Throat

Question 1

Pharyngitis/Tonsillitis

Answer 1

GABHS most common cause
Sx
Fever, exudate, anterior cervical adenopathy, malaise

Sequelae
Rheumatic Fever
Glomerulonephritis
Scarlet Fever

Severe in children, immunocomprimised, antibiotic use.

VIRAL
Sx include cough and other URTI sx (rhinorrhea, conjunctivitis)

Red Flags:
Abcsess: deviation of uvula, obstructed view, immense pain, palpable mass -- may need imaging of retropharyngeal space. 
Stridor
Bleeding in pharynx or ears
dysphagia
'hot potato voice'
>1wk
Severe pain in absence of erythema

Question 2

Laryngitis

Answer 2

D/t URTI or Smoking
Smoking related laryngitis –> laryngeal cancer

Sx
exudate
swelling - hoarseness of voice

Sequelae: Croup - moves to trachea and bronchioles.

Question 3

Epiglottitis

Answer 3

MEDICAL EMERGENCY in young
Causative Agent: B-hemolytic Strep or H.Influenza

Sudden swelling can lead to airway obstruction.

Sx
NO COUGH
Cyanosis
Dysphagia
drooling
Does not want to talk or lie down
tachypnea

DO NOT use tongue depressor for exam; need xray to confirm - thumb sign.

Question 4

Vocal Cord Polyps (unilateral pedunculated) + Nodules (bilateral rounded)

Answer 4

Benign tumour of vocal cords - rarely develop to cancer

Risk Factors:
Smoking
Overuse – chronic inflammation
Chronic inhalation of irritants

Vocal cords are covered by squamous epithelium - histological changes occur here.
Ulceration may occur from firction and cause hemoptysis.

Question 5

Papilloma

Answer 5

HPV virus 6,11 - non oncogenic
Soft neoplasms; fibrovascular core with stratified squamous epithelium
Hemoptysis from contact is possible

Question 6

Laryngeal Carcinoma

Answer 6

Smoking and Alcohol Use
>40yo males
Halitosis

Question 7

Epstein-Barr Virus

Answer 7

Herpes Virus
Cause of Mononucleosis a lymphoproliferative disorder transmitted via respiratory droplets - especially through saliva.
Benign + Self Limiting in most cases.

Latency occurs in B cells
Proliferation of atypical T cells
Heterophil Ab’s are present - no role in infx but marker for diagnosis.
Sx come from proliferation of T cells in lymphoid tissues.
B cells produce Ab’s - IgG comes from previously infected B cells. IgM shows acute infx. So we can see what stage of infection it is.

B cell proliferation is normally controlled by t cells.

Sx
Extreme fatigue
Sore throat
Lymphadenopathy
Splenomegaly
Hepatomegaly
Rash

CBC - lymphocytosis 
Distinctive atypical lymhocytes (CD8)
Monosppot (gluttination of RBC)
Serology (IgM or IgG)
Generalized lymphadenopathy
Splenomegaly: hyperemic/fragile 

Sequelae: splenic rupture
nasopharyngeal carcinoma
burkitt lymphoma - cancer of the lymphatic system
CFS, Fibromyalgia - low grade reactivation of dormant EBV.