Throat symptom/complaint Flashcards

Question

Pathogenesis of Rhinitis

Answer 1

Acute serous inflammation called Catarrhal = excess mucous | - infection -> mediator ->vasodilation -> excess mucous.

Answer 2

Severe facial pain | severe headache

Answer 3

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

Answer 4

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

Answer 5

Good health and nutrition | Pseudoephedrine

Answer 6

``` 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 ```

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

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. ```

Answer 11

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

Answer 12

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

Answer 13

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

Answer 14

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.

Answer 15

``` 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 ```

Answer 16

Respiratory syncytial | Parainfluenza virus

Answer 17

Inhaled foreign body Epiglottis Bacterial tracheitis

Answer 18

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

Answer 19

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

Answer 20

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

Answer 21

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

Answer 22

``` 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. ```

Answer 23

Age group - uncommon in

Answer 24

``` 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 ```

Answer 25

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

Answer 26

``` 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 ```

Answer 27

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

Answer 28

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

Answer 29

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)

Answer 30

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

Answer 31

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

Answer 32

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.

Answer 33

``` Depression Diabetes - Candida Drugs Anaemia -possible Thyroid disorder - thyroiditis Spinal dysfunction - cervical ```

Answer 34

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

Answer 35

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

Answer 36

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

Answer 37

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