Tonsillitis + Throat Pain Flashcards
Where can an infection in the throat occur and what can cause
Pharyngitis - infection pharynx
Tonsillitis - infection of palatine tonsil
Laryngitits - infection larynx
Can still get throat infections once tonsils removed
Epiglottis
Supraglottitis (infection above vocal cord)
Viral = most common (70%)
- Rhinovirus
- Parainfluenza
- Influenza A and B
- Adenovirus
- HSV
- EBV = 1%
Bacteria
- Group A strep = most common
- Strep pneumonia = next most likely
- H. influenza
- S.aureus if dehydration / previous Ax
What is not routine in sore throat
Throat swab / rapid antigen FBC / U+E / CRP / EBV serology LFT as EBV impact liver Blood cultures Ax Can be done if require / systemic upset
How do you Rx
Pain relief - paracetamol and Ibuprofen
Fluid if needed
When do you give Ax and when do you admit
Marked systemic upset
Hx rheumatic fever
Increased risk of infection - immunocompromised / co-morbid
Centor 3 / 4
Admit if
Grade 3 or 4 - tonsils touching
What are red flags with sore throat
If unexplained and prolonged >6 weeks
What are symptoms of bacterial tonsillitis
Pharyngitis - Sore throat - Dysphagia - Odnyophagia Ear ache Fever / malaise Pus on tonsils Bilateral cervical lymphadenopathy Absence of cough Viral tends to have midler Sx
What score is used to determine whether bacterial or not
Fever pain
- Fever
- Exudate
- Rapid presentation <3 day
- Severely inflamed
- No cough
- LN
Centor
- Fever
- Pus / exudate
- Tender LN
- Absence of cough
What is the most common cause of bacterial throat
Beta haemolytic strep
‘Strep throat’
When is tonsillectomy offered and
Due to tonsillitis >6 attacks in 1 year >5 in 2 years >3 in 3 years Disrupt QOL - snoring, difficulty swallowing >1 quinsy Repeated febrile convulsions If need to biopsy OSA
When do you admit for tonsillectomy
Severe OSA
<3 years
Down’s
Lives far from hospital
What are post op complications of tonsillectomy
Pain Infection Risk of GA Haemorrhage Anaemia
How do you deal with haemorrhage
Primary = immediate return to theatre Secondary 5-10 days = Ax and surgery if severe Call ENT registrar May need anaesthetist if airway compromise IV access FBC, clotting, G+S, X-match Analgesia NBM IV fluids
What is common cause of viral tonsillitis
EBV
How do you treat
Symptomatic
What are complications of bacterial tonsillitis
Quinsy Otitis media Scarlet fever Deep neck space abscess Rheumatic fever = rare GN = rare
What is quinsy
Peri-tonsillar abscess
What are the symptoms
Severe throat pain Lateralises to one side Deviation of uvula to unaffected side Trismus = difficulty opening jaw Reduced neck mobility Dysphagia Swollen tender LN Referred ear pain
How do you Rx
ENT review
Can give dexamethasone for swelling
Drainage and IV Ax - co-amoxiclav
Offer tonsillectomy to prevent recurrence
How do you manage bacterial tonsillitis
Penicillin V 500mg QDS 10 days Erthroymcin if penicillin allergic Anti-septic gargle Analgesia Protect airway Urgent advise if immunocompromised Can do delayed prescription
What do you avoid
Amoxicillin / ampicillin as EBV may mimic and would cause a rash due to type 4 hypersensitivity
What are anatomical differences in the larynx that cause airway issues
Relative macroglossia Tonsillar hypertrophy Large epiglottis Short neck High larynx Narrow subglottis (narrowest point in neck)
What are causes of throat pain
Congenital Infective Inflammatory Trauma - FB or assault Iatrogenic Malignancy of pharynx
What is common iatrogenic
Post op tonsillectomy
What are inflammatory causes
Reflux -> Oesophagitis
Granulomatous polyangititis
Vasculitis
What are infective causes
Tonsillitis - EBV vs strep Pharyngitis / laryngitis Epiglottitis Supraglottitis Abscess Quinsy
What are congenital causes
Infected thyroglossal cyst
Brachial cyst
If someone presents in ED with throat pain what do you do
History
Basic observation - sats, HR, RR, BP, temp
Neck examination
- Inspect and feel any swelling
Mouth examination with headlight and tongue depressor
What further Ix would you do
Bloods - FBC, U+E, CRP to show dehydration or inflammatory
Blood culture if spiking temp
Can do throat swab
When is lateral soft tissue X-ray indicated
If swallowed FB
What part of pharynx when looking in mouth
Oropharynx
Can see tonsils and uvula and arches
May be able to see epiglottis but rare
What do you need to use to view further down
Naso-endoscope
Require ENT
When would you suspect something further down than tonsillitis
If struggling to breath / stridor
If tonsils don’t look that enlarged to cause septic Sx
If airway issue who do you get help from
Anaethetist or ENT
Epiglottis background
Used to be common in kids but now vaccinated
Usually bacterial infection - proceeding URTI
Can be thermal
Presentation
Fever / unwell few days prior Throat pain Dysphagia Dysphonia Struggle to breath / stridor Pooling saliva
Why do you not examine in kids
A lot easier for airway to spasm and obstruct
Usually give parents dexamethasone in a syringe which mother can give if suspect
How do you manage epiglottis
EMERENCY ABCDE Dexamethasone to reduce swelling Adrenaline neb 1:1000 in 5ml saline IV Ax - ceftriaxone May need to secure airway
What do you give in any acute airway inflammation
Dexamethasone IV or PO 8mg stat
When is pred used
More long term conditions
