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Simmons NURP 503 Exam 2 > 5: Throat > Flashcards

5: Throat Flashcards

1
Q

What are some exam tricks for looking in a child’s throat (6)?

A
  1. Use a tongue blade to look into a puppet’s mouth.
  2. Use a mirror so that the child can look into his or her mouth while being examined.
  3. Show off missing or new teeth.
  4. “Open your mouth as big as a lion.”
  5. “Can you stick out your whole tongue? Can you move it to the left and right?”
  6. To enlarge your view of the oropharynx, ask the child to stick out the tongue and “pant like a dog.”
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2
Q

What are normal findings of tonsils (2)?

A
  1. Same pink as oral mucosa.

2. Surface is peppered with indentations (crypts).

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3
Q

Grade 1, 2, 3, or 4 tonsils?

Visible

A

1

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4
Q

Grade 1, 2, 3, or 4 tonsils?

Halfway between tonsillar pillars and uvula.

A

2

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5
Q

Grade 1, 2, 3, or 4 tonsils?

Touching uvula.

A

3

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6
Q

Grade 1, 2, 3, or 4 tonsils?

Touching each other (“kissing”).

A

4

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7
Q

T/F Acute viral pharyngitis is often paired with a URI.

A

True

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8
Q

What are common causative agents of viral pharyngitis (5)?

A
  1. Rhinovirus
  2. RSV
  3. Adenovirus
  4. Influenza
  5. Parainfluenza
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9
Q

How do clinical manifestations in children 3 months-3 years differ from those of older children/adults with viral pharyngitis?

A

Basically, illness is more severe in infants/children than adults.
Younger:
1. Fevers occur suddenly and are associated with irritability, restlessness, decreased appetite and fluid intake, and decreased activity.
2. Vomiting and diarrhea may also be present.
Older:
1. Low-grade fevers early in illness.
Both:
1. Nasal inflammation may lead to obstruction.

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10
Q

How long does it take for viral pharyngitis to resolve?

A

4-10 days without complications.

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11
Q

T/F If otitis media occurs after viral pharyngitis, it occurs much later.

A

False. It may lead to otitis media, which is usually early or after the initial phase of nasopharyngitis is past.

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12
Q

T/F Pharyngitis can lead to pneumonia.

A

True. Less frequent but may be observed in some infants.

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13
Q

What is the treatment for viral pharyngitis (4)?

A
  1. Encourage staying home.
  2. Antipyretics for mild fever/discomfort.
  3. Rest until afebrile for at least 1 day.
  4. Increase fluids but don’t push solids.
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14
Q

What age can use decongestants?

A

2 years and older. Use with caution in diabetics, as they affect all vascular beds.

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15
Q

Are decongestants more effective PO or nasal?

A

Nasal

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16
Q

What age can use cough suppressants with dextromethorphan?

A

4 years and older. Used for dry, hacking cough. Some contain up to 22% alcohol. Be aware of abuse potential. Street names: sizzurp, purple drank, lean, purple jelly, texas tea.

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17
Q

T/F Cough suppressants are effective and should be used for those with cough over the age of 4.

A

False. Lack of evidence that such medications reduce symptoms. They can help, but not for everyone. Use sparingly.

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18
Q

T/F Antihistamines possess a weak, atropine-like effect that dries secretions.

A

True. They also cause drowsiness.

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19
Q

T/F Antihistamines can cause hyperactivity.

A

True. Though mostly they cause drowsiness, some children have a paradoxical reaction and become hyper. So, try a first-time dose in the middle of the day.

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20
Q

What is the best prevention for pharyngitis/URI?

A

Hygiene. Encourage staying home. Children are so susceptible, b/c they have not yet developed resistance to many of the common viruses. Very young infants are especially susceptible and exposure should be minimized.

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21
Q

What is the rule of thumb for how often a child will be sick?

A

1 illness/month

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22
Q

T/F Older children often do not present with the “classic” strep symptoms.

A

False. Younger children often don’t.

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23
Q

_____ should always be on your differential for preschool or school age children with fever.

A

GABHS

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24
Q

If strep throat isn’t very serious and usually clears on its own, why do we treat with ABX?

A

It can lead to rheumatic fever about 18 days after. It can lead to AGN about 10 days after.

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25
Q

Clinical symptoms of strep (3)?

A
  1. Anterior cervical lymphadenopathy
  2. Difficulty swallowing s/t pain
  3. Tonsillar and pharyngeal inflammation and exudate on 2nd day of illness
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26
Q

How long does strep usually last?

A

3-5 days unless complicated by other issues.

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27
Q

S/S of strep, yes or no?

Scarlatina rash

A

Yes

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28
Q

S/S of strep, yes or no?

Cough

A

No

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29
Q

S/S of strep, yes or no?

Fever

A

Yes

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30
Q

S/S of strep, yes or no?

Hoarseness

A

No

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31
Q

S/S of strep, yes or no?

Abdominal pain

A

Yes

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32
Q

S/S of strep, yes or no?

Conjunctivitis

A

No

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33
Q

S/S of strep, yes or no?

Vomiting

A

Yes

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34
Q

S/S of strep, yes or no?

Stomatitis

A

No

35
Q

S/S of strep, yes or no?

Headache

A

Yes

36
Q

S/S of strep, yes or no?

Ulcerative lesions

A

No

37
Q

S/S of strep, yes or no?

Anterior cervical tenderness

A

Yes

38
Q

S/S of strep, yes or no?

Coryza

A

No

39
Q

S/S of strep, yes or no?

Diarrhea

A

No

40
Q

Common ages for scarlet fever?

A

Under 3 and adults.

41
Q

Does a scarlet fever rash blanch?

A

Yes. Similar to sandpaper in appearance.

42
Q

S/S of scarlet fever (4)?

A
  1. Sandpaper rash that blanches and appears along upper chest 24 hours after onset of GABHS symptoms.
  2. Pastia’s lines (petechia in intertriginous areas).
  3. Circumoral pallor.
  4. Desquamation 7-10 days after onset of rash.
43
Q

Name centor criteria for strep throat.

A 
Add 1 point for each:
1. Fever
2. Tonsillar exudate
3. Tender anterior cervical nodes
4. Absence of cough
5. Less than 15
Subtract 1 point for:
1. Older than 44
2-3 points = throat culture, treat with ABX if positive (15-32% chance of infx)
4-5 = throat culture, but treat empirically (56% chance of infx)
44
Q

T/F 80-90% of acute pharyngitis is viral, but you swab for strep b/c of the risk of complications if it is GABHS.

A

True

45
Q

T/F Strep infx should be suspected in children over the age of 2 who have pharyngitis even if no exudate is present.

A

True

46
Q

T/F ASO can be used to diagnose GABHS as well as throat culture.

A

False. ASO is useful only for retrospective diagnosis related to AGN.

47
Q

What is the treatment for strep throat?

A

Penicillin. Either Pen V K, Amoxicillin, or Pen G. If allergic, Clindamycin, Azithromycin, or Clarithromycin.

48
Q

There have been recent concerns about cardiac pathology with which med?

A

Clarithromycin

49
Q

T/F The best prevention for GABHS is immunization.

A

False. There is no immunization. Spread by respiratory droplets and direct contact of secretions.

50
Q

When is strep throat no longer infectious?

A

24 hours after ABX therapy initiated. Replace toothbrush at this point, too.

51
Q

T/F ABX should be used in GABHS carriers d/t risk of complications from AGN and rheumatic fever.

A

False. Reserve use of ABX in carriers. Carriers are unlikely to develop complications. However, if there is a family hx, outbreak of rheumatic fever or AGN, ping-ponging in family, undue anxiety, community GABHS outbreak, or tonsillectomy is being considered d/t chronic carrier state…then consider ABX.

52
Q

What is the treatment for GABHS carrier state (2)?

A
  1. Clindamycin or Rifampin + Pen G
  2. Pen V + Rifampin
    Eradication is longer course with potential side effects. After eradication, patients are treated as noncarrier state.
53
Q

What is the function of tonsils (2)?

A
  1. They filter and protect the respiratory and alimentary tract from pathogenic organisms.
  2. Role in formation of antibodies to protect from URIs.
54
Q

Name the tonsils (4).

A
  1. Pharyngeal (Adenoids)
  2. Tubal
  3. Palatine (Faucial)
  4. Lingual
55
Q

Why is tonsillitis common in children?

A

Abundance of lymphoid tissue + frequency of URIs

56
Q

T/F Mouth breathing enlarges the adenoids.

A

True

57
Q

Why might there be bad breath with tonsillitis?

A

Dry and irritated mucous membranes of the oropharynx can cause offensive mouth odor and impaired senses of taste and smell.

58
Q

Why does the voice chance with tonsillitis?

A

Nasal and muffled voice because air cannot be trapped for proper speech sounds.

59
Q

T/F Cough is present with tonsillitis.

A

True. Usually persistent cough.

60
Q

T/F Otitis media is a common co-infection with tonsillitis.

A

True. The proximity of the adenoids to the eustachian tubes means the passageway is frequently blocked by swollen adenoids, interfering with normal drainage.

61
Q

What is the connection between tonsillitis and conjunctivitis and who is the usual culprit?

A

H. influenza is the usual pathogen. Sore throat develops into asymptomatic otitis media, followed by symptomatic conjunctivitis. Usually associated with purulent rhinitis. Thought to spread from nasal cavity to lymph nodes to Eustachian tubes as bacteria pushes upward.

62
Q

What is the treatment for otitis-conjunctivitis (4)?

A
  1. Augmentin
  2. Ceftin
  3. Bactrim
  4. Pediazole
63
Q

What is the causative agent for mono?

A

Epstein-Barr Virus (EBV)

64
Q

How is mono transmitted?

A

Saliva

65
Q

What is the incubation of mono and how long is viral shedding?

A 
Incubation = 2-6 weeks
Shedding = 2-6 months
66
Q

What ages usually get mono?

A

Adolescents and young adults. Rare under 5 yo.

67
Q

What are the s/s of mono (10)?

A
  1. Pharyngitis
  2. High fever (102-104)
  3. Headache
  4. Mono exposure
  5. Fatigue/malaise
  6. Palatine petecchiae at hard/soft palate junction
  7. Erythematous posterior pharynx
  8. Posterior cervical adenopathy
  9. Hepatomegaly (25%), splenomegaly (50%), coexisting strep, lymphocytosis (>50%), atypical lymphs (10%), mono spot/heterophile AB +
  10. EBV titer +
68
Q

Treatment for mono (5)?

A
  1. Symptomatic.
  2. No contact sports with splenomegaly.
  3. Prednisone for significant adenopathy.
  4. ABX for coexisting strep.
  5. Monitor for complications (splenic rupture, blood dyscrsias, myocarditis, orchitis, chronic disease).
69
Q

A summer outbreak of Coxsackie virus and Echovirus combined with small oral vesicles or ulcers on tonsils, uvula, and soft palate with possible headache, fever, and malaise with sinus tachycardia would lead you to what diagnosis?

A

Herpangina Pharyngitis

70
Q

A summer/early fall outbreak with large vesiculated ulcer in the oropharynx and over palms, soles, buttocks, and diaper area would led you to what diagnosis?

A

Hand, Foot, and Mouth (Coxsackie A16)

71
Q

Viral vesicular lesions of tongue or labial, buccal, and gingival mucosa. May have fever and general malaise. What is your diagnosis?

A

Gingivostomatitis (HSV initial presentation). Can be treated with antivirals if caught within 72 hours of outbreak. May require IV fluids. Subsequent outbreaks less dramatic.

72
Q

Thought to be a complication of tonsillitis, where pathogens spread to the space around tonsils and infect it.

A

Peritonsillar Abscess

73
Q

S/S of peritonsillar abscess (5)?

A
  1. Fever
  2. Unilateral sore throat or ear pain
  3. Hot potato voice
  4. Pooling/drooling of secretions
  5. Deviated uvula
74
Q

Management for peritonsillar abscess (4)?

A
  1. Medical emergency!
  2. Refer to ED for I and D.
  3. IV ABX.
  4. Discharged with proof of response.
75
Q

When should fluoride start (3)?

A
  1. Avoid supplementation under 6 months old.
  2. Don’t introduce fluoride toothpaste until age 2.
  3. Don’t introduce fluoride mouthwash until age 6.
76
Q

When should dental visits start?

A

Within 6 months of first tooth eruption or 1 yo.

77
Q

T/F Oral care begins with the eruption of the very first tooth.

A

False. Clean gums after meals with clean cloth. Use toothbrush with water when teeth erupt.

78
Q

When should cups be used and pacifiers stopped?

A
  1. Transition to cup by age 1.

2. Discontinue pacifiers and thumb sucking at 2-4 years of age.

79
Q

Name 4 dental emergencies.

A
  1. Bone/tooth fracture.
  2. Crown or root fracture with visible pulp.
  3. Partial avulsion >2 mm mobility.
  4. Entire tooth is out.
80
Q

What is the immediate treatment on the way to the dentist for an entire tooth being out (2)?

A
  1. Primary tooth is not reimplanted.

2. Permanent tooth: Put in milk or saline and go to dentist immediately.

81
Q

Treatment for toothache with swelling and/or cellulitis?

A

Start ABX then discuss with dentist.

82
Q

Name 5 tooth situations where the patient can be seen in 1-3 days (not an emergency).

A
  1. Minor bumps <2 mm mobility.
  2. Toothache w/o swelling.
  3. Simple crown fractures.
  4. Broken braces/wires not causing irritation.
  5. Other broken dental appliances.
83
Q

What are the 2 main causes of oral malignancies?

A
  1. Carcinogens
  2. HPV
    Persons who smoke and with high-risk sexual activity should be examined at least once/year.
84
Q

T/F Oral malignancies are often painless lesions that don’t heal and continue to expand.

A

True. They can be tucked into buccal mucosal areas and difficult to see.

Simmons NURP 503 Exam 2 (17 decks)

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