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otolaryngology > Sore Throat > Flashcards

Sore Throat Flashcards

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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
Name some late complications of a strep A infection
Rheumatic fever Glomerulonephritis
26
ENT symptom of neutropenia
Sore throat
27
What is diphtheria
Bacterial infection that mainly affects the nose and throat
28
What causes diphtheria
Corynebacterium diphtheriae
29
Why does corynebacterium diphtheriae cause you to be ill
Produces a potent exotoxin which is cardiotoxic and neurotoxic
30
Characteristic symptom of diphtheria
Pseudomembrane across the pharynx
31
Other symptoms of diphtheria
Malaise, cervical lymphadenopathy, low grade fever
32
When do symptoms of diphtheria start following infection
2-5 days
33
Definitive diagnosis of diphtheria
Culture of c.diptheriae from resp tract, secretions or cutaneous lesion Positive toxin assay
34
What is used to treat diphtheria
Penicillin, erythromycin
35
What is used to treat severe diphtheria
Antibiotics + diphtheria antitoxin
36
What is used to prevent diphtheria
Toxoid vaccine
37
Progression of neurological toxicity in diphtheria
Local neuropathies Cranial neuropathies Peripheral neuritis
38
Name another complication of diphtheria
Renal failure
39
What is another name for glandular fever
Infectious mononucleosis
40
What causes glandular fever
EBV
41
Pathophysiology of glandular fever
EBV establishes itself in epithelial cells, notably in the pharynx
42
Clinical presentation of glandular fever
Classic triad of fever, pharyngitis and lymphadenopathy
43
Clinical signs of glandular fever
Gross tonsillar enlargement with membranous exudates Cervical lymphadenopathy Palatal petechial haemorrhages Rarely hepatosplenomegaly
44
Blood film in glandular fever
Atypical lymphocytes (activated cytotoxic T lymphocytes)
45
Investigations for glandular fever
FBC and film Serology (IgM) Inflammatory markers
46
CRP levels in patients with glandular fever
Low
47
Why do we not prescribe amoxicillin in patients with a sore throat
Generalised macular rash will result
48
Management of glandular fever
Supportive Antibiotics to prevent secondary infection Steroids if severe Avoid sport for 6 weeks due to risk of splenic rupture
49
Complications of glandular fever
Anaemia, thrombocytopenia Splenic rupture Upper airway obstruction Increased risk of lymphoma
50
What causes laryngeal nodes and polyps
Vocal abuse, infection, smoking
51
What are laryngeal nodes and polyps rarely associated with
Hypothyroidism
52
Who usually gets pharyngeal nodules
Young women
53
Where are pharyngeal nodes usually located
Bilaterally on the middle 1/3 to posterior 1/3 of the vocal chord
54
Where do pharyngeal polyps usually present
Unilaterally
55
Clinical presentation of laryngeal nodes and polyps
Voice changes: raspy, hoarseness Pain Frequent coughing or throat clearing
56
Management of laryngeal nodes and polyps
May do biopsy Voice therapy Some require surgery
57
What is a contact ulcer
Raw sore on the mucous membrane covering the cartilage to which the vocal chords attach
58
What causes contact ulcers
Injury to the posterior vocal chord: Chronic throat clearing, voice abuse, GORD, intubation
59
Clinical presentation of a contact ulcer
Mild pain while speaking or swallowing Varying hoarseness
60
Management of contact ulcers
Rest Voice therapy
61
What is another name for a peritonsillar abscess
Quinsy
62
What is the main cause of quinsy
Secondary to tonsillitis
63
Pathophysiology of Quincy
Bacteria between the muscle and the tonsil produce puss
64
Clinical presentation of quinsy
Unilateral throat pain and pain on swallowing Trismus Change in voice Medial displacement of tonsil and vulva Loss of concavity in palate
65
When does quinsy usually present
3-7 following acute tonsillitis
66
Management of quinsy
Aspiration and IV antibiotics Fluids and analgesia
67
What is classed as chronic tonsillitis
Symptoms that persist beyond 2 weeks
68
Clinical presentation of chronic tonsillitis
Chronic sore throat Bad breath Presence of tonsillitis Peritonsillar erythema Persistent tender cervical lymphadenopathy
69
Management of chronic tonsillitis
Surgery rarely offered Dental mouthwash Should settle by itself
70
What is epiglottitis
Inflammation of the epiglottis
71
Common causes of epiglottitis
Strep pneumo, strep pyogenes, staph aureus
72
Symptoms of epiglottitis
Severe sore throat, drooling saliva, pyrexia
73
Clinical signs of epiglottitis
No inflammation of tonsils May have Stridor
74
Management of mild epiglottitis
Supportive, antibiotics, nebulisers, corticosteroids
75
Management of severe epiglottitis
Antibiotics, intubation and ventilation, tracheostomy
76
What is Reinke’s oedema
Swelling of the vocal chords due to fluid collected within the reinkes space
77
What is the most common cause of Reinke’s oedema
Smoking
78
Clinical presentation of Reinke’s oedema
Hoarse voice, dysphonia, throat discomfort
79
What is dysphonia
Abnormal voice changes
80
Investigation for Reinke’s oedema
Laryngoscopy
81
Management of Reinke’s oedema
Smoking cessation Voice therapy Surgery may be required if symptoms don’t improve

otolaryngology (18 decks)

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