Throat conditions Flashcards
What is the most common bacterial cause of a sore throat?
Group a beta haemolytic strep (strep pyogenes)
List all the possible causes of a bacterial tonsillitis
Strep pyogenes
Haemophilus influenzae
Staph aureus
Strep pneumonia
What are the four criteria that indicate a bacterial tonsillitis over a viral tonsillitis?
- Fever
- Tonsillar exudate
- Tender anterior cervical adenopathy
4, Absence of cough
How many points should a patient have on the centor criteria if “they should receive an antibiotic if the symptoms progress”
2 - 3
How many points should a patient have on the centor criteria if you should start empirical antibiotic therapy?
4
What antibiotic therapy should you start for bacterial tonsillitis?
Penicilin
What antibiotic therapy should you start for bacterial tonsillitis in a penicillin allergic patient?
Clarithromycin
What antibiotic therapy should you start for bacterial tonsillitis if they are unable to swallow?
Benzyl penicillin IV
How many episodes of tonsillitis should a patient have in a year before surgery is performed?
7
What is the general criteria for receiving a tonsillectomy?
7 episodes in one year
5 episodes in each of two years
3 episodes each year for three years
What causes a peritonsillar abscess?
Production of pus from the bacteria between the muscle and the tonsil.
A patient who has had an extremely sore throat for the last 4 days presents with difficulty swallowing and difficulty opening and closing the mouth. On examination the uvula appears to be medially displaced.
Peri tonsillar abscess
What does waldeyers ring contain and where does it lie?
It surrounds the entrance to the aerodigestive tract. Includes palatine tonsils, lymphoid tissue in the tongue base and lingual tonsils.
A 4 year child presents with his mother. She says he snores very loudly and at times appears to stop breathing during the night,
Obstructive sleep apnea due to enlarged adenoids.
What is the treatment for obstructive sleep apnea in a child, due to enlarged tonsils?
Adenoidectomy
How do you treat a quinsy?
Aspiration o pus and antibiotic treatment
What organism causes glandular fever?
Epstein Barr virus
A 18 year old girl presents with extreme fatigue and a sore throat. On examination she has enlarged tonsils and cervical lympadenopathy.
Glandualr fever
A lady who has recently moved to the UK presents with an extremely painful throat and on examination you see a white membrane across the pharynx.
Diptheria
How do you treat a patient with diptheria?
Antitoxin
Supportive treatment
Penicillin or erythromycin
An asthmatic lady presents with white patches on her throat. One xamination these are visible as well as red, raw mucous membranes.
Canidida
What is the treatment of oral thrush?
Nystatin
What would you see in the peripheral blood of a patient with infectious mononucleosis?
Atypical mononuclear cells (activated CD8 + T lymphocytes)
How do you confirm a diagnosis of infectious mononucleosis?
Paul Bunnel test. This detects heterophile antibodies (IgM) that causes clumping of red blood cells.
What is the treatment for glandular fever?
Bed rest
Paracetamol
No sport (risk of splenic rupture)
Corticosteroids are sometimes indicated (if there is neurological involvement or marked haemolysis)
What virus causes cold sores?
Herpes simplex virus 1
What is the lab confirmation of HSV?
PCR
What virus causes herpangina (ulcers on the soft palate)
Coxsakie virus
What virus causes hand foot and mouth disease?
Coxsackie
What is wegners granulomatosis?
An autoimmune disorder characterised by a small vessel vasculitis limited to the respirator tract and kidneys.
In wegners granulomatosis ANCA positive or ANCA negative?
Positive
What are laryngeal polyps and what causes them?
The are caused by a recative change in the laryngeal mucosa secondary to vocal abuse (such as singing) and smoking.
A 28year old proffesional singer presents with hoarsness. What do you do?
Vocal polyp
Rest the voice
What is a laryngeal contact ulcer?
A benign ulcer on the larynx that occurs in response to injury such as vocal abuse or GORD
What types of HPV predispose you to getting a squamous papilloma?
6 and 11
A 34 year old lady present with hoarsness. She also complain of heartburn.
Contact ulcer due to GORD
What is a paraganglioma?
A tumour arising in clusters of neuroendocrine cells dispersed throughout the body
Are paragangliomas found in the larynx cromaffin positive?
No
Give an example of chromaffin positive paragangliomas?
Adrenal medulla tumours (phaechromocytoma)
What does it mean if a paraganglioma is chromaffin positive?
It is formed from the sympathetic nervous system and can secrete catecholamines
What condition are paragangliomas associated with?
MEN 2
What kind of cancer can be caused by HPV infection?
Squamous cell carcinoma. Most often in the oropharynx
Name the three main salivary glands
Parotid
Submandibular
Sublingual
What is sialolithiasis?
Salivary gland stones
What type of HPV infection predisposes you to getting a squamous cell carcinoma?
16
A 72 year old women presents to you worried about a lump on thus side of her face, just above her upper molars, that seems to be getting bigger.
Pleomorphic adenoma of the parotid gland
A 73 year old man presents with bilateral enlarged parotid glands. He smoked 20 a day.
Warthins tumour of the parotid
Name two benign salivary gland tumours
Warthins tumour
Pleomorphic ademona
In which salivary glands are you most likley to get a pathology?
Parotid
A 55 year old women presents with enlargement of her parotid gland which is very painful. She has recently started to get difficulty chewing.
Adenoid cystic tumour (malignant)
