Throat Infections Flashcards by James Nicolson

What is diptheria?

Highly contagious and potentially fatal throat infection by corynebacterium diptheriae

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Why is diptheria so life threatening?

Corynebacterium diptheriae produces cardiotoxic and neurotoxic endotoxins

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How does diptheria present?

Severe sore throar

Grey-white pseudomembrane across pharynx

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What is infectious mononucleosis?

Viral throat infection caused by Epstein-Barr virus

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How does infectious mononucleosis usually present?

Commonly in young adults (kissing)

Fever

Sore throat

Lymphadenopthy

Palatal petechial haemorrhages

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How does infectious mononucleosis present in children under 10?

Often asymptomatic

Patients still develop Epstein-Barr virus IgM

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What blood test can diagnose infectious mononucleosis?

Monospot test
Paul-Bunnel test

Test for heterophile antibodies

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What does a positive Epstein-Barr virus IgM test show?

Previous exposure to the virus

It is not diagnostic of infectious mononucleosis as immunity may have developed in asymptomatic infection in childhood

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What would infectious mononucleosis show on blood film?

Atypical lymphocytes “activated cytotoxic T lymphocytes”

(larger, irregular cytoplasm/nucleus, stippled cytoplasm)

Seen in any viral infection but large percentage is pathogneumonic of infectious mononucleosis

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What are CRP levels like in infectious mononucleosis?

Low CRP (<100)

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Name 5 blood tests which can be useful in diagnosing infectious mononucleosis and what they show.

Monospot/Paul-Bunnel tests - heterophile antibodies

Epstein-Barr IgM - positive if previous infection

Blood film - atypical lymphocytes

CRP - low (<100)

Liver function tests - raised ALT

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How is infectious mononucleosis treated?

Supportively

Self limiting but prolonged

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What 2 medications should not be prescribed to someone with infectious mononucleosis and why?

Amoxicillin - causes generalised macular rash

Antivirals - no clinical benefit

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Patient with infectious mononucleosis presents with sudden onset severe stomach pain. What has occurred?

Splenic rupture (surgical emergency)

50% of patients have splenomegaly but rupture is very rare

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What condition are people with infectious mononucleosis at increased risk of?

Lymphoma

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What conditions must be ruled out in a pregnant women presenting with infectious mononucleosis symptoms and why?

Cytomegalovirus
Toxoplasmosis

Can cause foetal damage

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Patient presents with infectious mononucleosis symptoms. Blood tests are performed and the Epstein-Barr virus IgM has come back negative.
What blood test do you do now?

HIV antibody blood test

What is oral candidiasis?

Oral yeast infectious with Candida species, most commonly candida albicans

How does oral candidiasis present?

White patches covering raw mucous memebranes in throat/mouth

What are risk factors for developing oral candidiasis?

Immunosuppression

Inappropriate steroid inhaler use

False teeth

Recent antibiotics

How is oral candidiasis treated?

Nystatin

What is tonsillitis?

Inflammation of the tonsils usually usually caused by viral infection

What causes tonsillitis?

Usually a viral infection

Streptococcus pyogenes is rarer that viral infection but causes a more severe infection with more complications

How does tonsillitis present?

Fever

Sore throat

Inflamed tonsils

How do you clinically assess whether tonsillitis is caused by a viral infection or by streptococcus pyogenes?

Centor criteria - tonsillar exudate - tender cervical lymphadenopathy - history of fever - absence of cough The more of the above criteria the patient has, the more likely it is that the tonsillitis is caused by streptococcus pyogenes

How is tonsillitis generally managed?

Supportively (fluids, analgesia and rest) Antibiotics if more 2/3 or more of Centor criteria

How do you know whether to prescribe antibiotics in tonsillitis?

Centor criteria - tonsillar exudate - tender cervical lymphadenopathy - history of fever - absence of cough If they have 2/3 or more of above criteria, prescribe antibiotics

What antibiotics are used to treat tonsillitis?

Penicillin or Clarithromycin

What should not be prescribed to a patient with tonsillitis and why?

Amoxilcillin (can cause rash if it is actually infectious mononucleosis)

What are the criteria for tonsillectomy?

>7 episodes in last year >5 episodes in last 2 years >3 episodes in last 3 years

Name 3 complications of tonsillitis.

Otitis media Peri-tonsillar abscess (quinsy) Infectious mononucelosis

How is quinsy treated?

Aspiration and antibiotics (penicillin or clindamycin)

18 year old presents with tonsillitis. He is managed appropriately but doesn't respond to treatment and is still ill after 2 weeks. What blood test do you do?

Monospot/Paul-Bunnel test | for infectious mononucleosis

Name 2 complications of streptococcal sore throat and how they present.

Rheumatic fever - fever, arthritis and pancarditis Glomerulonephritis - haematuria, albuminuria, gradual onset oedema

What is epiglottitis?

Inflammation and swelling of the epiglottis causing airway obstruction (medical emergency)

What causes epiglottitis?

Heamophilus influenzae type B

How does epiglottitis present?

Acute onset fever, sore throat, drooling and stridor in children

How investigations are done in the assessment of epiglottitis?

Blood cultures | not throat swab as it can cause muscle spasm which further obstructs airway

How is epiglottitis treated?

Intubation and ceftriaxone

What is mumps?

Viral infection caused by mumps paramyxovirus

How does mumps present?

Fever/myalgia/fatigue followed by parotitis | associated with orchitis

What can untreated mumps cause?

Meningitis