Throat Flashcards
Croup/LTB
A viral infection of the sub-glottic area leading to a barking cough
Croup occurs most often in:
Children younger than 5
Most common cause of croup:
Viral infection
-MC in fall through winter
-MC in boys than girls
Croup typically occurs in:
A toddler that develops seal-like barking cough after several days of cold symptoms
-No fever or drooling
Croup iffers from epiglottitis by:
-Croup: No fever/drooling, history of recent cold symptoms; sound worse, slow onset
-Epiglottitis: Fever/drooling (emergency), abrupt, occurs in slightly older patient; looks sicker
Epiglottitis can lead to sudden ______
Asphyxia, go to the ER
Think of Epiglottitis if:
-Patient cannot breathe unless sitting up
-Symptoms appear to be worsening
-Child can’t swallow saliva or drools
-Adult cannot swallow
Treatment of Croup/LTB
-Office: Adjust, thoracic percussion
-Home care: Mist therapy, cold air therapy (20 mins)
Further care of Croup/LTB
Humidify air, hydrate, Vitamin C + Echinacea, thoracic percussion
Treatment of severe croup
Epinephrine (to open airways), oxygen
Treatment of epiglottitis
-Don’t adjust: can cause sudden asphyxia
-ER referral
Epiglottis triad
Dysphagia, Drooling, Distress
Laryngitis
Inflammation and/or mass in the laryngeal part of the airway, leading to hoarseness, altered voice sounds and loss of voice
Laryngitis: Chief symptoms
Hoarseness, loss of normal voice
Laryngitis: Epidemiology & Risk Factors
-Acute laryngitis: Common in winter months, family history, patients who sing or talk for a living
-Chronic, persistent laryngitis: Smokers & people with allergies
Acute laryngitis is caused by:
-Viral upper respiratory infectoin
-Overuse of talking
Chronic laryngitis is caused by:
-Chronic overuse of voice
-Benign vocal cord nodule or cyst
-Laryngeal cancer
Laryngitis: Contributing factors
Dry air, breathing in smoke/dust/gas, allergies, use of corticosteroid inhalers
Main differential diagnoses of Laryngitis
-Over-use of the voice
-Viral upper respiratory infection
-Allergic reaction
-Acute exposure to dry/noxious air
-Benign lesions
-Malignant lesions
Chronic Laryngitis: Causes
Smoking, occupational exposure, chronic over use of voice
-Less common: Cancer of larynx or lung
Treatment of acute laryngitis
-Adjust subluxations
-Treat trigger points
Laryngitis: Patient Self-Care
-Resting voice (even whispering)
-Hydrate and humidify air
-Vitamin C: 200-500mg
-Echinacea and zinc
-Throat lozenges or cough drops
-Honey: <1 yoa
Treatment of Laryngeal Cysts, Nodules & Cancer
Surgical excision, chemo/radiation therapy (cancer), chiro care, removal of larynx
Pharyngitis
Acute inflammation of the mucosa of the pharynx
Sore throat is most common in:
School-aged kids
Infecious causes of sore throat
-Viruses (70% of cases)
-Other conditions: SLE, canker sores (rare)
Miscellaneous causes of sore throat
Burns, cancer, leukemia, irradiation, chemotherapy, polyps
Most common cause of sore throat to rule out is:
Group A Beta-Hemolytic Streptococcus (GABHS)
Strep throat requires antibiotic treatment due to risk of a serious complication called:
Rheumatic fever
Viral sore throat
Usually not severe or prolonged
-Usually cold symptoms are present
In young adults with viral sore throat consider:
Infectious mononucleosis
Sore throat from Post nasal drip
Irritation of the nasal mucosa can lead to increased mucus secretion
Causes of post nasal drip
Colds, sinusitis, allergies
Treatment of postnasal drip
1 teaspoon of liquid antacid at bedtime
Manifestations of Sore Throat
-Viral upper respiratory infection
-GABHS pharyngitis (sore throat): Absence of cold symptoms
GABHS/Strep throat includes
-Fever up to 105 degrees F
-Lymphdenopathy, especially tonsilar node
-Red and swollen pharynx and tonsils
-White tonilar exudates*
-Pain on swallowing: without cold symptoms
Scarlet fever is caused by:
GABHS infection
Symptoms of Scarlet Fever
-Characteristic rash w/ paleness around mouth circumoral pallor
-Red bumpy tongue, fever, swollen lymph nodes, headaches
GABHS Pharyngitis is most common in
Patients aged 6-12 yoa
GABHS Pharyngitis can lead to
Acute rheumatic fever and acute glomerulonephritis
(But usually self-resolves)
Diagnosis of GABHS
Rapid Step Test
Throat culture
Treatment of sore throat
OTC, analgesics, warm saline gargle, antibiotics
Rheumatic fever: Highest risk
Kids 5-15 yoa
-Can cause permenent damage to the heart
Rheumatic Fever: Symptoms
-1-4 weeks after strep throat
-Migrating polyarthritis & carditis (
Rheumatic fever can be prevented if antibiotic therapy is initiated within:
9-12 days of onset of strep infection
Rheumatic Fever Complications
Carditis: Heart Valves (1st)
-Migratory Polyarthritis (2nd MC)
-Chorea: Less Common
Rheumatic Fever: Treatment
Antibiotics (Penicillin)
-Monitor hear function
Follow-up Care: Rheumatic Fever
Chiro care, prebiotics
Diptheria
Acute contagious disease
Diptheria is characterized by a ___ that:
Extotoxin;
1. Forms fibrinous pseudomembrane
2. Causes myocardial damage
3. Causes neural tissue damage
Diptheria is caused by:
Corynebacterium diphtheriae
Progression of Diptheriae
Fatigue
Dysphagia
Signs of toxemia
Prostration
-Complications: Myocarditis and toxic neuritis (CNs then motor weakeness)
Treatment of Diptheriae
-Diptheria antitoxin, antibiotics, best rest, isolate patient until cultures are negative
Prevention: Diptheriae
DPT VAccine
-Shick Test
Pertussis
An acute, highly contagious bacterial disease characterized by a paroxysmal or spasmodic cough that usually ends in prolonged, high-pitched, crowing
Pertussis is caused by:
Bordatella pertussis
-Transmitted by respiratory droplets
Patients with pertussis are not usually infectious/contagious after:
3rd week of paroxysmal phase
50% of pertussis cases are in:
Children less than 2 yoa
(More common in developing countries)
Incubation period of pertussis
7-17 days
Manifestations of Pertussis
-Low Grade Fever
-Symptoms usually last 6 weeks
Stages of Pertussis
- Catarrhal (cold symptoms)
- Paroxysmal (coughing jags)
- Covalescent (healing)
Catarrhal Stage (Pertussis)
-Often looks like a bad chest cold or bronchitis
-Fever is rare
Paroxysmal Stage
-After 10-14 days
-Coughing jabs
-Vomitting is common (mucus is emetic)
Convalescent Stage
-Begins about 4 weeks after onset of illness
-Gradual decrease in frequency
-Patient looks/feels better
Diagnosis of pertussis
-Looks like cold but doesnt go away
-Child <2: Coughing jags, inspiratory whoop, vomitting, abscence of fever
-70% lymphocytes
Pertussis: Prognosis/Complications
-Pertussis is serious in kids <2 yoa
-Complications: Asphyxia, Pneumonia, Cerebral Hemorrhage, Otitis media
Treatment of Pertussis
Avoid cough triggers, bed rest/fluids
-Experctorants and cough suppressants not helpful & should be avoided
Prophylaxis: Prevention
-DPT vaccine
-Quarantine Early
-Exposted people should get a booster shot
