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Cumulative > Pharynx & Larynx > Flashcards

Pharynx & Larynx Flashcards

1
Q

Describe the etiology/risk factors of acute viral pharyngitis

A
  • most common PC visit
  • EBV, mpox, rhinovirus, coronavirus, influenza, adenovirus
  • common in children, those in close contact
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2
Q

Describe the clinical presentation of influenza related acute viral pharyngitis

A
  • cough
  • myalgia
  • headache
  • fever
  • “hit by a truck”
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3
Q

Describe the clinical presentation of EBV related acute viral pharyngitis

A
  • persistent fatigue
  • possible hepato/splenomegaly
  • tender posterior cervical nodes
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4
Q

Describe the clinical presentation of HSV related acute viral pharyngitis

A
  • vesicles
  • shallow ulcers
  • diffuse on palate
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5
Q

Describe the clinical presentation of adenovirus related acute viral pharyngitis

A
  • conjunctivitis
  • preauricular LAD
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6
Q

What are the bacterial causes of pharyngitis

A
  • GABH
  • strep
  • gonorrhea
  • diphtheria
  • mycoplasma
  • cornybacterium diphtheria
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7
Q

Describe the PE and diagnostic testing for acute viral pharyngitis

A
  • always include abdominal exam
  • +/- tonsillar exudates
  • cervical LAD not typically prominent or tender
  • negative RST/confirmatory test
  • heterophile Ab
  • flu test
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8
Q

Describe the treatment for acute viral pharyngitis

A

Usually self limited or supportive treatment
- antivirals with flu to shorten the course/lessen the symptoms (Tamiflu, baloxavir)

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9
Q

Describe the etiology/risk factors for mononucleosis

A
  • EBV aka HHV-4
  • saliva or close personal contact
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10
Q

Describe the clinical presentation of mononucleosis

A

persistent (1-2 mos) malaise, fatigue, HA, fever, sore throat
- milder forms can go undiagnosed

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11
Q

Describe the PE/diagnostic testing for mononucleosis

A
  • exudative tonsils
  • hepatosplenomegaly
  • posterior cervical lymphadenopathy
  • palatal petechiae
  • axillary, inguinal, generalized LAD
  • IgM heterophile Ab seen in 2nd week
  • EBV specific Ab testing
  • CBC w/ diff shows lymphocytosis
  • peripheral smear shows atypical lymphocytes
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12
Q

Describe the treatment for mononucleosis

A
  • treat symptoms: analgesics, corticosteroids for 4+ painful tonsils
  • may have secondary strep
  • avoid strenuous activity x21 days d/t risk of splenic rupture
  • rare risk of CNS infection
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13
Q

What happens if PCN/ampicillin is given in mononucleosis

A

rash

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14
Q

Describe the clinical presentation of bacterial pharyngitis

A

Worse in adults
- sore throat
- odynophagia
- rever
- HA
- scarlatina rash (scarlet fever)
- kids may have dysphagia, irritability, n/v
- cough/rhinorrhea absent
- fever >100.4
- beefy red tonsils/oropharynx with exudates
- tonsillar hypertrophy/edema
- halitosis
- tender anterior cervical nodes
- strawberry tongue

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15
Q

Describe the diagnostic criteria for bacterial pharyngitis

A

GABHS Centor Criteria
- fever >100.4
- tender anterior cervical adenopathy
- no cough
- pharyngotonsillar exudates

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16
Q

Describe the diagnostic testing for bacterial pharyngitis

A
  • **RST
  • POCT**
  • relfex to culture or PCR if RST neg
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17
Q

Describe the treatment for bacterial pharyngitis

A
  • treat symptoms
  • Amoxicillin or PCN VK PO BID x10 days
  • cephalexin, azithromycin, clindamycin, PCN G IM x1
  • **peds dosing: 50mg/kg/day divided BID x10 days
  • 50mg/kg once daily
  • max dose 1,000mg/day**
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18
Q

Describe the etiology/risk factors for rheumatic fever

A

can develop 1-5 weeks after strep infection

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19
Q

Describe the clinical criteria/presentation for rheumatic fever

A

Major
- J: joints (polyarthritis, hot/swollen)
- <3: heart (carditis, valve damage)
- N: Nodules (subq, extensor surfaces)
- E: Erythema marginatum (painless rash)
- S: Sydenham chorea (flinching movement disorder)

Minor
- P: Previous rheumatic fever
- E: ECG with PR prolongation
- A: Arthralgias
- C: CRP/ESR elevated
- E: elevated temp

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20
Q

Describe the diagnostic testing for rheumatic fever

A
  • ECG with PR prolongation
  • elevated ESR/CRP
  • history of recent strep infection with presence of 2 major criteria or 1 major and 2 minor critera
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21
Q

Describe the etiology/risk factors for peritonsillar abscess

A
  • can develop after strep infection (or staph)
  • MC in adolescents/young adults
  • usually unilateral
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22
Q

Describe the clinical presentation of peritonsillar abscess

A

gradually progressive: severe sore throat, dysphagia, fever, trismus, hot potato voice, fever

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23
Q

Describe the diagnostic testing/PE for peritonsillar abscess

A
  • medial displacement of tonsil
  • lateral displacement of uvula
  • purulent abscess
  • dehydration
  • needle aspiration or I&D
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24
Q

Describe the treatment of peritonsillar abscess

A
  • admit to hosp
  • IV abx and hydration
  • close follow up a day later d/t recurrence risk
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25
Q

Describe the etiology/risk factors of retropharyngeal abscess

A
  • kids 0-6
  • trauma/sharp object, post-pharyngitis, sinusitis, otitis
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26
Q

Describe the clinical presentation of retropharyngeal abscess

A

- trismus
- sore throat
- dysphagia
- stiff/swollen neck
- fever
- resp distress
- muffled voice
- drooling

27
Q

Describe the diagnostic testing for retropharyngeal abscess

A

CT with contrast

28
Q

Describe the treatment for retropharyngeal abscess

A
  • airway management
  • admit to hosp
  • empiric broad spectrum IV abx
  • serial CT
  • +/- surgical I&D
29
Q

Describe the etiology of sialadenitis

A

acute chronic recurrent inflammation of salivary gland (usually parotid) from infection, obstruction, or autoimmune cause (sjogren’s)

30
Q

Describe the clinical presentation of sialadenitis

A

- fever
- pain when eating
- facial swelling
- difficulty swallowing
- dry mouth

- fever, swelling, TTP on PE

31
Q

Describe the treatment for sialadenitis

A
  • hydration
  • NSAIDs
  • gland massage
  • warm compress
  • sialogogues (lemodrops/popsicles)
32
Q

Describe the etiology of mumps

A
  • paramyxovirus
  • trasmitted through saliva
  • less common now with MMR vax
33
Q

Describe the clinical presentation of mumps

A

- unilateral/bilateral swollen, painful salivary glands
- constitutional sxs
- orchitis: testicular swelling, infertility

34
Q

Describe the etiology/risk factors for herpetic gingivostomatitis

A
  • initial HSV-1 infection resulting in inflammation of gingiva and oral mucosa anywhere throughout oropharynx
  • RF: <3 y/o, primary exposure, adult family with cold sore
35
Q

Describe the clinical presentation of herpetic gingivostomatitis

A

- fever 1-2 days prior
- pain
- dysphagia
- perioral vesicular lesions
- shallow ulcerative enanthem
- irritability
- red gums that bleed easily
- drooling
- submandibular LAD

36
Q

Describe the diagnostic testing for herpetic gingivostomatitis

A

can swab and PCR assay/cell culture to confirm

37
Q

Describe the treatment of herpetic gingivostomatitis

A
  • spontaneous resolution in 1-2 weeks
  • topical liquid benadryl or antacid
  • analgesics
  • acyclovir
  • hydration
38
Q

What are some complications of herpetic gingivostomatitis

A

herpes simplex keratitis (eye), dehydration, encephalitis, recurrence as cold sores
- most contagious when vesicles/ulcers are present

39
Q

Describe the etiology/risk factors for aphthous ulcers

A

aka canker sore
- small ulcers
- likely due to stress, hormones, trauma

40
Q

Describe the treatment for aphthous ulcers

A

topical steroids, lidocain, heal in appx 10 days

41
Q

Describe the etiology/risk factors for herpangina

A
  • coxsackie virus, enterovirus, hand foot and mouth
  • most spread in summer and fall
  • respiratory, oral/fecal, fomite transmission
42
Q

Describe the clinical presentation of herpangina

A

- small gray spots/shallow ulcers in oropharynx
- sudden onset of prodromal fever, sore throat, HA, dysphagia
- vesicles/ulcers on posterior oropharynx, tonsillar pillars, soft palate, uvula, tongue

43
Q

Describe the treatment for herpangina

A
  • no antivirals
  • supportive, infection control
  • spontaneously resolves in 7-10 days
44
Q

Describe the etiology/risk factors for hand foot and mouth disease

A
  • coxackieviruses
  • RF kids in daycare, summer and fall
45
Q

Describe the clinical presentation of hand foot and mouth disease

A
  • fever, sore throat, malaise, dysphagia, irritability
  • painful red blister-like lesions on anterior tongue, gums, inside cheeks, mouth
  • red rash on palms, soles, diaper area
46
Q

Describe the treatment for hand foot and mouth disease

A
  • supportive, infection control
  • spontaneous resolution in 7-10 days
47
Q

Describe some complications of hand foot and mouth disease

A
  • dehydration
  • viral meningitis
  • encephalitis
  • skin may peel and nails fall off
48
Q

Describe the clinical presentation of oral thrush

A

white patches in mouth that easily scrape off and may reveal raw red skin

49
Q

Describe the etiology/risk factors of croup

A

laryngotracheitis
- inflammation of larynx and trachea
- marked swelling in subglottic area
- barky cough
- MC parainfluenza, RSV, adenovirus

50
Q

Describe the clinical presentation of croup

A
  • prodrome of nasal congestion/coryza
  • fever, stridor, barking cough, hoarseness, breathing retractions
  • stridor at rest = concerning
51
Q

Describe the diagnostic testing for croup

A

labs imaging not typical
- x-ray may show steeple sign (epiglottic narrowing)

52
Q

Describe the treatment for croup

A

Mild: manage at home with humid or cold air, antipyretics, oral fluids

Mod-Severe: dexamethasone, nebulized epinephrine, O2, IV fluids PRN

53
Q

Describe the etiology/risk factors of epiglottitis

A

Life threatening emergency
- rapidly progressing cellulitis of epiglottis & surrounding structures leading to progressive obstruction
- bacterial: h flu, s aureus, GABHS, strep pneum

54
Q

Describe the clinical presentation of epiglottitis

A

- fever
- severe sore throat
- drooling
- respiratory distress/stridor
- hot potato voice
- rapid onset an dprogression

55
Q

Describe the diagnostic testing for epiglottitis

A

DO NOT do laryngoscopy - spasm and compromise
- cherry red epiglottis seen in OR during airway establishment
- thumbprint sign seen on x-ray d/t enlarged epiglottis

56
Q

Describe the treatment for epiglottitis

A

Ambulance to ER
- +/- tracheostomy
- keep the patient calm
- IV abx
- consult ID for unvax household contacts
- HiB vax reducing incidence

57
Q

Describe the etiology/risk factors for laryngitis

A

inflammation of larynx
- acute: viral (rhino, flu, adeno, coxackie), bacterial (GABHS, m cat), vocal strain
- chronic: irritants, GERD, malignancy, sinusitis, TB, candida
- chronic if 3+ weeks

58
Q

Describe the clinical presentation of laryngitis

A
  • dysphonia
  • hoarseness
  • coryza
  • URI sxs
59
Q

Describe what is seen on PE in acute laryngitis

A
  • diffuse erythema
  • edema
  • vascular engorgement of vocal cords
60
Q

Describe what is seen on PE in chronic laryngitis

A
  • thickening
  • mucus
  • edema of vocal folds/lining
61
Q

Describe the treatment for acute vs chronic laryngitis

A

Acute: reassurance, rest, humidification, hydration, salt water

Chronic: treat underlying cause, refer to ENT PRN, hydration, humidification, smoking cessation

62
Q

Describe the etiology/risk factors of nodules vs polyps

A

Nodules: benign, chronic hoarseness in kids from vocal use, irritation in adults, bilateral

Polyps: chronic irritation in adults, unilateral, smoking, reflux, trauma

63
Q

Describe the treatment for nodules vs polyps

A

Nodules: resolves in 3-6 mos in kids, nonsurgical in adults

Polyps: surgical in adults

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