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ENT week 1 > ENT infections (throat) > Flashcards

ENT infections (throat) Flashcards

1
Q

What are the main causes of throat infections ?

A

Viral and bacterial - with 2/3rds being viral (hence most don’t need antibiotics)

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2
Q

What is the most common bacterial cause of sore throats ?

A

Group A strep - specifically Strep.pyogenes

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3
Q

What are 2 of the main causes of pain in the back of your mouth?

A

Acute pharyngitis and tonsillitis

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4
Q

What are some of the complications which can occur due to infections of the throat and pharynx?

A
  • Otitis media (most common)
  • Peri-tonsillar abscess (quinsy)
  • Parapharyngeal abscess
  • And mastoiditis
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5
Q

What should not be routinely used to diagnose throat infections ?

A

Throat swabs

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6
Q

What are the more common causes of sore throats ?

A

Common cold, influenza, streptococcal infection

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7
Q

What are the less common causes of sore throats ?

A

HIV, gonococcal pharyngitis, and diphtheria.

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8
Q

What are the common signs of tonsillitis ?

A
  • Pain on swallowing
  • Swollen tonsils
  • Dysphonia
  • Fever
  • Tonsillar exudate
  • Risk factors - most common in 5-15 yr olds
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9
Q

If sore throat and lethargy persist into the second week in 15-25 year olds what should be suspected ?

A

Infectious mononucleosis

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10
Q

What criteria is used to decide wether or not to give someone with a sore throat antibiotics ?

A

The FeverPain score or the centor criteria

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11
Q

List the FeverPain criteria which suggests bacterial infection of the throat

A
  • Presence of tonsillar exudate.
  • Presence of tender anterior cervical lymphadenopathy or lymphadenitis.
  • History of fever.
  • Absence of cough.
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12
Q

List the FeverPain criteria and state the score which is used to determine if antibiotics are given or not for tonsillitis in tayside

A
  • Fever (during previous 24 hours)
  • Purulence (pus on tonsils)
  • Attended rapidly (within 3 days of symptom onset)
  • Severely Inflamed tonsils
  • No cough or coryza

A score of ≥ 4 = 62 – 65% chance of isolating sterptococcus ==> give Antibiotics

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13
Q

What is the first and second line antibiotic treatmeant for sore throats ?

(This is talking about all of tonsillitis/pharyngitis/sore throat)

A
  • 1st line - Penicillin V
  • 2nd line (if penicillin allergic) - Clarithromycin
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14
Q

What complication of tonsillitis can develop ?

A

Peri-tonsillar abscess (quinsy)

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15
Q

What additional signs would suggest development of a quinsy ?

A
  • Unilateral bulging above & lateral to the affected tonsil
  • Uvula is displaced away from the quisy
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16
Q

What is the treatment of a quinsy?

A

Anitbiotics + drainage + consideration of tonsillectomy in 6 weeks

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17
Q

What is the 1st and 2nd line antibiotics used to treat a quinsy?

A
  • 1st line = IV benzylpenicillin or PO Penicillin V if able to swallow (+ mentronidazole if not resolving after 48hrs)
  • 2nd line = PO clindamycin or IV if unable to swallow (dont need to add metronidazole here)
18
Q

What are the 2 main late serious complications of a streptococcal throat infection and there signs?

A
  • Rheumatic fever - 3 weeks post infection, fever, arthritis and pancarditis
  • Glomerulonephritis - 1-3 weeks post infection, haematuria, albuminuria and oedema
19
Q

What is the criteria someone must meet for consideration of doing a tonsillectomy for recurrent tonsillitis ?

A
  1. Sore throats are definitley due to tonsillitis (i.e. not recurrent URTI’s)
  2. Has five or more episodes of sore throat per year
  3. Symptoms have been occurring for at least a year
  4. The episodes of sore throat are disabling and prevent normal functioning
20
Q

What are the main complications of a tonsillectomy and what is done to treat these complications ?

A
  1. Pain - analgesia
  2. Haemorrhage; 1. Primary = haemorrhage usually in the first 6-8hrs. Treat this with immediate return to theatre as it could be masking a larger bleed! 2. Secondary = usually occurs 5-10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics.
21
Q

What is the causative organism of diphtheria ?

A

Corynebacterium diphtheriae

22
Q

Describe the clinical presentation of diphtheria

A

Severe sore throat with a grey white membrane across the pharynx.

23
Q

What is the treatment of diphtheria ?

A
  • Antitoxin, supportive care
  • And penicillin / erythromycin
24
Q

What is the cause of oral candida/thrush?

A

Candida albicans

25
Q

What is the clinical presentation of oral candida/thrush ?

A

White patches on red, raw mucous membranes in throat/ mouth

26
Q

What is the treatment of oral candida/thrush ?

A
  • Nystatin in lecuture but
  • Miconazole on antibiotic man
27
Q

What is infectious mononucleosis caused by ?

A

EBV

28
Q

Describe the clinical presentation of infectious mononucleosis

A
  • Fever
  • Enlarged lymph nodes
  • Sore throat, pharyngitis, tonsillitis
  • Malaise, lethargy
  • Spelnomegaly
  • Most common aged 15-25

May cause - rash, jaundice etc

29
Q

What are some of the complications of infectious mononucleosis ?

A
  • Anaemia, thrombocytopenia
  • Splenic rupture
  • Upper airway obstruction (stridor)
  • Increased risk of lymphoma
30
Q

What is the treatment of infectious mononucleosis ?

A
  • 1st line - supportive care
  • e.g. Bed rest, Paracetamol, Avoid sport

Corticosteroids may be used if theres signs of upper resp obstruction etc

31
Q

How is infectious mononucleosis diagnosed ?

A
  • 1st line - monospot test
  • 2nd line (if monspot negatve but still suspect IM) - Epstein-Barr virus IgM
32
Q

Describe what epiglottitis is

A
  • It is a condition in which there is inflammation of the epiglottis.
  • It may also affect the soft tissues surrounding the epiglottis, particularly in affected adults - hence the term supraglottitis.
  • It is potentially life-threatening if complete obstruction of the airway occurs.
33
Q

What is the cause of epiglottitis ?

A
  • Classically - H.influenxa type B
  • But since the Hib vaccine other bacteria have been more common causes e.g. strep penumonia or pyogenes or staph aureus
34
Q

What are the presenting features of epiglottitis ?

A

Rapid onset:

  • Sore throat
  • Stridor
  • Odynophagia
  • Inability to swallow causing drooling
  • Muffled voice - ‘hot potato’ voice
  • Fever & generally unwell
35
Q

How is epiglottis diagnosed ?

A

Laryngoscopy in operating theatre

36
Q

What is the treatment of epiglottitis ?

A

1st line = ceftriaxone & secure the airway with ET tube

37
Q

Define what the common cold (corzya) is

A

The common cold is an acute, self-limiting, viral inflammation of the mucosa of the upper respiratory tract.

38
Q

What are the causes of the common cold ?

A

It is caused by a vast array of different viruses, some of which include:

  • Adenovirus
  • Rhinovirus
  • Respiratory syncytial virus
  • Coronavirus
39
Q

On average how common is the common cold?

A
  • Adults get 2-3 per year
  • Children get 5-6 per year
40
Q

What are the main presenting features of the common cold ?

A
  • Nasal discahrge
  • Nasal obstruction
  • Sneezing
  • Sore thorat
  • General malaise
  • Cough

Note - Headache & fever are less common

41
Q

What is the treatment of the common cold ?

A

It is self-limiting, so supportive

ENT week 1 (8 decks)

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