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- FINALS > Throat and Mouth > Flashcards

Throat and Mouth Flashcards

1
Q

Viral causes of tonsillitis/pharyngitis?

A
  • Common cold – rhinovirus, coronavirus, parainfluenza = 25% of sore throats
  • Influenza A/B (4%)
  • Adenovirus (4%)
  • HSV (2%)
  • EBV (glandular fever – 1%)
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2
Q

Bacterial cause of tonsillitis?

A

Group A β-haemolytic streptococcus (GABHS) – 15-30% of sore throats in children, 10% in adults

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3
Q

General symptoms of tonsillitis?

A

Sore throat, dysphagia, otalgia, malaise, headache

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4
Q

Complications of tonsillitis?

A
  • Otitis media/Sinusitis
  • Peritonsillar abscess (quinsy)
    • Sore throat, dysphagia, peritonsillar bulge, uvular deviation, trismus, muffled voice.
  • Parapharyngeal abscess
    • Diffuse swelling in neck. Rare but serious.
  • Lemierre syndrome
    • Acute septicaemia and jugular vein thrombosis secondary to infection with Fusobacterium species + septic emboli. Rare.
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5
Q

Centor criteria?

A
  1. Presence of tonsillar exudate
  2. Presence of tender anterior cervical lymphadenoapthy
  3. History of fever
  4. Absence of cough

3/4 = infection due to strep (+ve PV = 50%)

all 4 absent = strep unlikely (-ve PV = 80%)

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6
Q

Differentials for sore throat?

A

Infectious Mono

Scarlet Fever

Diptheria

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7
Q

What is scarlet fever? How does it present?

A

Endotoxins from Strep Pyogenes

  • Rash on chest, axillae, behind ears 12-48h after initial sore throat.
  • Pin prick blanching rash, facial flushing with circumoral pallor, strawberry tongue
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8
Q

Management of tonsillitis/pharyngitis?

A

Symptomatic

  • Regular PCM/ibuprofen to relieve pain and fever
  • Consider mouthwashes or spray (benzydamine)

Antibiotics

  • Not routine
  • If centor +ve
    • Penicillin V (10 days)
    • Clarithromycin or erythromycin (5 days)
  • Avoid amoxicillin –> EBV causes rash
  • If immunosuppressed seek advice
  • If DMARDs or carbimazole - check FBC urgently

Surgery

  • Tonsillectomy
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9
Q

Criteria for tonsillectomy?

A
  • Recurrent sore throat due to tonsillitis (definitely)
  • Episodes of sore throat are disabling and prevent normal functioning
    • >7 well documented, clinically significant adequately treated sore throats in the preceding year
    • >5 episodes in each of the last 2 years
    • >3 in the last 3 years

Complications = primary/secondary bleeding

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10
Q

Causes of laryngitis?

A

Infective

  • Viral – most common. Rhinovirus, adenovirus, influenza, parainfluenza.
  • Bacterial – HiB, strep pneumonia, Staph Aureus, Moraxella catarrhalis
  • Fungal – (10%) recent abx or ICS = risk factors.

Trauma

  • Excessive voice use or misuse during phonation (yelling, screaming, forceful singing)
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11
Q

Symptoms of laryngitis?

A
  • Dysphonia
    • Breathlessness, harshness, limited pitch range, reduced vocal projection or loudness
  • Dysphagia
    • Globus, choking sensations, pain on swallowing, regurgitation, feeling of food getting stuck
  • Fever and systemic symptoms
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12
Q

Management of laryngitis?

A

Self-limiting, usually resolved in 2 weeks.

  • Vocal Hygeine
    • Voice rest and hydration
    • Humidifcation (inhalation of steam, use humidifier and avoid air con and dry heat)
    • Limit caffeine intake
    • Stop predisposing factors (smoking, alcohol)
  • Abx
    • Not routine
    • Consider if persistent fever, purulent sputum, associated distant disease etc.
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13
Q

Causes of croup?

A

Viral (95%)

  • Parainfluenza
  • RSV, adenovirus, influenza

Bacterial Tracheitis

  • Pseudomembranous croup
  • Similar to viral croup but child has high fever, appears toxic and has rapidly progressive airways obstruction.
  • Caused by Staph Aureus –> IV Abx
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14
Q

Presentation of croup?

A

Children aged 6 months - 6 years

  • Prodrome: coryza
  • Barking cough (seal cough)
  • Harsh stridor
  • Hoarseness of voice
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15
Q

Score for assessing croup severity?

A

Westley Croup Score

  • Stridor
  • Subcostal recession
  • Air entry
  • O2 saturation
  • Consciousness level
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16
Q

Croup severity?

A

Mild

  • Occasional cough
  • No stridor
  • No respiratory distress
  • Good O2 sats

Moderate

  • Barking cough
  • Intermittent stridor
  • Mild respiratory distress

Severe

  • Severe respiratory distress
  • Fatigue
  • Altered mental state
  • Cyanosis
17
Q

Management of mild croup?

A

Reassure parents + home with advice.

If stridor or subcostal recession will need to return to hospital.

18
Q

Management of moderate croup?

A

Steroids

  • Oral (dex or pred)
  • Nebulised (budesonide)
  • Reduces severity and duration of croup)
19
Q

Management of severe croup?

A
  • Oxygen
  • Steroids
  • Nebulised adrenaline
  • Anaesthetist
20
Q

What is epiglottitis? What causes it?

A
  • Life threatening swelling of the epiglottis and septicaemia.
  • Most common in 1-6 year olds

Caused by HiB - now rare due to HiB vaccine.

21
Q

Presentation of epiglotitis?

A
  • Occurs rapidly within a few hours
  • Drooling saliva
  • Fever
  • Silent voice
  • May have slight cough (if any – minimal)
22
Q

Management of epiglottitis?

A

Do not examine the throat or lie the child flat or perform lateral X-ray (may cause total obstruction)

  • Main priority is differentiating between acute epiglottitis and viral croup
  • Alert emergency otolaryngologist and anaesthetist as likely to need intubation and airway support
  • Emergency intubation & Admit to ICU
  • Blood cultures
  • Steroids
  • IV Abx
    • 2nd/3rd gen cephalosporin – Cefuroxime/Ceftriaxome/Cefotaxime
    • 7 days

Rifampicin prophylaxis given to close contacts

23
Q

What makes up the majority of oral tumours?

A
  • Squamous cell carcinomas (HNSCC) = 90%
  • Develop from linings of upper aerodigestive tract
  • Uncommon in the UK
24
Q

Risk factors for oral cancer?

A
  • Smoking
  • Alcohol
  • Vitamin A/C deficiency
  • Nitrosamines (salted fish)
  • HPV
  • GORD
  • Deprivation
25
Q

Presentation of oral cancer?

A
  • Persistent painful ulcers
  • White or red patches on tongue, gums or mucosa
  • Otalagia; odonophagia
  • Lymphadenopathy
26
Q

Presentation of trigeminal neuralgia?

A
  • Typically female >50 yrs
  • Paroxysms of intense stabbing pain, lasting seconds, in trigeminal nerve distribution.
  • Unilateral – usually mandibular or maxillary.
  • Triggers = washing affected area, shaving, eating, talking, dental prostheses
27
Q

Management of trigeminal neuralgia?

A

Investigation

  • MRI necessary to exclude secondary causes

Medical

  • Carbamazepine = 1st line
  • Lamotrigine, phenytoin

Surgery

  • Directed at peripheral nerve, trigeminal ganglion or nerve root.

- FINALS (24 decks)

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