Throat Disorders Flashcards
What is the term for a “sore throat”?
Pharyngitis/tonsillitis
What is the most common etiology of pharyngitis/tonsillitis?
viral
Which type of pharyngitis/tonsillitis is described below?
Minimal signs and symptoms
Cough
Rhinorrhea
Hoarseness
Minimal exudate (Exception: Mono)
Viral
Which type of pharyngitis/tonsillitis is described below?
Symptoms more severe
Fever
Dysphagia/odynophagia
Anterior cervical adenopathy
Tonsillar exudate
Bacterial
What is the most common bacterial pathogen in pharyngitis?
Strep
Name some conditions in a differential diagnosis of a sore throat?
Viral
Mono
Bacterial
Post nasal drip
Peritonsillar abscess
Retropharyngeal abscess
diphtheria
What are some absolute indications for a tonsillectomy?
Obstructive sleep apnea
Cor pulmonale
Tonsillar asymmetry
What are some relative indications for a tonsillectomy?
Recurrent streptococcal tonsillitis
Recurrent PTA
Chronic tonsillitis
What are some complications of a tonsillectomy?
Post-op bleeding
Airway obstruction
Pain
Protracted emesis and fever
In cases of tonsillar asymmetry, what is recommended?
Biopsy for lymphoma
What criteria do we use in cases of suspected strep pharyngitis, that when the four features are present, GABHS pharyngitis is strongly suspected?
Centor Criteria
List the four features of the Centor Criteria
Fever over 100.4
Tender anterior cervical adenopathy
Lack of cough
Pharyngotonsillar exudate and erythema
What are complications/sequela of GABHS Pharyngitis?
Rheumatic fever
Glomeronephritis
Scarlet fever
What is the drug of choice for treatment of GABHS Pharyngitis?
Penicillin x 10 days
What diagnostic test for GABHS Pharyngitis has 90-99% sensitivity?
Rapid Strep test
Can mimic/resemble strep
Characteristic whitish purple exudate extending into the nasopharynx
Typically young patients
Can have marked lymphadenopathy
Mononucleosis
What is the virus responsible for mononucleosis?
EBV
What cause of pharyngitis is described below?
Shaggy white-purple exudate extending into nasopharynx
Excessive fatigue
Tender posterior and cervical adenopathy
Marked lymphadenopathy
hepatosplenomegaly
Mononucleosis
Quinsy Throat
Infection of tonsillar fossa
Suppurative complication of tonsillitis
Typically unilateral
Peritonsillar Abscess
What cause of pharyngitis is described below?
Fever, chills, malaise
Odynophagia/dysphagia/otalgia
History of tonsillitis – inadequately treated
“hot potato” voice (muffled)
Trismus (lockjaw)
Drooling (pending airway problems)
Fluctuant peritonsillar fullness
Uvular base deviated away from lesion
Tonsil displaced medially
Cervical lymphadentitis
Peritonsillar Abscess
What is the DOC for peritonsillar abscess?
Clindamycin
What is the definitive treatment for peritonsillar abscess?
I&D – need to go to OR
What are some complications of peritonsillar abscess?
Asphyxia (Laryngeal edema)
Aspiration pneumonia
Retropharygeal abscess
Descending infections
Ascending infections (Brain abscess, Meningitis, Cavernous sinus thrombosis)
Most commonly encountered neck space infection
Primarily in anterior neck (worry about compression)
Cellulitis of the sublingual and submaxillary space
Ludwig’s Angina
What are some etiologies of ludwig’s angina?
Hx dental abscess
Strep infection
What cause of pharyngitis is described below?
Edema and erythema of upper neck
Displacement of tongue up and back (Can occlude airway)
Respiratory distress
Ludwig’s Angina
What are some complications of Ludwig’s Angina?
Extension to deep neck space
Airway compromise
Infection due to penetrating trauma or extension from a peritonsillar abscess, dental infection, or lateral space infection
This is an emergency!
Typically affects children ages 2 and younger
Retropharyngeal Abscess
What are some complications of a retropharyngeal abscess that makes it an emergency?
May quickly compromise airway (laryngeal edema)
May spread to the mediastinum (Mediastinitis)
May cause septicemia
Aspiration pneumonia
Hemorrhaging (Carotid, internal jugular)
What cause of pharyngitis is described below?
Fever
Dysphagia/ Odynophagia/Drooling
May look toxic
Asymmetrical swelling in posterior pharynx
Pain with neck ROM
Anterolateral neck swelling
Dyspnea
Cervical lymphadentitis
Cervical lordosis
Tender posterior pharyngeal swelling (50%)
Sub-Q emphysema (rare)
Retropharyngeal Abscess
What is the mortality rate with a retropharyngeal abscess even despite treatment?
Mortality rate of 25%
Syndrome of temporary airway obstruction
90% oropharynx
80% hypopharynx
Absolute indication for tonsillectomy
Obstructive Sleep Apnea
What condition or disorder is described below?
Snoring
Excessive daytime sleepiness
Falling asleep during normal activities
Witnessed apnea
Obstructive Sleep Apnea
Patients with obstructive sleep apnea are at risk for what other things?
Accidents
HTN
IHD
Cardiac ectopy
CVA
What neck radius in men and women is suggestive of obstructive sleep apnea?
Neck >17” – males
Neck >15” – females
Using polysomnography (sleep study), what reading is diagnostic of obstructive sleep apnea?
AHI >/= 15, desats
What is the gold standard treatment for obstructive sleep apnea?
Tracheostomy
