF
diabetes or HIV
Necrotizing Fascitis SX
intense pain and swelling, fever, fatigue, and vomiting.
The affected area may also appear red, and the skin may feel warm or hot to the touch.
As the infection progresses, blisters or ulcers may form, and the skin may turn black and die.
Necrotizing Fascitis TX
antibiotics and surgery
amputation
Epiglottitis pop
2-5 years old
Epiglottitis cause
Haemophilus influenzae type B.
bacteria, viruses, or fungi.
Epiglottitis sx
- Difficulty breathing
- Painful swallowing
- High fever
- Drooling
- Stridor
- Trismus - painful/difficulty to open mouth and swallow, excess drooling
Epiglottitis dx
x-ray with thumb print sign
Epiglottitis TX
hospitalization
Chronic Sore Throat DDX
EBV
Fusobacterium necrophorum
Reflux pharyngitis
Post-nasal drip
Toxins
Improper vocal cord hygiene, vocal abuse
Chronic cough
Vascular
nasopharyngeal cancer
oropharyngeal cancer
laryngeal cancer
upper esophageal carcinomas
tumor under the sternum
Chronic sore throat TX
- The only effective means of management of the chronically sore throat is to direct therapy at the underlying cause.
- Reflux pharyngitis - treatment the same as reflux esophagitis
- Treat allergic rhinitis or sinusitis
- Environmental controls – cleaning
- Improve hydration - especially in winter
- Vitamin A can improve epithelial integrity.
- Probiotics can help prevent recurrent infectious pharyngitis.
Kawasaki disease pop
children
Kawasaki disease SX
widespread inflammation of medium- and small-sized blood vessels
bilateral nonexudative conjunctivitis
erythema of the lips and oral mucosa
rash
extremity change
lymphadenopathy
develop after a brief nonspecific prodrome of respiratory or gastrointestinal symptoms
Kawasaki disease DX
The diagnosis of Kawasaki disease requires the presence of fever lasting at least five days without any other explanation combined with at least four of the five following criteria:
- Bilateral bulbar conjunctival injection
- Oral mucous membrane changes, including injected or fissured lips, injected pharynx, or strawberry tongue
- Peripheral extremity changes, including erythema of palms or soles, edema of hands or feet (acute phase),
- Polymorphous rash
- Cervical lymphadenopathy (at least one lymph node >1.5 cm in diameter)
Kawasaki disease TX
immunoglobulin treatment
Hoarseness
