Throat MDT Flashcards
What is epiglottitis?
Inflammation of epiglottis of viral or bacterial origin
Who is predisposed to epiglottis?
- DM patients
- contact with group A-beta hemolytic streptococci
Physical findings of epiglottitis
- rapidly developing sore throat or odynophagia out of proportion with findings
- laryngoscopy may find swollen erythematous epiglottis
What would radiologic studies show in epiglottitis?
“Thumb sign”
Treatment of epiglottitis
Antibiotics
- Ceftriaxone (rocephin)
Steroid
- Dexamethasone
What is leukoplakia?
White lesions unable to be removed by rubbing of mucosal surface
What is hyper keratosis?
Response to a physical or chemical irritant
What percentage of leukoplakia show dysplastic changes?
2%-4%
What predisposing factors can lead to leukoplakia?
- alcohol and tobacco use
- ill fitting dentures or ill contoured dental restoration
Where is leukoplakia most common?
Buccal mucosa (cheeks)
What locations of leukoplakia are associated with malignancy?
Floor of mouth, tongue and vermillion border
Signs and sx of leukoplakia
- white or painless lesions that cannot be removed
- wet finger appearance
What labs should be done for leukoplakia?
Refer for biopsy to r/o dysplasia
What treatment is required for leukoplakia?
No treatment required
What is peritonsillar abscess?
Infection penetrates tonsillar capsule and involves the surrounding tissues
What predisposes a patient to peritonsillar abscess?
- chronic tonsillitis
- multiple trials of oral antibiotics
- hx of PTA
Sx and findings of PTA
- hot potato voice
- cervical lymphadenopathy
- Uvula deflection
Treatment of PTA
Ceftriaxone + Metronidazole
If PCN allergy:
Clindamycin
What procedure must be done to treat PTA?
Needle aspiration with 19-21g needle
How deep should needle aspiration be for PTA I&D?
No deeper than 1cm due to internal carotid artery
Who should PTA be referred to?
ER, ENT or Gen surg for I&D
What is pharyngitis?
Inflammation and infection of the pharynx
What is tonsillitis?
Inflammation and infection of the tonsils
What percentage of office visits are due to pharyngitis/tonsillitis?
10%
What percentage of outpatient antibiotics are due to pharyngitis/tonsillitis?
50%
What infection is most concerning for management of pharyngitis/tonsillitis?
Group A-B hemolytic streptococcal infection (GABHS)
What complication can GABHS lead to?
Rheumatic fever
What kind of pharyngitis is common after antibiotic treatment or if patient is immunocompromised?
Fungal Pharyngitis (candida albicans)
How long is the incubation period of GABHS?
2-5 days
What is the CENTOR criteria?
- Fever over 38C (100.4F)
- Lymphadenopathy
- Lack of a cough
- Pharyngotonsillar exudates
What is indicative of shaggy white-purple exudates that often extends into the nasopharynx?
Mononucleosis
What is indicative of vesicular and petechial pattern on the soft palate?
Viral Pharyngitis/Laryngitis
What is indicative of white, cheesy exudates?
Fungal Pharyngitis/Laryngitis
What labs should be done when examining a patient with pharyngitis/laryngitis?
- Rapid Strep
- Monospot
- Throat Culture
- HIV
What medications should be given to patients with GABHS?
Benzathine PCN 1.2million units IM
PCN VK 500mg PO BID/TID for 10 days
Dicloxacillin 250-500mg PO QID
Augmentin 500mg PO TID
Azithromycin 500mg daily for 3 days
What can a patient do that can also assist with viral laryngitis/pharyngitis?
Warm, salt water gargles
What is paradise criteria?
Referral for tonsillectomy
- 3 or more episodes in each of 3 years
- 5 or more episodes in each of 2 years
- 7 or more episodes in one year
What is sialadentitis?
Dutcal obstruction often by mucus plug or stone followed by salvary stasis and secondary infection
What glands does acute bacterial sialdentitis commonly affect?
Parotid or submandibular glands
What is the most common organism from purulent discharge of sialadentitis?
S aureus
What predisposes a patient to siladentitis?
- dehydration
- chronic illness
- chronic periodontitis
Sx and physical findings of sialadentitis
- acute swelling of gland
- pus can often be massaged from the duct
- increased pain and swelling with meals
Radiologic studies for sialadentitis
- Ultrasound
- CT
Medications for sialadentitis
Antibiotics
- Nafcillin
- Oxacillin
PO Antibiotics if patient stable
- Clindamycin
- Cipro
Conservative treatment of sialadentitis
- hydration
- warm compress
- sialogogues
- massage gland
What is tonsilloliths?
Tonsil stones, soft aggregates of bacterial and cellular debris that form in tonsillar crypts, crevices
Signs and sx of tonsilloliths
- may be asymptomatic
- Putrid breath
- Metallic taste
Treatment of tonsiloliths
- no treatment if asymptomatic
- irrigation
- tonsillectomy maybe indicated
