URI/Pharyngitis/Tonsillitis

Question 1

Manifestations of URI’s

Answer 1

• Nose: rhinitis, rhinosinusitis
• Tonsils: tonsillitis
• Pharynx: pharyngitis
• combination

Question 2

URI Etiology

Answer 2

• same bugs for adults and children
• > 90% viral (adenovirus, rhinovirus, influenza)
• bacteria: strep pneumo > H.flu > M. cat

Question 3

Treatment of URI’s

Answer 3

• NO ANTIBIOTICS
• if sx not improving by 7 days maybe bacterial
• hold off abx if under 7 days unless strep throat is suspected
• educate on inappropriate use of abx
• runny nose: OTC antihistamines
• congestion: decongestants
• thick secretions - guaifenesin
• single dose of steroid

Question 4

Non-infectious rhinitis

Answer 4

• allergies: same (sneezing, itching, runny nose/eyes, nasal congestion, clear to yellow d/c) not same (chronic, no sudden onset, no fever)
• Pregnancy: same (nasal congestion, +/- runny) not same (chronic, not sudden, no fever or purulence)

Question 5

Waldeyer’s ring

Answer 5

• adenoids
• palatine tonsils
• lingual tonsils (tongue)

Question 6

Stomatitis

Answer 6

• mouth
• usually viral - aphthous ulcers, herpangina, herpes simplex
• fungal: thrush (candida)

Question 7

Aphthous ulcer

Answer 7

• viral
• inside of mouth (unlike herpes which is outside)
• whitish ulcers with a red base
• tender

Question 8

Herpangina

Answer 8

• coxsackievirus A
• fever, sore throat, rash/ulcer on palate
• small vesicles w/ erythematous base that becomes ulcers
• pain can be severe
• tx supportive

Question 9

Pharyngitis

Answer 9

• refers to internal throat
• typically does not involve tonsils
• erythema, lateral walls or cobblestoned posteriorly
• 90% viral
• Viral sx: runny nose, cough, +/- conjunctivitis, +/- diarrhea
• if there are GI symptoms it will not be strep

Question 10

Noninfectious causes

Answer 10

• snoring: red uvula

- laryngeal acid reflux: chronic/recurrent pharyngitis/laryngitis, nighttime cough, “something in throat”

Question 11

Acute tonsillitis sx

Answer 11

• odynophagia: pain w/ swallowing
• dysphagia: difficulty swallowing
• fever
• enlarged, tender lymph nodes in upper neck

Question 12

Tonsillitis complications

Answer 12

• missed work/school
• dehydration
• abscess: peritonsillar or deep neck
• systemic complications (strep)

Question 13

Acute tonsillitis exam

Answer 13

• tonsillar enlargement, erythema, exudate
• chronic or recent infections (tonsil calculi)
• bad breath
• cervical adenopathy anterior

Question 14

Tonsillitis etiology

Answer 14

• viral: adenovirus, rhinovirus, influenza
• bacterial: often w/ exudate, not diagnostic
• mono: EBV (also has exudation)

Question 15

Bacterial tonsillitis bugs

Answer 15

• group A beta-hemolytic strep
• streph pneumo, staph aureus, H. flu
• chronic tonsillitis: group A strep - actinomyces
• Rare: n. gonorrhoeae, clamydia, cornebacterium diphtheria

Question 16

Group A strep diagnosis

Answer 16

• clinical course: sudden onset sore throat and fever, +/- HA, nausea, swollen lymph nodes
• sx greater than 3 days
• bacterial may have purulent exudate, tonsil involvement (except mono)
• rapid strep test and culture

Question 17

Group A strep tx

Answer 17

• penicillin (amoxicillin) still drug of choice
• erythromycin if allergic
• 2nd line: amoxicillin/calvulante (augmentin), cephalosporins, clindamycin

Question 18

Why treat strep?

Answer 18

• most resolve w/o abx
• shorten course
• local complications (abscess)
• systemic complications
• contagious nature

Question 19

Peritonsillar abscess

Answer 19

• unilateral sx
• uvula medially deviated
• bulging soft palate
• trismus: inability to fully open jaw
• dysphagia: hot-potato voice

Question 20

Peritonsillar abscess tx

Answer 20

• < 3 days and mild findings: abx and close follow up
• otherwise needle aspiration
• I & D
• quinsy tonsillectomy

Question 21

Systemic complications of Group A strep

Answer 21

• rheumatic fever: infects heart valves
• Scarlet fever: toxin produced (HA, nausea, widespread rash)
• glomerulonephritis: “coca-cola” urine

Question 22

Diphtheria

Answer 22

• rare
• grey pseduomembrane (can obstruct)
• systemic toxins: cardiac, neurologic
• Tx: erythromycin or PCN

Question 23

Infectious mononucleosis

Answer 23

• Epstein-Barr virus
• prolonged malaise, fatigue
• lasts 1-3 months or more
• significant tonsil and LN enlargement
• posterior neck nodes also
• tonsil exudate common (all connected not scattered)
• 20-30% also infected w/ strep

Question 24

Complications of Mono

Answer 24

• splenomegaly: 50%, risk of rupture and hemorrhage
• hepatomegaly: 10%
• hepatospleomegaly: 2nd to 4th week

Question 25

Dx of infectious mononucleosis

Answer 25

• monospot: rapid
• WBC
• Mono panel: IgM (acute) and IgG

Question 26

Treatment of Mono

Answer 26

• supportive
• steroids if having trouble breathing
• abx if coinfected (NO AMOXICILLIN)
• limits activity (spleen)

Question 27

Tonsil & Adenoid Hypertrophy

Answer 27

• childhood obstructive sleep apnea
• loud snoring, poor sleep, bedwetting, apneas, hard to awaken, daytime somnolence, behavioral problems
• adenoids: otitis media, mouth breathing, chronic rhinorrhea, “nasal” speech
• Tx: T&A curative

Question 28

Epiglottitis

Answer 28

• airway emergency
• epiglottis and supraglottic swelling
• H.flu
• rare in children since HIB vaccine
• immunocompromised adults (alcoholics)
• sitting forward, drooling, cannot swallow secretions
• inspiratory stridor (noise w/ inhalation)
• fever
• Do not use tongue blade or scope
• IV steroids, abx, racemic epi
• urgent ansethesia, ENT evaluation
• may need intubation vs trach