Throat: epiglottitis, tonsillitis, pharyngitis

Question 1

Define/cause epiglottitis?

Answer 1

A severe, potentially life-threatening condition characterised by inflammation and infection of the epiglottis.

Can lead to blockage of the upper airway.

Bacteria:
- Streptococcus spp.
- Staphylococcus aureus
- Haemophilus influenzae b (Hib)
- Pseudomonas

Herpes simplex virus

Non-infectious cause:
- Thermal injuries
- Presence of foreign bodies
- Inflammatory response to radiotherapy

Question 2

Presentation of epiglottitis?

Answer 2

Stridor
Dyspnoea
Drooling
Odynophagia
Fever
Sore throat
Tripod position

Question 3

Diagnosis/IVx of epiglottitis?

Answer 3

Clinical diagnosis

Lateral x-ray of throat
- THUMPRINT SIGN

Question 4

Management of epiglottitis?

Answer 4

MEDICAL EMERGENCY

ABCDE approach

Secure airway through endotracheal intubation.

Culturing and examination of the throat once airway secure.

IV abx -CEFUROXIME

Question 5

Define/cause of tonsillitis?

Answer 5

Inflammation of the tonsils.

Bacterial or viral cause.
- Group A Strep
- EBV (Epstein-Barr virus)

Question 6

Presentation of tonsillitis?

Answer 6

Sore throat
Inflamed, erythema tonsils
Dysphagia
Fevere
Odynophagia (painful swallowing)
White exudate on tonsils (bacterial)
Cervical lymphadenopathy (bacterial)
Headache (viral)
Abdominal pain (viral)
Apathy (viral)

Question 7

Diagnosis/IVx of tonsillitis?

Answer 7

Clinical diagnosis
Use CENTOR or feverPAIN criteria

Question 8

Management of tonsillitis?

Answer 8

≥3 on CENTOR criteria = offer ABx
- Tonsillar exudate
- Tender anterior cervical lymphadenopathy
- Fever over 38deg
- Absence of a cough

FeverPAIN score
- fever in past 24hrs
- Absence of a cough or coryza
- symptom onset ≤3days
- purulent tonsils
- severe tonsil inflammation

• kids: score ≥3 = GIVE ABx
• adults: score ≥4 = GIVE ABx

Viral
- conservative

Bacterial
- phenoxymethylpenicillin (5-10days) or clarithromycin for 5days

Tonsillectomy if recurrent 7 times within a year.

Question 9

Define/causes of pharyngitis (sore throat)?

Answer 9

Inflammation of the mucous membranes of the oropharynx.

Viral cause

Question 10

Presentation of pharyngitis (sore throat)?

Answer 10

Fever
Erythema throat
Dry and scratching throat
Mild cough

Question 11

Diagnosis/IVx of pharyngitis (sore throat)?

Answer 11

Clinical diagnosis

Question 12

Management of pharyngitis (sore throat)?

Answer 12

Conservative
- gargle with warm, salty water
- eat cool or soft foods
- avoid smoking or smoky places
- suck ice cubes, ice lollies, or hard sweets (risk of choking in children, so don’t give hard sweets)
- rest
- paracetamol for fever