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otolaryngology > Sore Throat > Flashcards

Sore Throat Flashcards

1
Q

What is acute tonsillitis

A

Inflammation of the tonsils

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2
Q

What does acute tonsillitis frequently occur with

A

Pharyngitis

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3
Q

What is pharyngitis

A

Inflammation of the oropharynx

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4
Q

What is the most common cause of tonsillitis and pharyngitis

A

Viruses
Rhinovirus, influenza, enterovirus etc.

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5
Q

What is the most common bacterial cause of tonsillitis and pharyngitis

A

Strep pyogenes

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6
Q

Name some other bacterial causes of tonsillitis and pharyngitis

A

H. Influenza
S. Aureus
Strep pneumo

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7
Q

Name some non-infectious causes of pharyngitis

A

GORD, chronic irritation from cigarette smoke

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8
Q

Clinical presentation of viral tonsillitis

A

Malaise, sore throat, temp, able to do normal activity, possibly lymphadenopathy

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9
Q

How long does viral tonsillitis usually last

A

3-4 days

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10
Q

Clinical presentation of bacterial tonsillitis

A

Systemic upset, fever, painful swallowing, halitosis, unable to work, lymphadenopathy

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11
Q

What is halitosis

A

Bad breath

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12
Q

How long does bacterial tonsillitis last

A

1 week, requires antibiotics to settle

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13
Q

Main scoring system to decide if a patient with tonsillitis needs antibiotics

A

FeverPAIN

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14
Q

What does FeverPAIN stand for

A

Fever
Purulence
Attend rapidly (within 3 days)
Inflamed tonsils
No cough

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15
Q

What is the antibiotic prescribed for tonsillitis

A

Phenoxymethylpenicillin

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16
Q

Antibiotic prescribed for tonsillitis if allergic to penicillin

A

Clarithromycin

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17
Q

When do you prescribe antibiotics using FeverPAIN

A

4/5 points
2/3 consider delayed presentation for antibiotics

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18
Q

When to admit or refer a patient with tonsillitis

A

Difficulty breathing
Neck mass
Persistent symptoms >3 weeks

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19
Q

How is tonsillitis managed in hospital

A

IV fluids, antibiotics and steroids

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20
Q

Infection control for group A strep infections

A

Isolate for the first 48 hours of treatment

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21
Q

When is tonsillectomy indicated for adults

A

Recurrent severe sore throat

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22
Q

Most common complication of tonsillitis

A

Otitis media

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23
Q

Name some other complications of tonsillitis

A

Quinsy, parapharyngeal abscess, lemierre syndrome

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24
Q

What is lemierre syndrome

A

Suppurative thrombophlebitis of jugular vein

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25
Q

Name some late complications of a strep A infection

A

Rheumatic fever
Glomerulonephritis

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26
Q

ENT symptom of neutropenia

A

Sore throat

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27
Q

What is diphtheria

A

Bacterial infection that mainly affects the nose and throat

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28
Q

What causes diphtheria

A

Corynebacterium diphtheriae

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29
Q

Why does corynebacterium diphtheriae cause you to be ill

A

Produces a potent exotoxin which is cardiotoxic and neurotoxic

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30
Q

Characteristic symptom of diphtheria

A

Pseudomembrane across the pharynx

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31
Q

Other symptoms of diphtheria

A

Malaise, cervical lymphadenopathy, low grade fever

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32
Q

When do symptoms of diphtheria start following infection

A

2-5 days

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33
Q

Definitive diagnosis of diphtheria

A

Culture of c.diptheriae from resp tract, secretions or cutaneous lesion
Positive toxin assay

34
Q

What is used to treat diphtheria

A

Penicillin, erythromycin

35
Q

What is used to treat severe diphtheria

A

Antibiotics + diphtheria antitoxin

36
Q

What is used to prevent diphtheria

A

Toxoid vaccine

37
Q

Progression of neurological toxicity in diphtheria

A

Local neuropathies
Cranial neuropathies
Peripheral neuritis

38
Q

Name another complication of diphtheria

A

Renal failure

39
Q

What is another name for glandular fever

A

Infectious mononucleosis

40
Q

What causes glandular fever

A

EBV

41
Q

Pathophysiology of glandular fever

A

EBV establishes itself in epithelial cells, notably in the pharynx

42
Q

Clinical presentation of glandular fever

A

Classic triad of fever, pharyngitis and lymphadenopathy

43
Q

Clinical signs of glandular fever

A

Gross tonsillar enlargement with membranous exudates
Cervical lymphadenopathy
Palatal petechial haemorrhages
Rarely hepatosplenomegaly

44
Q

Blood film in glandular fever

A

Atypical lymphocytes (activated cytotoxic T lymphocytes)

45
Q

Investigations for glandular fever

A

FBC and film
Serology (IgM)
Inflammatory markers

46
Q

CRP levels in patients with glandular fever

A

Low

47
Q

Why do we not prescribe amoxicillin in patients with a sore throat

A

Generalised macular rash will result

48
Q

Management of glandular fever

A

Supportive
Antibiotics to prevent secondary infection
Steroids if severe
Avoid sport for 6 weeks due to risk of splenic rupture

49
Q

Complications of glandular fever

A

Anaemia, thrombocytopenia
Splenic rupture
Upper airway obstruction
Increased risk of lymphoma

50
Q

What causes laryngeal nodes and polyps

A

Vocal abuse, infection, smoking

51
Q

What are laryngeal nodes and polyps rarely associated with

A

Hypothyroidism

52
Q

Who usually gets pharyngeal nodules

A

Young women

53
Q

Where are pharyngeal nodes usually located

A

Bilaterally on the middle 1/3 to posterior 1/3 of the vocal chord

54
Q

Where do pharyngeal polyps usually present

A

Unilaterally

55
Q

Clinical presentation of laryngeal nodes and polyps

A

Voice changes: raspy, hoarseness
Pain
Frequent coughing or throat clearing

56
Q

Management of laryngeal nodes and polyps

A

May do biopsy
Voice therapy
Some require surgery

57
Q

What is a contact ulcer

A

Raw sore on the mucous membrane covering the cartilage to which the vocal chords attach

58
Q

What causes contact ulcers

A

Injury to the posterior vocal chord:
Chronic throat clearing, voice abuse, GORD, intubation

59
Q

Clinical presentation of a contact ulcer

A

Mild pain while speaking or swallowing
Varying hoarseness

60
Q

Management of contact ulcers

A

Rest
Voice therapy

61
Q

What is another name for a peritonsillar abscess

A

Quinsy

62
Q

What is the main cause of quinsy

A

Secondary to tonsillitis

63
Q

Pathophysiology of Quincy

A

Bacteria between the muscle and the tonsil produce puss

64
Q

Clinical presentation of quinsy

A

Unilateral throat pain and pain on swallowing
Trismus
Change in voice
Medial displacement of tonsil and vulva
Loss of concavity in palate

65
Q

When does quinsy usually present

A

3-7 following acute tonsillitis

66
Q

Management of quinsy

A

Aspiration and IV antibiotics
Fluids and analgesia

67
Q

What is classed as chronic tonsillitis

A

Symptoms that persist beyond 2 weeks

68
Q

Clinical presentation of chronic tonsillitis

A

Chronic sore throat
Bad breath
Presence of tonsillitis
Peritonsillar erythema
Persistent tender cervical lymphadenopathy

69
Q

Management of chronic tonsillitis

A

Surgery rarely offered
Dental mouthwash
Should settle by itself

70
Q

What is epiglottitis

A

Inflammation of the epiglottis

71
Q

Common causes of epiglottitis

A

Strep pneumo, strep pyogenes, staph aureus

72
Q

Symptoms of epiglottitis

A

Severe sore throat, drooling saliva, pyrexia

73
Q

Clinical signs of epiglottitis

A

No inflammation of tonsils
May have Stridor

74
Q

Management of mild epiglottitis

A

Supportive, antibiotics, nebulisers, corticosteroids

75
Q

Management of severe epiglottitis

A

Antibiotics, intubation and ventilation, tracheostomy

76
Q

What is Reinke’s oedema

A

Swelling of the vocal chords due to fluid collected within the reinkes space

77
Q

What is the most common cause of Reinke’s oedema

A

Smoking

78
Q

Clinical presentation of Reinke’s oedema

A

Hoarse voice, dysphonia, throat discomfort

79
Q

What is dysphonia

A

Abnormal voice changes

80
Q

Investigation for Reinke’s oedema

A

Laryngoscopy

81
Q

Management of Reinke’s oedema

A

Smoking cessation
Voice therapy
Surgery may be required if symptoms don’t improve

otolaryngology (18 decks)

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