URTI (Sore Throat) Flashcards
What is your pharynx and how is it divided up?
12cm flattened tube extending from base of skull (occipitus) to oesophagus (C6) which bears the inner longitudinal layer, outer circular layer made up of superior, middle and inferior constrictor muscles; pharynx is divided up into nasopharynx (base of skull to soft palate), oropharynx (soft palate to floor of vallecula), hypopharynx/laryngopharynx (floor of vallecula to oesophagus (C6)
What is the function of the pharynx?
respiratory (condition inspired air + propagate into larynx) + immune defence (adenoid tonsils)
What are the tonsils?
sub-epithelial lymphoid tissue collections, of which in throat, they are situated in the pharynx - classified by location. Oropharynx bears tonsils (adenoid, lingual + palatine + tubal + ) which form Waldeyer’s Ring
What is the larynx?
organ located in anterior neck suspended from hyoid bone spanning C3-C6 which is continuous inferiorly with the trachea and opens superiorly into the laryngopharynx. Laryngeal muscles act to move larynx components for phonation + breathing
What is the function of the larynx?
Protect lower respiratory tract (trachea + bronchi) + Assist respiration + Phonation + Effort closure (tighter occlusion of laryngeal inlet as aryeepiglottic muscles contract ≈ as sphincter)
What are the worrying signs of a lymph node examination?
rough + hard + fixed
List 3 common causes of a sore throat.
Tonsilitis
Infectious Mononucleosis
Croup
Supraglottitis (Epiglottitis)
Deep Neck Space Infections
Diptheria
Burns
Reflux (GORD)
A 13 year old girl presents with dysphagia and a cough.
O/E you notice fever, exudate on her tonsils and lymphadenopathy.
What is her CENTOR score?
What is your Differential Diagnosis?
Tonsilitis
CENTOR: 3
Exudate
Nodes
Temperature
thus 3/5
Unlikely to be GABHS thus infects agent likely to be Rhinovirus/Coronavirus/Adenovirus/Influenza/Herpes viruses/EBV/Mycoplasma pneumoniae/Neisseria Gonorrhoea
List 5 pathogens which may cause Tonsillitis.
- Rhinovirus
- Coronavirus
- Adenovirus
- Influenza
- Herpes viruses
- Epstein-Barr Virus (Infectious Mononucleosis)
- Group A ß-haemolytic streptococci
- Group C ß-haemolytic streptococci (GCBHS)
- Mycoplasma pneumoniae
- Neisseria gonorrhoea
List 3 clinical features of tonsillitis.
- Dysphagia
- Fever
- Exudate
- Cough (absence is Centor criteria)
- Lymphodenpathy
A 13 year old girl presents with dysphagia and a cough.
O/E you notice fever, exudate on her tonsils and lymphadenopathy. She has no PMHx and no allergies.
What is her CENTOR score?
What is your Differential Diagnosis?
Outline your management plan.
Tonsillitis - non-streptococcus
Phenoxymethylpenicillin (Penicillin V) 500mg QDS 5-10 days
A 15 year old girl presents with dysphagia and a cough.
O/E you notice fever, exudate on her tonsils and lymphadenopathy. She has no PMHx and is allergic to penicillin.
What is her CENTOR score?
What is your Differential Diagnosis?
Outline your management plan.
Clarithromycin 500mg BDS 5 days
OR
Erythromycin 500mg QDS 5 days
State the main pathogen causing Infectious Mononucleosis.
EBV (90%)
List 3 pathogens which can cause Infectious Mononucleosis.
- EBV (90%)
- HHV
- CMV
- HSV-1
- Measles
An 18 year old university student, Harry, presents with a sore throat, weakness and a fever. He is a healthy weight, socially active going out clubbing three times a week and has no partner. He has had numerous sexual relationships in the last 2 weeks.
O/E you notice petechiae on his soft palate and splenomegaly.
What is the likely diagnosis?
Infectious Mononucleosis
An 18 year old university student, Harry, presents with a sore throat, weakness and a fever. He is a healthy weight, socially active going out clubbing three times a week and has no partner. He has had numerous sexual relationships in the last 2 weeks.
O/E you notice petechiae on his soft palate and splenomegaly.
What is the likely diagnosis?
Outline the investigations you may want to carry out.
- Clinical diagnosis
- FBC: lymphocytosis, atypical lymphocytosis
- Monospot test: Positive for heterophile antibodies
- Serology: EBV-specific antibodies. VCA-IgM, VCA-IgG, EA, EBV EBNA
An 18 year old university student, Harry, presents with a sore throat, weakness and a fever. He is a healthy weight, socially active going out clubbing three times a week and has no partner. He has had numerous sexual relationships in the last 2 weeks.
O/E you notice petechiae on his soft palate and splenomegaly.
What is the likely diagnosis?
Outline the management for Harry.
• Supportive care
(+ Upper airway obstruction/haemolytic anaemia)
• Corticosteroid: Prednisolone
(+ Thrombocytopenia)
Which patient is most likely at risk of Laryngotracheobronchitis?
A. Elderly patient
B. University student
C. Toddler
D. Middle aged woman
C. Toddler
List 3 pathogens which can cause Croup.
- Influenza A/B
- Respiratory syncytial virus
- Adenovirus
- Coronavirus
- Measles
A 5 year old, Jimmy, presents with agitation, fever and coryza. O/E you notice a barking cough, stridor and a hoarse voice (dysphonia).
What is your differential diagnosis?
Croup (laryngotracheobronchitis)
A 5 year old, Jimmy, presents with agitation, fever and coryza. O/E you notice a barking cough, stridor and a hoarse voice (dysphonia).
Outline your investigations you may order.
• Clinical exam = diagnosis
• XR of AP/lateral neck
- Steeple sign (narrowed trachea)
A 5 year old, Jimmy, presents with agitation, fever and coryza. O/E you notice a barking cough, stridor and a hoarse voice (dysphonia).
Outline your management plan.
• Corticosteroids
- Dexamethasone
• Supportive care
- Fluids
- Rest
- Adrenaline nebulised
- Supplemental oxygen
(Respiratory failure)
• Intubation
List the risk factors for Epiglottitis.
- Unvaccinated for Hib
- Immunocompromised
- Middle-aged
Give 3 pathogens which can cause Epiglottitis.
- Haemophilus influenzae
- Streptococcus pneumoniae
- Staphylococcus aureus / MRSA
- Traumatic insult to epiglottis
Karen, a 54 year old dinner lady from Sheffield, presents with odynophagia, dysphagia and fever. She drinks 18 units of alcohol a week, her BMI is 34 and she has a pack years of 20.
O/E you identify a cherry-red spot in her throat as well as respiratory difficulty.
What is your differential diagnosis?
Epiglottitis
Karen, a 54 year old dinner lady from Sheffield, presents with odynophagia, dysphagia and fever. She drinks 18 units of alcohol a week, her BMI is 34 and she has a pack years of 20.
O/E you identify a cherry-red spot in her throat as well as respiratory difficulty.
Outline any investigations you may wish to order to support your diagnosis of Epiglottitis..
• Examination –> clinical diagnosis
• Laryngoscopy
- Swelling of Supraglottis structures
• Lateral neck radiograph
- Enlarged epiglottis (thumb-print sign)
Karen, a 54 year old dinner lady from Sheffield, presents with odynophagia, dysphagia and fever. She drinks 18 units of alcohol a week, her BMI is 34 and she has a pack years of 20.
O/E you identify a cherry-red spot in her throat as well as respiratory difficulty.
Outline your management plan.
- Secure airway + oxygen
- IV ABX
- Cefotaxime
- Ceftriaxone
• Corticosteroids
- Dexamethasone
• Racemic epinephrine
- Adrenaline inhaled
A patient presents with fever, cervical pain and neck swelling. She says she has had dysphagia and dyspnoea.
She has a PMHx of meningitis, gastroenteritis and has never received any vaccinations.
What is your differential diagnosis?
Deep Neck Space Infection
A patient presents with fever, cervical pain and neck swelling. She says she has had dysphagia and dyspnoea.
She has a PMHx of meningitis, gastroenteritis and has never received any vaccinations.
Her Lateral Neck Radiograph shows fluid in the deep neck space.
What is your differential diagnosis and what is your management plan?
Deep Neck Space infection
ABX
Intubation
Drainage
What pathogen causes Diphtheria?
Corynebacterium diptheriae (or Corynebacterium pseudotuberculosis)
A 24 year old student on his Gap Year, volunteering in China returns with a fever, dyspnoea, dysphonia and odynophagia.
O/E you identify a croupy cough, pseudomembranous formation on his upper soft palate, cervical lymphadenopathy and stridor.
Outline any investigations you may want to conduct.
- Bacterial culture and microscopy: black colonies with halos (Tindale media); Metachromatic granules (Loeffler media), Irregular staining pleomorphic bacilli (microscopy)
- Diphtheria antibodies: Positive
A 24 year old student on his Gap Year, volunteering in China returns with a fever, dyspnoea, dysphonia and odynophagia.
O/E you identify a croupy cough, pseudomembranous formation on his upper soft palate, cervical lymphadenopathy and stridor.
The blood tests return back showing bacterial culture was positive for C. diphtheria
What is your differential?
Outline your management of this student.
Diphtheria
- Diphtheria antitoxin (equine)
- ABX: Benzylpenicillin sodium
- Airway protection + ventilation
- Diphtheria immunisation
A 9 month old child presents with a sore throat. He is crying and clearly agitated.
O/E you notice neck swelling, erythema and mucosal damage. The mother is concerned but looks dishevelled and appears dirty and anxious. She says her partner is sometimes in the house but is not the baby’s father. She says they have a balanced diet with very little money and uses formula milk which she mixes with boiling water.
What is your differential?
- Clinical diagnosis
- Laryngoscope
Burns?
A 24 year old Law graduate presents with burning in the tummy and throat. He has no remarkable PMHx or DHx, including allergies.
O/E there is nothing remarkable. He is adamant something is wrong.
You order a Gastroesophagoscopy which is unremarkable.
What is your differential diagnosis and outline a management plan.
GORD
Treatment:
• Supportive
• PPIs: Omeprazole, Lansoprazole
• Medication withdrawal: NSAIDs
List 3 risk factors of Oropharyngeal cancer.
- Smoking
- Alcohol abuse
- HPV exposure
- Chewing betel nuts
A 54 year old female presents with Oral pain and marked weight loss in the past 6 months. She has a PMHx of MI, COPD. She drinks 30 units of alcohol per week for the past 20 years. Additionally, she is a smoker and has 30 pack years.
O/E you identify cervical lymphadenopathy and a neck mass.
What investigations will you order?
Biopsy
CT/PET Scan
A 54 year old female presents with Oral pain and marked weight loss in the past 6 months. She has a PMHx of MI, COPD. She drinks 30 units of alcohol per week for the past 20 years. Additionally, she is a smoker and has 30 pack years.
O/E you identify cervical lymphadenopathy and a neck mass.
What is your differential?
Oropharyngeal Cancer
A 48 year old African American Male presents with dysphonia and odynophagia. He has previously had alcohol dependence for which he is now recovered. Additionally, he is a smoker with 30 pack years. He has worked in industry for the past 20 years which bears some occupational exposures which he had to sign a disclaimer for but he is not fully aware of the exact details.
O/E you identify a laryngeal mass, cervical lymphadenopathy.
What is your differential?
Outline any investigations you may wish to order.
Laryngeal Ca
Investigation:
• CT: laryngeal mass, metastases, lymphadenopathy
• Fine needle aspiration: squamous cell carcinoma
• Laryngoscopy: lesion of vocal folds, epiglottis, arytenoids or aryepiglottic folds
