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general practices > Throat symptom/complaint > Flashcards

Throat symptom/complaint Flashcards

1
Q

Predisposing factos for Candida pharyngitis

A 
HIV infection
Diabetes mellitus
Broad spectrum antibiotics
Corticosteroids, including inhalers
Dentures
Debility
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2
Q

Symptoms and signs of Candida phyaryngitis

A

Presentation - Milky white growths on palate, buccal, gingival mucosa, pharynx and dorm of the tongue.
If scraped away a bleeding ulcerated surface remains
Metallic taste
Sore throat and tongue
dysphagia

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3
Q

Mx of Candida pharyngitis

A

Determine underlying cause
Nystatin suspension rinse and swallow QID
or amphotericin 10mg lozenge dissolved slowly in oral cavity, 6hrly for 7-14days.

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4
Q

Presentation of Hand, foot and mouth

A 
fever sore throat
dysphagia
oral
tiny papulovesicles
erythematous halo
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5
Q

Cause of Hand, foot and mouth

A

Coxsackie virus A

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6
Q

Transmission and incubation of hand, foot and mouth

A

Face - oral and incubation for 2-6 days

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7
Q

Cause of Glandular fever

A

Epstein Barr Virus (Infectious monocytosis)

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8
Q

Transmission of Epstein Barr Virus

A

Youth, close contact, saliva, kiss

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9
Q

Incubation time for EBV

A

1-2 months

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10
Q

Pathogenesis of EBV

A

EBV infect epithelium cells of the URT and infect B lymphocytes where they start multipling in the B lymphocytes. From there they spread and infect other organs by infected B lymphocytes.
EBV specific CD8+ T cells - defines (atypical lymph)

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11
Q

Symptoms of EBV

A 
15-25 yrs with a painful throat that take 7d to reach the peak.
Prodromal fever, malaise, lethargy
Anorexia, myalgia
Nasal quality voice
Skin Rash
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12
Q

Signs of EBV infection

A 
URTI+
Petechiae on palate
Enlarged tonsils with or without
Periorbital oedema
Lymphadenopathy
Splenomegaly - enlarged spleen = easy rupture - youth death
Hepatitis
The rash - Primary rash 5%, Secondary rash when treatment with ampicillin, amoxycillin and some with penicillin
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13
Q

Cx of EBV infection

A

Hepatitis
Spleen rupture - they can die from minor trauma
Organ failure - fatal

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14
Q

Dx of EBV infection

A

FBC - Absolute lymphocytosis
Blood firm - atypical lymphocytes
heterophil antibodies or Monospot test or EBV IgM test

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15
Q

Tx of EBV infection

A

Prognosis - self limited 4-6 wks
Symptomatic support - paracetamol
Parenteral corticosteroids only in most severe cases
Hydration - admit if unable to tolerate fluids

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16
Q

Symptoms of Diptheria

A 
Insidious onset
Fever
SOB
Sore throat
Dysphagia
Cough
Nausea and vomiting
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17
Q

Signs of Diptheria

A 
Pharynx inflamed and swollen with enlarged tonsils
Pseudomembrane
Hoarse voice
Lymphadenopathy
Cutaneous diphtheria (non healing ulcer)
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18
Q

Cx of Diptheria

A

Aspiration of pseudomembrane and airway obstruction
spread of exotoxin to cause myocarditis and HF
Peripheral neuritis

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19
Q

Tx of Diptheria

A

Throat swabs
Antitoxin
Penicillin or erythromycin 500mg QID for 10 days
Isolate patient

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20
Q

Cause of diptheria

A

Corynebacterium diphtheria which is gram +ve, pleomorphic bacilli, with exotoxin AB

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21
Q

Prevention of diptheria

A

DPT at 2m, 4m, 6m, 4yr, 10yr, 15yr and booster every 10yrs

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22
Q

Pathogenesis of diptheria

A

Infection results in mucosal necrosis with fibrinopurulent exudate (pseudomembrane).

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23
Q

Most common causes of Rhinitis

A 
Rhinovirus 
most common cause
>100 serotypes
Other causes
Influenza
Parainfluenza
Corona (SARS)
Adenovrius 
RSV
May be bacteria after 7-10 days
Allergy - frequent or persistent symptoms
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24
Q

Rhinovirus
Transmission
Incubation period
and epidemiology

A 
Seasonal
Highly contagious
Transmission Droplet spread by sneezing, coughing, hand contact with the nose, eyes or face.
Incubation period 2-4 days
Prevention hand hygiene
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25
Q

Pathogenesis of Rhinitis

A

Acute serous inflammation called Catarrhal = excess mucous

- infection -> mediator ->vasodilation -> excess mucous.

26
Q

Red flags of rhinitis

A

Severe facial pain

severe headache

27
Q

Symptoms of Rhinitis

A

Sneezing
coughing
Malaise lasting 3-6 days
unilateral symptoms may be foreign body in children or malignancy in adult

28
Q

Cx of Rhinitis

A

Secondary bacterial infection is common = suppurative
Sinusitis
Pharyngitis
Tonsilitis
otitis media
Septicemia
Nasal polyps - inflammatory (allergy) - long term complication in hypersensitive people

29
Q

Tx of Rhinitis

A

Good health and nutrition

Pseudoephedrine

30
Q

Presentation of Peritonsillar abscess/Quinsy

A 
Presentation of tonsillitis that is followed by increasing difficulty in swallowing the trismus (spasm of jaw = lock jaw)
Usually ill with high fever +/-
Dysphagia
Odynophagia
Most common in teenager and young adults
31
Q

Signs of peritonsillar abscess/Quinsy

A

Pooling of secretion in treat
Difficulty moving/uwilling to move their neck
Hyperextension of neck
- usually unilateral

32
Q

Most likely organism that causes peritonsillar abscess/Quinsy

A

polymicrobial including staph aureus and street pyogenes
usually GABHS or anaerobes
Occasionally Haeophilus sp and Stagpylococcus aurues

33
Q

Tx of Peritonsillar abscess/Quinsy

A

Admit to hospital
Antibiotics - procaine penicillin IM or clindamycin
IV Benzylpenicillin 6hrly
ENT Surgery - Aspiration or drainage

34
Q

Symptoms of Croup

A

presentation – coryza present or absent, seal-like harsh barking cough, inspiratory stridor and variable degree of distress, chest wall retraction in 6month to 3yr and increases in winter

Starts with coryza symptoms then
Barking cough
Inspiratory Stridor - loudness does not correlate with severity of obstruction
\+/- Wheeze
\+/- Hoarse voice 
\+/- Fever but no signs of toxicity
Increased Work of breathing
Worse at night, peaks night 2 or 3. Then settles down.
35
Q

Signs of Croup

A

Minimal, don’t examine the throat or upset the child

36
Q

Characteristics of Mild Croup

A 
Behaviour- normal
Stridor - Barking cough, Stridor only when active or upset
RR - normal
Accessory muscle use - none or minimal
Oxygen - None
37
Q

Characteristics of moderate Croup

A

Behaviour - some/intermittent irritability
Stridor - some at rest
RR - increased, Tracheal tug, nasal flaring
Accessory muscle- moderate chest wall retraction
O2- none

38
Q

Characteristics of severe croup

A

Behaviour - increase irritability and/or lethargy
Stridor- at rest
RR- Marked increase or decrease, tracheal tug, nasal flaring
Accessory muscle - marked chest wall retraction
O2 - Hypoxia is a late sign of significant upper airways obstruction.

39
Q

Pt who are at risk of severe Croup

A 
Preexisting narrowing of upper airways
Down’s syndrome
Sub-glottic stenosis or chronic stridor from other cause
other neurological disorders
Previous admission with severe croup
40
Q

Causes of Croup

A

Respiratory syncytial

Parainfluenza virus

41
Q

DDX for Croup

A

Inhaled foreign body
Epiglottis
Bacterial tracheitis

42
Q

Mx for severe croup

A

Minimal handling
nebuliser adrenalin - 1mL of 1% adrenaline solution plus 3ml Normal saline or 4 ml of adrenaline 1:1000
And
Give 0.6 mg/kg (max 12mg) IM/IV dexamethasone
Improvement - observe for 4 hours post adrenaline then consider discharge once stridor free at rest
Improvement than deterioration - give further doses of adrenaline, Then consider admission/transfer as appropriate
No Improvement - reconsider diagnosis. Acute upper airway obstruction

43
Q

Mx of mild to moderate Croup

A

Prednisolone 1mg/kg and prescribe a second dose for the next evening
Or
A single dose of oral dexamethasone 0.15mg/kg
Observe for half an hour post steroid administration
Discharge once stridor-free at rest

44
Q

When to consult paediatric team or transfer

A

Consider consultation with local paediatric team when
severe airways obstruction
no improvement with nebuliser adrenaline
Child has risk factors
Consider transfer when
No improvement following nebuliser adrenaline.
> 2 doses of nebuliser adrenaline are required
Children requiring care above the level of comfort of the local hospital

45
Q

Discharge requirements for croup

A

Four hours post nebulised adrenaline (if given) and/or half an hour post oral steroid, and stridor free at rest
- Parents should be advised and able to seek help if stridor at rest regardless of whether they have received steroids

46
Q

DDX for Pharyngitis

A 
Bacteria: Group A Strep pyogenes 15-30% of children with sore throat (3yr to 15yr)
Virus: 33% 
Rhino, Adeno, EBV etc - common cause of sore throat in children.
Fusobacterium necrophorum 15%
Unknown 22%
Uncommon
Spirochets (Vincent ́s angina)
STI: Gonorrhoea, Chlamydia, Syphilis, HIV
Corynebacterium influenza or diphtheria
Arcanobacterium haemolytic
Streptococci of group C or G
Haemophilus influenza
TB
Cancer in tonsil.
47
Q

Who get Pharyngitis

A

Age group - uncommon in

48
Q

Features of a Streptococcal features

A 
Constitutional symptoms
fever >38
Toxicity
absence of cough
Tonsillar exudate and swelling >6yr
Swollen tender anterior cervical LN.
Other symptoms
difficulty in swallowing
Significant pain including pain on talking
foul smelling breath
49
Q

signs of Pharyngitis

A

Pharynx very inflamed and oedematous
Tonsils swollen with pockets of yellow exudate on surfaces
Very tender enlarge tonsillar LN

50
Q

Modified Centor criteria

A 
Tonsillar exudate or erythema
Anterior cervical adenopathy
Cough absent
Fever present
Age 3-14 +1, 15-45 =0, >45 -1
Score 4-5 Tx ABx
Score 2-3 Perform rapid antigen test. + = Abx, - = throat culture
Score 0-1 symptomatic tx
51
Q

Indications for antibiotics in pharyngitis

A

Servere tonsillitis with above features of GABHS
existing RHD at any age
Scarlet fever
Peritonsillar cellulitis or abscess
pt 2-25 with presumptive FABHS for special communities e.g. remote that have a high incidence of ARF
?Vomiting or diarrhoea

52
Q

Mx for Streptococcal pharyngitis

A

Antibiotic if indicated
Phenoxymethyl Penicillin BD for 10 days or Cephalexin or Roxithromycin if allergic
Analgesics
Corticosteroid if severe pain and unresponsive to analgesia

53
Q

when to admit or transfers to tertiary centre for pt with Pharyngitis

A

Suspected upper airway obstruction
Systemically unwell patients
Evidence of acute complications e.g. abscess formation, upper airway obstruction
Significant comorbidity e.g. immunosuppression (after discussion with relevant treating team)

54
Q

Common causes of Sore throat

A 
Pharyngitis
50% virus
Coryza prodromata, hoarseness, cough, conjuctivitis, nasal stuffiness
Streptococcal GABHS Tonsillitis
Chronic sinusitis with postnasal drip
Oropharyngeal candidiasis
Epstein-Barr mononucleosis
55
Q

Sore throat, Serious disorders not to be missued

A

CV- ANGINA, MI
Severe infections
Epiglottitis - Haemophilus influenza in children 2-4 years, Acute onset
short febrile illness, respiratory difficulty but no cough and unable to swallow.
Streptococcal pharyngitis with Cx
Quinsy - peritonsillar abscess
Diphtheria
HIV
Neoplasia - Cancer of oropharynx or tongue. Pharyngeal cancer = painful swallowing +referred ear pain + hoarseness
Blood Dyscrasias - agranulocytosis, Acute leukaemia,
Foreign body- sudden onset of throat pain, then drooling and dysphagia

56
Q

Sore throat - Diagnostic pitfalls

A

classic being to Dx exudative tonsillitis of EBM as streptococcal tonsillitis and prescribe penicillins which may precipitate a severe rash
Primary HIV infection may present with sore throat throat.

57
Q

Sore throat - seven masquerades

A 
Depression
Diabetes - Candida
Drugs
Anaemia -possible
Thyroid disorder - thyroiditis
Spinal dysfunction - cervical
58
Q

Red flags of a sore throat

A

Persistent high fever
Failed antibiotic tx
Medication - induced agranulocytosis
Mouth drooling - consider epiglottis - don’t examine throat
Sharp pain on swallowing - foreign body
Marked swelling of quinsy
Candidiasis - consider diabetes or immunosuppression

59
Q

What to ask on a hx for someone with a sore throat

A

differentiate between sore throat, deep pain or neck pain
Ass symptoms
Metallic taste in mouth, fever, URTI,
Other pain e.g. ear pain, nasal stuffiness or discharge and cough
PmHx - Asthma,
Med - Corticosteroid inhaler
Immunisation - especially about diphtheria
Social Hx - Smoker, environmental irritants
Screen for Angina

60
Q

What to look for on examination of a pt with a sore throat

A

GI - toxicity , anaemic pallor of leukaemia, Nasal stuffiness of infectious mononucleosis. Characteristic halitosis of streptococcal throat.
Inspect - ears and check sinus areas, oral cavity and pharynx for ulcers, abnormal masses and exudates. Note if uvula and soft palate, tonsils, faces or pharynx are swollen, red or covered in exudate.
Palpate - neck for soreness and lymphadenopathy

61
Q

Tx for a sore throat

A

Depends on cause
Supportive symptomatic ts
adequate nothing fluids e.g. icy poles
Analgesia - Aspirin for adults and paracetamol for children
Rest with adequate fluid intake
Soothing gargles
Advise against overuse of throat lozenges and topical sprays ->sensitise the throat. Limit use of decongestants to 3days

general practices (53 decks)

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