Throat

Question 1

What is infectious mononucleosis?

Answer 1

EBV glandular fever URTI & oral infection
enlarged lymph nodes
temperature
sore throat, tonsillitis, pharyngitis
malaise, lethargy

Question 2

classic triad of glandular fever?

Answer 2

lymphadenopathy
fever
pharyngitis

Question 3

other signs & symptoms of EBV?

Answer 3

Jaundice/hepatitis
Rash
Haematology
Leucocytosis (lymphocytosis)
Presence of atypical lymphocytes in blood film
Splenomegaly
Palatal petechiae

Question 4

Complications of EBV?

Answer 4

Protracted but self limiting illness
Anaemia, thrombocytopenia
Splenic rupture
Upper airway obstruction
Increased risk of lymphoma, especially in immunosuppressed.

Question 5

which virus causes glandular fever?

Answer 5

Epstein Barr Virus
Virus of the Herpes family
establishes a persistent infection in epithelial cells (notably in the pharynx)
Two phases of primary infection with EBV
Primary infection in early childhood rarely results in infectious mononucleosis
Primary infection in those >10 years often causes infectious mononucleosis

Question 6

Treatment of EBV?

Answer 6

Bed rest
Paracetamol
Avoid sport
Antivirals not clinically effective
Corticosteroids may have a role in some complicated cases

Question 7

Lab confirmation of glandular fever?

Answer 7

Heterophile antibody
Paul-Bunnell test
Monospot test
Epstein-Barr virus IgM
Blood count and film

Question 8

Differentials for glandular fever?

Answer 8

Cytomegalovirus
Toxoplasmosis
Early HIV infection
seroconversion illness

Question 9

what are the most common viral causes of oral ulceration?

Answer 9

Herpes Simplex Type 1

Question 10

Symptoms of Herpes Simplex Type 1?

Answer 10

usually asymptomatic carrier - salivary transmission
gingivostomatitis: Disease of pre-school children
primary infection
systemic upset
lips, buccal mucosa, hard palate
vesicles 1-2mm
ulcers

Question 11

Gingivostomatitis from HSV1 prognosis?

Answer 11

Fever, local lymphadenopathy
May take up to 3 weeks to recover
spread beyond mouth

Question 12

Treatment of HSV1 gingivostomatitis?

Answer 12

Aciclovir

Question 13

Where does latency occur?

Answer 13

Trigeminal ganglia
After primary infection
Inactive form of virus in sensory nerve cells
Can reactivate to re-infect mucosal surfaces
Moves to lips to become active

Question 14

What is a cold sore?

Answer 14

Reactivation from nerves causes active HSV1 infection

various stimuli

Question 15

Treatment of cold sore?

Answer 15

Symptomatic or Aciclovir

Question 16

What is herpetic whitlow?

Answer 16

Occupational hazard of dentistry

Use of gloves essential in prevention

Question 17

Lab tests for HSV?

Answer 17

Swab of lesion in virus transport medium

detection of viral DNA by PCR

Question 18

Herpes simplex encephalitis?

Answer 18

temporal lobe necrosis

Question 19

What is herpangina?

Answer 19

Vesicles/ulcers on soft palate
coxsackie viruses (not HSV)
enterovirus
similar patient age range to 1ry HSV gingivostomatitis
diagnosis clinically or by PCR test of swab in viral transport medium

Question 20

What is hand, foot and mouth disease?

Answer 20

Also due to coxsackie viruses (enteroviruses)
family outbreaks common
diagnosis clinically or by PCR test of swab in viral transport medium

Question 21

Centor Criteria?

Answer 21

Fever
Exudates
Absence of cough
Tender lymphadenopathy
Modified centor criteria also includes age 44 subtract 1 point

Question 22

how does epiglottitis present and how do we manage it?

Answer 22

severe sore throat, drooling, pyrexia with normal oral examination, may have stridor, life threatening if not treated (Haemophilus Influenzae B)
mild - supportive, antibiotics, nebulisers, steroids
moderate/severe - antibiotics, intubation & ventilation, tracheostomy