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clin med I exam II > tonsilitis + pharyngitis > Flashcards

tonsilitis + pharyngitis Flashcards

1
Q

what is tonsillitis

A

inflammation of PALATINE tonsil gland

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2
Q

what tonsil is affected by tonsillitis

A

palatine

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3
Q

what is pharyngitis

A

inflammation of any structure of pharynx including adenoids + lingual tonsils

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4
Q

what is the main focus of dx + tx of tonsillitis

A

identify GABHS to prevent complications

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5
Q

peak season for tonsillitis

A

winter + spring

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6
Q

cause of viral tonsillitis

A 
rhinovirus
EBV
adenovirus
coronavirus
influenza a+b
acute retroviral syndrome
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7
Q

symptoms of viral tonsillitis

A

coryza, cough
malaise, fatigue
hoarseness

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8
Q

symptoms of viral tonsillitis caused by mono

A

viral sx + posterior LAD, kissing tonsils, hepatosplenomegally

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9
Q

diagnosis of viral tonsillitis

A

no dx tests
rapid flu

for mono- monospot, CBC w diff (atypical lymphs), elevated LFTs

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10
Q

treatment of viral tonsillitis

A

gargle w warm water
antipyretics
analgesia
rest

+/- single dose decadron
+/- IVF if dehydrated

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11
Q

treatment of viral tonsillitis caused by flu

A

tamiflu

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12
Q

treatment of viral tonsillitis caused by mono

A

no contact sports!

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13
Q

what sx are present in viral + bacterial tonsillitis

A 
dysphagia
odynophagia
sore throat
fever
lymphadenopathy
exudate
headache
N/V
abd pain
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14
Q

complications of tonsillitis

A

peritonsillar abscess
rheumatic fever
glomerulonephritis

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15
Q

cause of bacterial tonsillitis

A

group A beta hemolytic strep (GABHS - strep pyo or group A strep- GAS)
diphtheria
neisseria

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16
Q

symptoms of bacterial tonsillitis

A 
no coryza, cough or other URI sx
sudden onset of sore throat
anterior LAD
fever 
petecchiae of soft palate
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17
Q

if pt has tonsillitis w anterior LAD, what is the most likely cause

A

bacterial

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18
Q

if pt has tonsillitis w posterior LAD, what is the most likely cause

A

viral

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19
Q

diagnosis of bacterial tonsillitis

A

GC throat

diphtheria swab

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20
Q

sx of bacterial tonsillitis caused by GABHS

A

clinical- fever, anterior cervical LAD, tonsillar exudate, absence of cough

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21
Q

diagnosis of bacterial tonsillitis caused by GABHS

A

clinical
rapid antigen detection test (90-99% sensitive)
throat culture (most reliable)

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22
Q

score rating for likelihood of GABHS-caused tonsillitis

A

0-1 = low, no further testing

2-3 = confirm via RAPDT

4= treat

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23
Q

treatment of bacterial tonsillitis in adults

A

pen G benzathine

penVk

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24
Q

treatment of bacterial tonsillitis in kids

A

penVk

amox

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25
treatment of bacterial tonsillitis in PCN allergy
1st gen CPN (cephalexin, cefazolin, cefadroxil)
26
when is peritonsillar abscess more common
nov-dec | april-may
27
what age group is most affected by peritonsillar abscesses
20-40yrs
28
what is the most common deep space infection of head + neck
peritonsillar abscess
29
what is a peritonsillar abscess
collection of pus btw capsule of palatine tonsil + pharyngeal muscle
30
what is the most common location of a peritonsillar abscess
superior pole of tonsil
31
causes of peritonsillar abscess
GABHS S.aureus neisseria corynebacterium
32
most common cause of peritonsillar abscess
GABHS
33
how does peritonsillar abscess typically develop
preceded by tonsillitis + pharyngitis --> cellulitis --> phlegmon --> abscess
34
symptoms of peritonsillar abscess
``` severe unilateral sore throat fever ipsilateral ear pain fatigue irritability decreased PO intake trismus neck pain w movement ```
35
physical exam findings of peritonsillar abscess
``` muffled voice (hot potato) unilateral swollen + fluctuant tonsil w contralateral deviation of uvula drooling trismus neck swelling fever rancid or fetor breath erythema or exudate of tonsil ```
36
ddx for peritonsillar abscess
``` epiglottitis retropharyngeal abscess ludwig angina dental infection peritonsillar cellulitis infection mono ```
37
diagnosis of peritonsillar abscess
clinical CT of head/neck w IV contrast intra-oral ultrasound lateral soft tissue (only to exclude other pathologies)
38
treatment of peritonsillar abscess
``` secure airway drain w needle or I+D empiric abx (unasyn, clinda, augmenten) antipyretics analgesia +/- steroids ```
39
complications of peritonsillar abscess
airway obstruction internal jugular seeding of infection pseudo aneurysm of carotid artery septicemia
40
most common age group w rheumatic fever
5-15yrs
41
what is the leading cause of acquired heart dz in developing countries
rheumatic fever
42
jones criteria
diagnosis of rheumatic fever | 2 major or 1 major + 2 minor sx
43
minor criteria for jones criteria
rheumatic fever diagnosis arthralgia fever elevated ESR or CRP
44
major criteria for jones criteria
``` rheumatic fever diagnosis migratory arthritis carditis/valvulitis erythema marginatum syndenham chorea subcutaneous nodules ```
45
migratory arthritis
``` major criteria for jones diagnosis of rheumatic fever self-limiting, lasts overall 4wks in older teen/adult 75% occur w 1st attack asymmetric, large joints edema in joints ```
46
carditis/valvulitis
major criteria for jones diagnosis of rheumatic fever self-limiting or long-term kids > adults 30-60% in 1st attack pericardium, epicardium, myocardium valves mitral valve is most affected pericardial friction, rub, new murmur, CHF sx
47
erythema marginatum
major criteria for jones diagnosis of rheumatic fever self-limiting, weeks-months children, rare in adults 10% in first attack non-pruritic rash on trunk > proximal extremities
48
syndenham chorea
``` major criteria for jones diagnosis of rheumatic fever self-limiting (2-3yrs) children, rarely adults females > males 25% in 1st attack neurological + psychological abrupt, rhythmic purposeless movement emotion lability ```
49
subcutaneous nodules
major criteria for jones diagnosis of rheumatic fever rare, associated w carditis 1-2wks painless nodules over tendon sheaths of wrist, ankles, achilles
50
treatment of acute rheumatic fever
penVk salicylates (aspirin) +/- corticosteroids
51
secondary prophylaxis of rheumatic fever
PCN G benzathine IM every 4wks | duration uncertain- w.o carditis (5yrs), w carditis (10yrs)
52
lab work up for rheumatic fever
non specific rapid strep throat culture anti-strep titers (antistrepolysin O or anti-DNAse B) C reactive protein (CRP) or erythrocyte sedimentation rate (ESR)
53
imaging + other tests for rheumatic fever
EKG- prolonged PR interval CXR- cardiomegaly or CHF echocardiogram
54
sialadenitis + parotitis viral causes
non suppurative mumps- most common sialadenitis, paramyoxyvirus HIV- most common parotid
55
sialadentitis + parotitis bacterial causes
suppurative S.aureus- most common submandibular- stone parotid- elderly, malnourished or postoperative
56
other causes of sialadenitis + parotitis (not viral or bacterial)
inflammatory + autoimmune | neoplastic
57
sx of sialadenitis + parotitis caused by mumps
bilateral parotitis + edema | prodrome for 48hrs before
58
sx of sialadenitis + parotitis caused by HIV
parotitis, bilateral, tender, erythematous
59
sx of sialadenitis + parotitis caused by bacteria
sudden onset pain unilateral firm + tender pus expression
60
workup for sialadenitis + parotitis
``` mumps titer HIV RNA ultrasound CT of face/neck sialadenoscopy ```
61
treatment of sialadenitis + parotitis caused by mymps
supportive- bed rest, hydration, sialogogues
62
tx of sialadenitis + parotitis caused by HIV
antiviral + supportive (bed rest, hydration, sialogogues)
63
tx of sialadenitis + parotitis caused by bacteria
``` broad spectrum abx (augmentin massage ducts warm compress sialogogues surgical drainage if abscess present ```
64
complications of mumps-caused sialadenitis + parotitis
deafness orchitis meningitis fetal congenital abnormalities

clin med I exam II (10 decks)

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