Throat infections Flashcards
Tonsillitis
inflammation of the palatine tonsils
Pharyngitis
inflammation of any structure of the pharynx including adenoids and lingual tonsils
Causes of viral tonsillitis/pharyngitis
- rhino virus
- EBV
- adenovirus
- coronovirus
- influenza A/B
- acute retroviral syndrome
Causes of bacterial tonsillitis/pharyngitis
- group A beta hemolytic strep
- diptheria
- neisseria gonorrhoeae
- mycoplasma pneumoniae
- chlamydia pneumoniae
S&S bacterial tonsillitis/pharyngitis
- lack coryza, cough or other URI sx
- sudden onset sore throat
- anterior LAD
- fever
- petecchiae of soft palate
S&S viral tonsillitis/pharyngitis
- coryza
- cough
- malaise
- fatigue
- hoarseness
Diptheria
dense grey pseudomembrane covering the tonsils
Scarlet fever
aka. GABHS pharyngitis
- fever
- strawberry tongue
- sandpaper like rash on trunk and armpits
What do you need to differentiate viral and bacterial tonsillitis/pharyngitis
HISTORY
Clinical diagnosis of GABHS
Centor criteria
- fever
- anterior cervical lymphadenopathy
- tonsillar exudate
- absence of cough
score:
0-1 no further testing
2-3 confirm vis RAPDT
4 treat for strep
What is the gold standard for diagnosis of GABHS
throat culture
Other ways to diagnose viral tonsillitis/pharyngitis
- most etiologies there is no testing available
- rapid influenza test
- tests for EBV (mono)
Other ways to diagnose bacterial pharyngitis/tonsillitis
GC throat
diptheria swab
Treatment of viral pharyngitis/tonsillitis
SUPPORTIVE
- +/- single dose of decadron
Treatment of bacterial (GABHS) tonsillitis/pharyngitis in adults
Pen Vk PO
Penicillin G Benzathine
Treatment of bacterial (GABHS) tonsillitis/pharyngitis in children
Pen Vk
Amoxicillin
Peritonsillar abscess
collection of pus located between the capsule of palatine tonsil and pharyngeal muscle
Common location of PTA
superior pole of the tonsil
PTA, unilater or bilateral
bilateral
Development of PTA
tonsillitis/pharyngitis–>cellulitis–>phlegmon–>abscess
What causes a PTA
-usually microbial
GABHS most common
-staph aureus, neisseria, corynebacterium
Symptoms of PTA
- severe sore throat (usually unilateral)
- fever
- ipsilateral ear pain
- fatigue
- irritability
- decreased PO intake
- trismus
- neck pain with movement
Signs of PTA
- muffled/”hot potato” voice
- unilateral swollen and fluctuant tonsil with contralateral deviation of uvula
- pooling of saliva/drooling
- trismus
- neck swelling
- fever
- bad breath
- erythema or exudate of the tonsil
Diagnostics for PTA
CLINICALLY
- CT neck with IV contast (best imaging)
- inta oral ultrasound
- lateral soft tissue (exclude other pathologies)
Treatment of PTA
- ensure airway is secured
- drainage
- emperic abx (unasyn/clinda IV, augmentin)
- antipyretics
- analgesics
- single dose steriod
Complications of untreated PTA
- airway obstruction
- internal jugular seeding of infection
- pseudo aneurysm of carotid artery
- septicemia
Rheumatic fever
delayed, non-suppurative sequelae of GABHS pharyngitis involving lesions of joints, heart, SQ tissue and CNS
Average age of onset of Rheumatic fever
5-15
What is Jones criteria
diagnostic tool for rheumatic fever
What do you need for diagnosis of Rheumatic fever
evidence of recent strep infection PLUS
2 major
1 major 2 minor
3 minor (recurrent AF only)
Major criteria in Jones criteria
- migratory arthritis
- carditis/valvulitis
- sydenham chorea
- erythema marginatum
- subcutaneous nodules
Minor criteria in Jones criteria
- arthralgia
- fever
- elevated ESR or CRP
- prolonged PR interval
Erythema Marginatum in rheumatic fever
non puritic, serpiginous erythematous eruption to the trunk
Pneumotic for remember Jones criteria major sx
J- joints (migratory arthritis) O- oh my heart (carditis) N- nodules E- erythema marginatum S- syndenham chorea
Lab work up for rheumatic fever
non specific
- rapid strep
- throat culture
- anti strep titers
- C reactive protein or sed rate
Imaging/misc work up for Rheumatic fever
- EKG (prolonged PR)
- chest xray (cardiomegaly or CHF)
- echo
Acute management for rheumatic fever
- Pen VK
- aspirin
- cortocosteroids
- bed rest until fever gone until tests normalize
Secondary prophylaxis for rheumatic fever
to prevent recurrence
-PCN benzathine q 4 weeks
longer if carditis was present
When does post strep glomerulonephritis appear
1-3 weeks after strep infection (skin or throat)
Classic signs of APSGN
- edema
- hematuria
- hypertension
- porteinuria
- oliguria
Diagnosis of APSGN
- urine dip and microscopy
- Sterptozyme test (looks for strep)
- rapid strep/throat culture
- renal function (increased BUN/Cr)
Treatment of APSGN
- treat underlying condition if discovered
- mostly supportive therapy
- restrict salt/water intake
- diuretics
- HTN control
- limited activity
- dialysis if necessary
Laryngitis
inflammation of larynx and vocal fold mucosa, edematous vocal cords
Causes of acute laryngitis
- viral
- bacterial
- GERD
- environmental
- vocal trauma
How long does chronic laryngitis last
more than 3 weeks
S&S of laryngitis
- preceding URI sx
- dysphonia
- odynophagia
- odynophagia
Treatment of laryngitis
symptomatic
- voice rest
- inhaled humidifier
Three major salivary glands
- parotid
- submandibular
- sublingual
What causes sialadenitis
- viral
- bacterial
- inflammatory/autoimmune
- stone
- dehydration
- neoplastic
Two most common causes of viral sialadenitis
Mumps and HIV
Work up for sialadenitis
- physical exam
- mumps titer
- HIV RNA
- if unclear do ultrasound, CT of face/neck, sialadenoscopy
S&S of bacterial sialadenitis
- sudden onset of pain
- unilateral
- firm and tender
- expression of pus
Most common pathogen for bacterial sialadenitis
staph aureu
Treatment for bacterial sialadenitis
- abx (nafcillin, dicloxacillin, augmentin)
- massage of duct
- warm compress
- sialogogues
- surgical drain if abscessed
