Disorders of the Pharynx and Tonsils

Question 1

Acute Pharyngitis:

Answer 1

Inflammation of the oropharynx from infectious causes
usually viral

SORE THROAT

Question 2

Viral Pharyngitis:

Answer 2

most common - adenovirus

orthomyxoviridae (influenza)

Question 3

Infectious mononucleosis:

Answer 3

epstien barr virus

posterior lymph swelling and oxidative tonsillitis w/ remarked redness and swelling of throat

Question 4

Pharyngitis due to rhinovirus (common cold)

Answer 4

infection of the throat, ear, and lungs causing standard cold like symptoms and often extreme pain

Question 5

Bacterial Pharyngitis:

Answer 5

streptococcus pyrogenes- erythematous pharynx, tonsillar exudates, anterior cervical adenopathy, fever, petechiea on soft palate and uvula

Question 6

Tx of Bacterial Pharyngitis:

Answer 6

amoxicillin or penecillin

Question 7

Diptherpia causing phayrngitis:

Answer 7

positive culture, with adherent grayish membrane on uvula/throar w/ inflammation of tonsils and throat

Question 8

Dx of bacterial pharyngitis:

Answer 8

culture, rapid strep test

Question 9

Peritonsillar Abscess:

Answer 9

CAUSE- Usually an untreated acute tonsillitis or ineffectively treated acute tonsillitis

PATHOGENS-Strep, Anaerobes

Question 10

Sypmtoms of Peritonsillar abscess:

Answer 10

SXS- Localized unilateral throat pain, high fever, difficulty swallowing, drooling, “Hot Potato” voice, trismus, unilateral cervical adenopathy

PE- Deviated uvula away from the midline toward the uninvolved side, unilateral fullness of the soft palate, trismus, drooling, voice change

Question 11

Dx of peritonsillar absess:

Answer 11

DXs- Made by physical exam, very rarely is a CT Scan needed.

Question 12

Tx for Peritonsillar abscess:

Answer 12

TREATMENT: I&D (needle aspiration); Formal I&D in OR; Occasional need for Quinsy tonsillectomy

Question 13

Acute Tonsillitis:

Answer 13

Pathogens: 60% viral, 40% bacterial (Group A strep)

Sxs: 
Sore throat
Dysphagia
Odynophagia
Fever
Ear pain
Cervical lymphadenopathy
Rash
Nausea
vomiting(usually associated with strep)

Question 14

Dx of Tonsillitis:

Answer 14

Dx: Clinically not reliable to make diagnosis of strep solely on exam. Recommend culturing.

Question 15

Tx of Tonsillitis:

Answer 15

Treatment: If symptoms seem to be associated with URI can choose to observe and follow closely. If culture positive Rx with antibiotics

Question 16

Complications of Tonsillitis:

Answer 16

Acute Glomerulonephritis
Scarlet Fever- Sandpaper rash occurring 1-2 days after onset of tonsillitis

Rheumatic Fever- evidence of a recent streptococcal infection, will help confirm rheumatic fever.

Question 17

Retropharyngeal Abscess:

Answer 17

Etiology- OM, Severe Nasopharyngitis, Tonsillitis, peritonsillar abscess, Iatrogenic following endoscopy

Sxs- Sore throat, fever,dysphagia,odynophagia, neck pain, neck stiffness, dyspnea

Question 18

Dx of Retropharyngeal Abscess:

Answer 18

PE- Nuchal stiffness, Torticollis, fever, drooling, stridor, posterior pharyngeal edema(usually unilateral)

Diagnosis- CT if stable airway, if not secure airway first

Question 19

Tx of Retropharyngeal Abscess:

Answer 19

Treatment- I&D in OR, IV Antibiotics
Complications- Mediastinitis
Mortality- Overall 1%, but if on presentation infection is already in the mediastinum 50%