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ENT > Tonsillitis + Throat Pain > Flashcards

Tonsillitis + Throat Pain Flashcards

1
Q

Where can an infection in the throat occur and what can cause

A

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
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2
Q

What is not routine in sore throat

A 
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
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3
Q

How do you Rx

A

Pain relief - paracetamol and Ibuprofen

Fluid if needed

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4
Q

When do you give Ax and when do you admit

A

Marked systemic upset
Hx rheumatic fever
Increased risk of infection - immunocompromised / co-morbid
Centor 3 / 4

Admit if
Grade 3 or 4 - tonsils touching

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5
Q

What are red flags with sore throat

A

If unexplained and prolonged >6 weeks

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6
Q

What are symptoms of bacterial tonsillitis

A 
Pharyngitis 
- Sore throat
- Dysphagia 
- Odnyophagia 
Ear ache 
Fever / malaise 
Pus on tonsils
Bilateral cervical lymphadenopathy
Absence of cough
Viral tends to have midler Sx
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7
Q

What score is used to determine whether bacterial or not

A

Fever pain

  • Fever
  • Exudate
  • Rapid presentation <3 day
  • Severely inflamed
  • No cough
  • LN

Centor

  • Fever
  • Pus / exudate
  • Tender LN
  • Absence of cough
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8
Q

What is the most common cause of bacterial throat

A

Beta haemolytic strep

‘Strep throat’

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9
Q

When is tonsillectomy offered and

A 
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
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10
Q

When do you admit for tonsillectomy

A

Severe OSA
<3 years
Down’s
Lives far from hospital

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11
Q

What are post op complications of tonsillectomy

A 
Pain
Infection 
Risk of GA
Haemorrhage
Anaemia
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12
Q

How do you deal with haemorrhage

A 
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
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13
Q

What is common cause of viral tonsillitis

A

EBV

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14
Q

How do you treat

A

Symptomatic

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15
Q

What are complications of bacterial tonsillitis

A 
Quinsy
Otitis media
Scarlet fever 
Deep neck space abscess 
Rheumatic fever = rare
GN = rare
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16
Q

What is quinsy

A

Peri-tonsillar abscess

17
Q

What are the symptoms

A 
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
18
Q

How do you Rx

A

ENT review
Can give dexamethasone for swelling
Drainage and IV Ax - co-amoxiclav
Offer tonsillectomy to prevent recurrence

19
Q

How do you manage bacterial tonsillitis

A 
Penicillin V 500mg QDS 10 days
Erthroymcin if penicillin allergic 
Anti-septic gargle
Analgesia 
Protect airway
Urgent advise if immunocompromised
Can do delayed prescription
20
Q

What do you avoid

A

Amoxicillin / ampicillin as EBV may mimic and would cause a rash due to type 4 hypersensitivity

21
Q

What are anatomical differences in the larynx that cause airway issues

A 
Relative macroglossia
Tonsillar hypertrophy
Large epiglottis
Short neck
High larynx
Narrow subglottis (narrowest point in neck)
22
Q

What are causes of throat pain

A 
Congenital
Infective
Inflammatory
Trauma - FB or assault 
Iatrogenic
Malignancy of pharynx
23
Q

What is common iatrogenic

A

Post op tonsillectomy

24
Q

What are inflammatory causes

A

Reflux -> Oesophagitis
Granulomatous polyangititis
Vasculitis

25
Q

What are infective causes

A 
Tonsillitis - EBV vs strep
Pharyngitis / laryngitis
Epiglottitis 
Supraglottitis 
Abscess
Quinsy
26
Q

What are congenital causes

A

Infected thyroglossal cyst

Brachial cyst

27
Q

If someone presents in ED with throat pain what do you do

A

History
Basic observation - sats, HR, RR, BP, temp
Neck examination
- Inspect and feel any swelling
Mouth examination with headlight and tongue depressor

28
Q

What further Ix would you do

A

Bloods - FBC, U+E, CRP to show dehydration or inflammatory
Blood culture if spiking temp
Can do throat swab

29
Q

When is lateral soft tissue X-ray indicated

A

If swallowed FB

30
Q

What part of pharynx when looking in mouth

A

Oropharynx
Can see tonsils and uvula and arches
May be able to see epiglottis but rare

31
Q

What do you need to use to view further down

A

Naso-endoscope

Require ENT

32
Q

When would you suspect something further down than tonsillitis

A

If struggling to breath / stridor

If tonsils don’t look that enlarged to cause septic Sx

33
Q

If airway issue who do you get help from

A

Anaethetist or ENT

34
Q

Epiglottis background

A

Used to be common in kids but now vaccinated
Usually bacterial infection - proceeding URTI
Can be thermal

35
Q

Presentation

A 
Fever / unwell few days prior 
Throat pain 
Dysphagia
Dysphonia 
Struggle to breath / stridor
Pooling saliva
36
Q

Why do you not examine in kids

A

A lot easier for airway to spasm and obstruct

Usually give parents dexamethasone in a syringe which mother can give if suspect

37
Q

How do you manage epiglottis

A 
EMERENCY 
ABCDE 
Dexamethasone to reduce swelling 
Adrenaline neb 1:1000 in 5ml saline 
IV Ax - ceftriaxone 
May need to secure airway
38
Q

What do you give in any acute airway inflammation

A

Dexamethasone IV or PO 8mg stat

39
Q

When is pred used

A

More long term conditions

ENT (14 decks)

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