The Throat and Neck

Question 1

How does Pharyngitis present?

Answer 1

Pain on swallowing
Enlarged lymph node in neck
Exudate in pharynx
Fever
No cough or hoareseness

Question 2

What is the most common cause or Pharyngitis?

Answer 2

Streptococcal Pharyngitis

Question 3

What is the best initial test for Pharyngitis?

Answer 3

Rapid strep test: (+) test = Postive culture

Question 4

What do small vesicles or ulcers in the Pharynx suggest?

Answer 4

HSV or Herpangina

Question 5

What is Herpangina caused by?

Answer 5

Coxsackievirus

Question 6

Where are lesions in Herpangina?

Answer 6

Posterior Pharynx

Question 7

How is Herpangina treated?

Answer 7

No treatment

Question 8

What do membranous exudates in the pharynx suggest?

Answer 8

Diphtheria, vincent angina or EBV

Question 9

What is the best initial therapy for Pharyngitis?

Answer 9

Penicillin or Amoxicillin

Question 10

What is used to treat Pharyngitis in patients with Rash allergy to Penicillin?

Answer 10

Cefdinir or Cefpodoxime

Question 11

What is used to treat pharyngitis in patients with anaphylaxis allergy to Penicillin?

Answer 11

Clindamycin or a macrolide

Question 12

What are the common adverse effects of Erythromycin?

Answer 12

Nausea, vomit and diarrhea

Question 13

Why is Streptococcal Pharyngitis treated?

Answer 13

To prevent Rheumatic Fever

Question 14

What is Lemierre Syndrome (Septic Jugular Thrombophlebitis)

Answer 14

Infection of Fusobacterium Necrophorum expands beyond the mouth to infect the nearby neurovascular bundle around the jugular vein

Question 15

How do you diagnose Lemierre Syndrome (Septic Jugular Thrombophlebitis)?

Answer 15

CT of the neck

Question 16

How do you treat Lemierre Syndrome (Septic Jugular Thrombophlebitis)?

Answer 16

Ampicillin/Sulbactam
Piperacillin/Tazobactam
Carbapenems
Ceftriaxone + Metronidazole

Question 17

What is Ludwig Angina?

Answer 17

Cellulitis of the floor of the mouth

Question 18

What causes Ludwig Angina?

Answer 18

Spread of oral flora from dental infection of the mandibular molars into the submandibular and sublingual spaces

Question 19

How does Ludwig Angina present?

Answer 19

Swelling of the tongue: may compromise airway necessitating intubation or tracheostomy

Question 20

What is the best initial test for Ludwig Angina?

Answer 20

CT of the neck

Question 21

How do you treat Ludwig Angina?

Answer 21

Ampicillin/Sulbactam
Piperacillin/tazobactam

Question 22

What are Sialolithiasis?

Answer 22

Stones in the ducts draining the salivary glands that cause postprandial pain and local swelling

Question 23

What do recurrent salivary gland stones lead to?

Answer 23

Strictures and Sialadentitis

Question 24

What is the treatment for Sialolithiasis?

Answer 24

Palpate and remove stone manually
Incise the distal duct
Sialoendoscopy
Lithotripsy
Surgery

Question 25

What is Sialadenitis?

Answer 25

Acute bacterial infection of the parotid or submandibular gladnd

Question 26

What pathogen is most commonly associated with Sialadenitis?

Answer 26

Staphylococcus Aureus

Question 27

How does Sialadentitis Present?

Answer 27

Eating causes swelling and increased pain in the erythematous duct: pus can often be expressed from the duct

Question 28

How do you diagnose Sialadenitis?

Answer 28

Clinical; CT or US can help

Question 29

How do you manage Sialadenitis?

Answer 29

Abx Warm Compress Massage Sour candy to increase salivary flow