Throat MDT Flashcards
Predisposing factors for:
Epiglottitis
Diabetes
Contact with group A-B-hemolytic Streptococci
Symptoms and physical exam:
Rapidly developing sore throat or odynophagia is out of proportion to minimal oropharyngeal findings
Laryngoscopy may demonstrate swollen, erythematous epiglottis
Epiglottitis
Labs/Studies:
Epiglottitis
Lateral plain radiography may demonstrate enlarged epiglottis (thumb sign)
Treatment for:
Epiglottitis
IV Antibiotics
- Ceftizoxime 2g x 8-12 hours
- Levofloxacin 750mg IV q 24 + Clindamycin 900mg IV q6-8 hours
IV Corticosteroid
-Dexamethasone
White lesion that cannot be removed by rubbing the mucosal surface
Hyperkeratosis usually in response to a physical or chemical irritant
Leukoplakia
Most common oral precancer
2-4% show dysplastic changes
Most common site is buccal mucosa
Leukoplakia
Leukoplakia lesions of the floor of the mouth, tongue, and vermilion border are most likely associated with:
Malignancy
Predisposing factors for:
Leukoplakia
Alcohol
Tabacco
Dentures that don’t fit
Symptoms and physical exam:
- White painless lesion that cannot be scraped or removed
- Small to several cm in diameter
- Usually superficial but may have submucosal depth upon palpation
- May have wrinkled “wet finger” appearance
- May have redness or dysplasia
Leukoplakia
Labs/studies:
Leukoplakia
Refer to biopsy to rule out dysplasia
Treatment for:
Leukoplakia
None
Remove irritants and educate patient
Measure and document for malignancy
Refer if redness or submucosal depth
Follow-up for:
Leukoplakia
Refer if malignancy pathology suspected
If not, re-evaluate annually
A collection of purulent material between the tonsillar capsule and the superior constrictor and palatopharyngeal muscles
Peritonsillar abscess
Predisposing factors for:
Peritonsillar abscess
Chronic tonsillitis
Multiple trials of oral antibiotics
Previous peritonsillar abscess
Symptoms and physical exam:
- Severe sore throat
- Odynophagia
- Muffled (hot potato) voice
- Trismus
- Inferior and medial displacement of infected tonsil
- Moist and translucent
- Palatal edema
- Tender cervical lymphadenopathy
- Drooling
- Dehydration
- Color ranging from nearly none to deep erythema
Peritonsillar abscess
Labs/studies:
Peritonsillar abscess
Ultrasound
Treatment for:
Peritonsillar Abscess
Ceftriaxone 2g IV QD & Metronidazole 500mg IV q6h
-PCN Allergy: Clindamycin 600mg IV q8h
MEDEVAC for I&D
If you had to I&D a peritonsillar abscess, how would you?
19-21 gauge needle
Medial to the molar
No deeper than 1 cm because the carotid artery is there
Accounts for 10% of office visits for primary care
50% of outpatient antibiotic use
Tonsillitis and pharyngitis
Main concern for pharyngitis/tonsillitis, as this could pose a threat for complications such as rheumatic fever and glomerular nephritis
Determining who has group A-B hemolytic streptococcal infection (GABHS)
More than what percentage of primary infections of HIV are associated with acute pharyngitis
70%
Fungal pharyngitis
Candida albicans
Symptoms and physical exam:
- Incubation period of 2-5 days a sudden onset of sore throat, painful swallowing, chills, fever, headache, nausea, and vomiting
- Erythema of the tonsils, tonsillar pillars and edematous uvula
CENTOR criteria:
1) Fever over 38 degrees C
2) Tender anterior cervical lymph nodes
3) Lack of cough
4) Pharyngotonsillar exudates
A-B-Hemolytic streptococcal (GABHS) infection Pharyngitis/Tonsillitis
Symptoms and physical exam:
Marked lymphadenopathy with shaggy white-purple exudates that often extends into the nasopharynx
Mononucleosis
Symptoms and physical exam:
Vesicular and petechial pattern on the soft palate and tonsils with rhinorrhea, no tonsillar exudates or cervical lymphadenopathy
Viral pharyngitis/tonsillitis
Symptoms and physical exam:
White, cheesy exudates that can be scraped off an erythematous base
Fungal pharyngitis/tonsillitis
Labs/studies:
Pharygitis/tonsillitis
Rapid strep
Mono spot
Throat culture
HIV
Treatment for:
GABHS pharyngitis/tonsillitis
Penicillin or macrolides
Acetaminophen and NSAIDS
Warm saltwater gargles
Lozenges
Treatment for:
Viral pharyngitis/tonsillitis
Acetaminophen and NSAIDS
Warm saltwater gargles
Lozenges
Pharyngitis/Tonsillitis:
Refer for tonsillectomy if:
Three or more episodes in each of three years (3:3)
Five or more episodes in each of two years (5:2)
Seven or more episodes in one year (7:1)
Complications of:
Pharyngitis/tonsillitis
Scarlet fever
Glomerulonephritis
Rheumatic myocarditis
Local abscess
Rheumatic valve disease
Acute bacterial, commonly affects either the parotid or submandibular glands
Ductal obstruction, often by an inspissated mucous plug or a stone, is followed by salivary stasis and secondary infection
Sialadenitis
More common organism recovered from purulent draining saliva from sialadenitis
Staph aureus
Predisposing factors of:
Sialadenitis
Dehydration
Chronic illness
Sjogren syndrome
Chronic periodontitis
Symptoms and physical exam:
- Acute swelling of the salivary gland
- Increased pain and swelling with meals
- Tenderness and erythema of duct opening
- Pus can often be massaged from the duct
Sialadenitis
Labs/studies:
Sialadenitis
Ultrasound
CT scan
Treatment for:
Sialadenitis
IV antibiotics
-Nafcillin, Oxacillin
PO antibiotics (if stable) -Clindamycin PLUS ciprofloxacin
Increase salivary flow (warm compresses, massage, Fluids)
MEDEVAC
Soft aggregates of bacterial and cellular debris that form in the tonsillar crypts, the crevices of tonsils
Occur mostly in palatine tonsils
Usually not harmful
Can cause bad breath
Tonsilloliths (Tonsil stones)
Predisposing factors:
Tonsilloliths
Chronic or repeated tonsillitis
Post-nasal drip
Larger tonsilloliths may cause multiple symptoms, including:
- Halitosis
- Sore throat
- White debris
- Bad taste (metallic) in back of throat
- Dysphasia
- Ear ache
- Tonsillitis
Labs/studies:
Tonsilloliths
X-ray
CT scan
Treatment for:
Tonsilloliths
None if asymptomatic
Irrigation
Curettage of larger stones
What may be indicated if bad breath continues due to tonsillar stones, persists despite other measures?
Tonsillectomy
Initial care/Follow-up:
Tonsilloliths
Instruct patient to gargle saltwater as a prophylaxis
