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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
Q

treatment of bacterial tonsillitis in PCN allergy

A

1st gen CPN (cephalexin, cefazolin, cefadroxil)

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26
Q

when is peritonsillar abscess more common

A

nov-dec

april-may

27
Q

what age group is most affected by peritonsillar abscesses

A

20-40yrs

28
Q

what is the most common deep space infection of head + neck

A

peritonsillar abscess

29
Q

what is a peritonsillar abscess

A

collection of pus btw capsule of palatine tonsil + pharyngeal muscle

30
Q

what is the most common location of a peritonsillar abscess

A

superior pole of tonsil

31
Q

causes of peritonsillar abscess

A

GABHS
S.aureus
neisseria
corynebacterium

32
Q

most common cause of peritonsillar abscess

A

GABHS

33
Q

how does peritonsillar abscess typically develop

A

preceded by tonsillitis + pharyngitis –> cellulitis –> phlegmon –> abscess

34
Q

symptoms of peritonsillar abscess

A 
severe unilateral sore throat
fever
ipsilateral ear pain
fatigue
irritability 
decreased PO intake
trismus
neck pain w movement
35
Q

physical exam findings of peritonsillar abscess

A 
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
Q

ddx for peritonsillar abscess

A 
epiglottitis
retropharyngeal abscess
ludwig angina
dental infection
peritonsillar cellulitis
infection mono
37
Q

diagnosis of peritonsillar abscess

A

clinical
CT of head/neck w IV contrast
intra-oral ultrasound
lateral soft tissue (only to exclude other pathologies)

38
Q

treatment of peritonsillar abscess

A 
secure airway
drain w needle or I+D
empiric abx (unasyn, clinda, augmenten)
antipyretics
analgesia
 \+/- steroids
39
Q

complications of peritonsillar abscess

A

airway obstruction
internal jugular seeding of infection
pseudo aneurysm of carotid artery
septicemia

40
Q

most common age group w rheumatic fever

A

5-15yrs

41
Q

what is the leading cause of acquired heart dz in developing countries

A

rheumatic fever

42
Q

jones criteria

A

diagnosis of rheumatic fever

2 major or 1 major + 2 minor sx

43
Q

minor criteria for jones criteria

A

rheumatic fever diagnosis
arthralgia
fever
elevated ESR or CRP

44
Q

major criteria for jones criteria

A 
rheumatic fever diagnosis
migratory arthritis
carditis/valvulitis
erythema marginatum
syndenham chorea
subcutaneous nodules
45
Q

migratory arthritis

A 
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
Q

carditis/valvulitis

A

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
Q

erythema marginatum

A

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
Q

syndenham chorea

A 
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
Q

subcutaneous nodules

A

major criteria for jones diagnosis of rheumatic fever
rare, associated w carditis
1-2wks
painless nodules over tendon sheaths of wrist, ankles, achilles

50
Q

treatment of acute rheumatic fever

A

penVk
salicylates (aspirin)
+/- corticosteroids

51
Q

secondary prophylaxis of rheumatic fever

A

PCN G benzathine IM every 4wks

duration uncertain- w.o carditis (5yrs), w carditis (10yrs)

52
Q

lab work up for rheumatic fever

A

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
Q

imaging + other tests for rheumatic fever

A

EKG- prolonged PR interval
CXR- cardiomegaly or CHF
echocardiogram

54
Q

sialadenitis + parotitis viral causes

A

non suppurative
mumps- most common sialadenitis, paramyoxyvirus
HIV- most common parotid

55
Q

sialadentitis + parotitis bacterial causes

A

suppurative
S.aureus- most common
submandibular- stone
parotid- elderly, malnourished or postoperative

56
Q

other causes of sialadenitis + parotitis (not viral or bacterial)

A

inflammatory + autoimmune

neoplastic

57
Q

sx of sialadenitis + parotitis caused by mumps

A

bilateral parotitis + edema

prodrome for 48hrs before

58
Q

sx of sialadenitis + parotitis caused by HIV

A

parotitis, bilateral, tender, erythematous

59
Q

sx of sialadenitis + parotitis caused by bacteria

A

sudden onset pain
unilateral
firm + tender
pus expression

60
Q

workup for sialadenitis + parotitis

A 
mumps titer
HIV RNA
ultrasound
CT of face/neck
sialadenoscopy
61
Q

treatment of sialadenitis + parotitis caused by mymps

A

supportive- bed rest, hydration, sialogogues

62
Q

tx of sialadenitis + parotitis caused by HIV

A

antiviral + supportive (bed rest, hydration, sialogogues)

63
Q

tx of sialadenitis + parotitis caused by bacteria

A 
broad spectrum abx (augmentin
massage ducts
warm compress
sialogogues
surgical drainage if abscess present
64
Q

complications of mumps-caused sialadenitis + parotitis

A

deafness
orchitis
meningitis
fetal congenital abnormalities

clin med I exam II (10 decks)

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