THROAT AND MOUTH

Question 1

** Acute Tonsillitis

common causes:

Management

Answer 1

Most frequent between 5-10 and 15-25
Infectious causes: Strep Pyogenes (GABS), Haemophillus
RF: atopic, immune deficiency, Family history

CF: sore throat, swollen red tonsils coated or white fleks of pus, purulent exudate, abdo pain in small kids, headache, rash

Signs: Fever, lymphadenopathy, rhinorrhea, oropharygneal erythema

IVX: dont swab superficial bacteria
EXAMINATION ONLY
Diagnosis of GABS best done on hx and exam
–> Hx fever, tonsillar exudates, no cough and tender cervical lymphadenopathy (centor)

Management: Anaegisia + Penicillin or erythromycin if allergic if Centor >3 or increased risk/ unilateral peritonsilliits

Refer for removalif >5 one year

RX: Quinsy (peritonsillar abscess)

Prevention: smoking cessation for parents

Question 2

** Acute Pharyngitis

Commonest cause:

Answer 2

-Inflammation of the oropharynx but not the tonsils

Cause: Adenovirus and Step Pyogenes GBAS

CF: hoarse voice, mild cough, fever, headache, swollen glands in neck

IVX: one needed/ glandular fever screening

Management: Supportive, paracetemol, gargles, hydrate
Abx only if systemically very unwell

Question 3

Upper Resp Tract Infection

Answer 3

• Common cold
  Causes: Rhinovirus, coronavirus, influenza, parainfluenza, RSV

CF: Nasal discharge, sneezing
soar throat, cough

Management: supportive, 10 days duration average, steam inhailation

Question 4

Acute Epiglottitis

Common cause

Syx

TREATMENT

prevention

Answer 4

Inflammation of the epiglottitis
Potentially LIFE THREATNING
Cause: Haemophilus influenza B, Strep

CF: Sore throat, drooling, odynophagia, fever, tripod sign, muddled voice, stridor

NO COUGH (unlike croup)

DO NOT EXAMINE –> anaesthetist
Intubate or trachy then blood cultures

HiB Treat with Cefotaxime and Hydrocortisone

Prevention Hib vaccine

Question 5

Oral Tumours

Answer 5

RF: heavy smoking, alcohol, poor dentition

Tongue cancer, tonsillar, buccal mucosa,

Question 6

Trigeminal neuralgia

Symtpoms:

Treatment:

Answer 6

• Chronic, debilitating condition
• Intense exteme episodes of pain in face
  “Electric shocks” 5th cranial nerve

RF: tumuors, MS

Syx: Sudden, unilateral, brief, stabbing, recurrent pain in the distribution of one or more branches of the Vth cranial nerve

Triggers = eating, cold wind, brushing teeth

Management: support, education
CARBAMAZEPINE 1st line
Surgery: relieve pressure

Question 7

Oral ulcers

Answer 7

Unexplained ulceration of oral cavity lasting >3 week = urgent referral

Question 8

Hoarseness

Answer 8

• Abnormal change in voice

>3 weeks = sign of laryngeal cancer

Question 9

Globus

Answer 9

• the feeling of a lump in the throat where no true lump exists

Question 10

Stridor

Answer 10

• High-pitched, wheezing sound caused by disrupted airflow

- Usually caused by a blockage or narrowing in upper airway