URI- part 2 Flashcards
Peritonsillar abscess etiology
s. pyrogenes, s. aureus (including MRSA)
cellulitis- infection and inflammation of tissue between palatine tonsil capsule and pharyngeal muscles
No discrete pus collection
Abcess
collection of pus between capsule of tonsil and pharyngeal muscles
-usually a progression of cellulitis
-requires drainage
peritonsillar absces presentation
Symptoms: severe sore throat- uslayy unilateral drooling trismus spasm of internal pterygoid muscle fever neck swelling and pain
Signs:
swellin pushin tonsil with deviation of uvula to opposite side
cervical LAD
bilateral peritonsillar abscess rare, uvula may be displaced anteriorly
“hot patato voice”
Peritonsillar abscess diagnostics
labs: cbc white count electrolytes throat culture culture gram stain of abscess fluid
imaging:
ct with iv contrast
peritonsillar abscess management
Drainage antimicrobial therapy -parenteral- unitl afebrile ampicillin-sulbactam clindimycin vancomycin if high rates of MRSA
-oral 14 days
amoxicillin-clavulanate(augmentin)
clindamycin
fluids, pain control
Epiglottitis etiology
typically H. influenzae
epiglottitis signs and symptoms
consider in unvaccinated children and older adults
drooling (difficulty swallowing)
stridor
severe sore throat
toxic appearance
danger of airway obstruction, rapid course
ACT FAST, CAN BE FATAL
DO NOT exam oropharynx if patient in repiratory distress, secure airway first
Imaging
lateral neck x-ray “thumb sign-swollen epiglottis” CT/MRI
management of epiglottitis
hospitalization, intubation, antibiotics
laryngitis etiology
virus are most common
bacterial etiologies
streptococci species
moraxella catarrhalis
h. influenza
non-infectious vocal abuse intubation toxic exposure smoke inhalation radiation GERD vocal cord nodules or laryngeal polyps carcinoma of vocal folds neurologic dysfunction
laryngitis presentation
sypmptoms: hoarseness is KEY symptom dysphonia vairiation in vocal quality URI symptoms rhinorrhea, congestion, cough, etc
Signs: if URI related nasal edema, congestion, typical benign post pharynx erythema edema nodules ulcerations
laryngitis differentials
acute:
bacterial/viral
irritant exposure
acute epiglottitis (h. influenzae type b)
Chronic:
head neck cancer
GERD
vocal nodule
laryngitis diagnosis
largely based on history and PE
HOARSENESS > 2W IN ABSENCE OF URI SYMPTOMS
requires ENT referral for laryngoscopy, head/neck exam
especially with history of tobacco or alcohol use
Hoarseness from URI can last 2-3 weeks
laryngitis management
TREAT THE UNDERLYING CAUSE removal of offending agents voice rest humidification cool mist increased fluid intake hydration
Acute rhinosinusitis (ARS) etiology
MOST COMMON VIRAL
rhonovirus, influenza, parainfluenza
BACTERIAL only in 0.5-2% acute bacterial rhinosinusitis (ABRS) streptococcus pneumoniae h. influenzae moraxella catarrhalis
Acute rhinosinusits presentation
purulent nasal drainage AND nasal obstruction and/or facial pain, pressure, fullness
can be associated with allergies, tumors, polyps, deviated nasal septum or foreign bodies
acute<4 weeks
subacute 4-12 w
chronic >12 w
recurrent more than 4 episodes per year
Symptoms: fever low grade nasal congestion facial pain fatigue cough
Signs: purulent drainage nose or postnasal nasal mucosal edema tenderness to percussion of upper teeth sinus tenderness
acute viral rhinosinusitis diagnosis
clinically
<10 days of symptoms consistent with symptoms of ARS that are not worsening
