Throat and Neck - Angioedema, Epiglottitis, Quinsy, Tonsilitis, Glandular fever, Croup, Scarlet fever, Kawasaki disease Flashcards

1
Q

Angioedema
-pathophysiology
-presentation
-investigations
-management

A

Sudden facial swelling within hours - eyes, lips, tongue

Hereditary
Allergen - hives
Idiopathic - SLE
ACEi

If severe - respiratory distress
-stridor
-difficulty swallowing

Identify and avoid the underlying cause
Antihistamine - ceterizine
Severe - PO pred 40mg 7days

If symptoms settle
If likely to be recurrent - daily antihistamine for 3-6months
If multiple episodes of angioedema, hives - daily antihistamine for 6-12months
If recurrence unlikely - PRN antihistmaine

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2
Q

Ludwig’s angina
-pathophysiology
-risk factors
-presentation
-investigations
-management

A

Dental infection (Sviridans, Saureus, Sepidermidis) => Cellulitis of mouth and soft tissues of neck

Neck swelling
Difficulty swallowing, speaking
Cannot open mouth
Fever
Respiratory distress - stridor, SOB, high RR

FBC - high WCC
CRP
Blood cultures - any hematogenous spread
Needle aspiration - culture, analysis
Dental Xray

Urgent airway assessment and admit to HDU + broad spectrum IV ABx
-intubate?
Surgical abscess drainage

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3
Q

Peritonsillar abscess/quinsy
-pathophysiology
-presentation
-investigations
-management

A

Complication of tonsilitis (GAS) => collection of pus in the tissue surrounding the tonsils

Severe lateralising sore throat
Difficulty swallowing, speaking
Fever
Trismus
Uvula deviation, swollen tonsil

Clinical diagnosis
FBC - high WCC
CRP - high
LFT, U&E - baseline
EBV/glandular fever screen - viral cause of tonsilitis
Blood cultures - sepsis?
CT neck

Analgesia, IV fluids, IV ABx
Surgical abscess drainage

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4
Q

Tonsilitis
-causes
-presentation
-investigations
-management
-complications

A

Sore throat, fever

Viral - rhino, corona, paraflu, EBV
-nasal congestion, headache, earache, cough
Bacterial - GAS
-purulent tonsilitis

Clinical diagnosis + Centor (is it GAS)

Conservative - paracetamol/ibuprofen, fluids

Phenoxymethylpenicilin/erythromycin if
-systemic upset due to sore throat
-Hx of rheumatic fever
-peritonsilitis
-increased risk of severe infection
-3+ Centor criteria met

AOM
Quinsy
Sinusitis
Scarlet fever
Rheumatic fever
Post-strep glomerulonephritis

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5
Q

Epiglotitis
-causative organism
-presentation
-diagnosis and investigations
-management

A

HiBs - disease of childhood

Rapid onset high fever, generally unwell
Stridor
Drooling
Tripod

Direct visualisation by airway trained staff
-if suspected, do NOT examine throat due to risk of obstruction
Xray - thumb sign

Emergency airway support - intubation
O2, IV ABx

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6
Q

Croup
-causative organism
-presentation
-diagnosis, investigations
-management

A

Paraflu - 6months - 3 years

Stridor
Barking cough
Fever
Flu-like

Admit if
-U6months
-known upper airway issues
-uncertainty about diagnosis

Clinical diagnosis
AP neck Xray - steeple sign

Dexmeth
O2
Adrenaline nebs

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7
Q

Glandular fever
-causative organism
-presentation
-management

A

EBV

Sore throat, fever, LN, purulent
Splenomegaly, hepatitis (ALT increase)

FBC and monospot

Resolve after 2-4wks, mainly supportive
-rest, fluids, simple analgesia
-avoid contact sports for 4wks after recovery to reduce risk of splenic rupture

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8
Q

Scarlet fever
-causative organism
-presentation
-investigations
-management

A

Scarlet fever - GAS strep pyogenes
-2-6years

2 day fever
Headache
Sore throat
Strawberry tongue
Sandpaper rash on torso, spares palms and soles

Throat swab but can start ABx whilst waiting for results

PO pen V 10 days (azithromycin if pen allergic)
-can return to school 24hrs after ABx started
Must notify

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9
Q

Kawasaki disease
-pathophysiology
-presentation
-diagnosis
-management

A

Medium vasculitis

5 day fever - resistant to antipyretics
Conjunctival injection
Bright, red, cracked lips
Strawberry tongue
Cervical LN
Red palms and soles which peel

Clinical diagnosis

High dose aspirin
IVIG
Echo - coronary artery aneurysm

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