Throat and Neck - Angioedema, Epiglottitis, Quinsy, Tonsilitis, Glandular fever, Croup, Scarlet fever, Kawasaki disease Flashcards
Angioedema
-pathophysiology
-presentation
-investigations
-management
Sudden facial swelling within hours - eyes, lips, tongue
Hereditary
Allergen - hives
Idiopathic - SLE
ACEi
If severe - respiratory distress
-stridor
-difficulty swallowing
Identify and avoid the underlying cause
Antihistamine - ceterizine
Severe - PO pred 40mg 7days
If symptoms settle
If likely to be recurrent - daily antihistamine for 3-6months
If multiple episodes of angioedema, hives - daily antihistamine for 6-12months
If recurrence unlikely - PRN antihistmaine
Ludwig’s angina
-pathophysiology
-risk factors
-presentation
-investigations
-management
Dental infection (Sviridans, Saureus, Sepidermidis) => Cellulitis of mouth and soft tissues of neck
Neck swelling
Difficulty swallowing, speaking
Cannot open mouth
Fever
Respiratory distress - stridor, SOB, high RR
FBC - high WCC
CRP
Blood cultures - any hematogenous spread
Needle aspiration - culture, analysis
Dental Xray
Urgent airway assessment and admit to HDU + broad spectrum IV ABx
-intubate?
Surgical abscess drainage
Peritonsillar abscess/quinsy
-pathophysiology
-presentation
-investigations
-management
Complication of tonsilitis (GAS) => collection of pus in the tissue surrounding the tonsils
Severe lateralising sore throat
Difficulty swallowing, speaking
Fever
Trismus
Uvula deviation, swollen tonsil
Clinical diagnosis
FBC - high WCC
CRP - high
LFT, U&E - baseline
EBV/glandular fever screen - viral cause of tonsilitis
Blood cultures - sepsis?
CT neck
Analgesia, IV fluids, IV ABx
Surgical abscess drainage
Tonsilitis
-causes
-presentation
-investigations
-management
-complications
Sore throat, fever
Viral - rhino, corona, paraflu, EBV
-nasal congestion, headache, earache, cough
Bacterial - GAS
-purulent tonsilitis
Clinical diagnosis + Centor (is it GAS)
Conservative - paracetamol/ibuprofen, fluids
Phenoxymethylpenicilin/erythromycin if
-systemic upset due to sore throat
-Hx of rheumatic fever
-peritonsilitis
-increased risk of severe infection
-3+ Centor criteria met
AOM
Quinsy
Sinusitis
Scarlet fever
Rheumatic fever
Post-strep glomerulonephritis
Epiglotitis
-causative organism
-presentation
-diagnosis and investigations
-management
HiBs - disease of childhood
Rapid onset high fever, generally unwell
Stridor
Drooling
Tripod
Direct visualisation by airway trained staff
-if suspected, do NOT examine throat due to risk of obstruction
Xray - thumb sign
Emergency airway support - intubation
O2, IV ABx
Croup
-causative organism
-presentation
-diagnosis, investigations
-management
Paraflu - 6months - 3 years
Stridor
Barking cough
Fever
Flu-like
Admit if
-U6months
-known upper airway issues
-uncertainty about diagnosis
Clinical diagnosis
AP neck Xray - steeple sign
Dexmeth
O2
Adrenaline nebs
Glandular fever
-causative organism
-presentation
-management
EBV
Sore throat, fever, LN, purulent
Splenomegaly, hepatitis (ALT increase)
FBC and monospot
Resolve after 2-4wks, mainly supportive
-rest, fluids, simple analgesia
-avoid contact sports for 4wks after recovery to reduce risk of splenic rupture
Scarlet fever
-causative organism
-presentation
-investigations
-management
Scarlet fever - GAS strep pyogenes
-2-6years
2 day fever
Headache
Sore throat
Strawberry tongue
Sandpaper rash on torso, spares palms and soles
Throat swab but can start ABx whilst waiting for results
PO pen V 10 days (azithromycin if pen allergic)
-can return to school 24hrs after ABx started
Must notify
Kawasaki disease
-pathophysiology
-presentation
-diagnosis
-management
Medium vasculitis
5 day fever - resistant to antipyretics
Conjunctival injection
Bright, red, cracked lips
Strawberry tongue
Cervical LN
Red palms and soles which peel
Clinical diagnosis
High dose aspirin
IVIG
Echo - coronary artery aneurysm
