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Throat conditions Flashcards

(56 cards)

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1
Q

What is stridor

A

Noisy breathing caused by partial obstruction of the respiratory tract
at or below the larynx

High-pitched, whistle-like sound most noticeable on inspiration

Red flag

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2
Q

DDx of stridor in children

A

Croup - Barking cough
Inhaled FB
Anaphylaxis
Epiglottis
Congenital - Laryngomalacia

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3
Q

DDx of stridor in adults

A

Trauma
Anaphylaxis
Laryngitis
Epiglottitis
Laryngeal tumour
Iatrogenic - Bronchoscopy, prolonged intubation, neck surgery

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4
Q

Cause of epiglottitis (aetiology)

A

▫ Infection - Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, Streptococcus A/B/C,
Staphylococcus aureus

▫ Trauma - Chemical or thermal burns, foreign object

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5
Q

Risk factors of Epiglotitis

A

Male
Unvaccinated
Immunocompromised

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6
Q

Epiglottis presentation - symptoms in children

A
  • Acute (hours)
  • Fever
  • Severe sore throat
  • Stridor
  • Odynophagia
  • Drooling
  • Anxious, restless
  • Tripod position
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7
Q

Epiglottis presentation - symptoms in adults

A
  • Progressive (days)
  • Fever
  • Severe sore throat
  • Muffled or hoarse voice
  • Stridor
  • Dyspnoea
  • Odynophagia
  • Drooling
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8
Q

Epiglottis diagnosis

A

DON’T EXAMINE ORAL CAVITY
Secure airway
Laryngoscopy - confirmative
Lateral neck X ray - thumbprint sign

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9
Q

Epiglottitis management

A

AIRWAY EMERGENCY
In GP call 999 and administer oxygen

In A+E
Prep immediate airway management
Fast bleep ENT
Humidified oxygen
IV antibiotics

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10
Q

Risk factors for head and neck cancers

A
  • Smoking cigarettes, cigars, pipes
  • Chewing tobacco or betel
  • Alcohol
  • HPV 16
    ▫ Base of tongue and tonsil
  • Diet
    ▫ Salt cured fish – nitrosamines - nasopharynx
  • Exposure to chemicals
    ▫ Formaldehyde
  • Pre-cancerous conditions
    ▫ Leukoplakia
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11
Q

Sx of head and neck cancers

A
  • Dependent upon site of cancer
  • General symptoms
    ▫ Localised pain
    ▫ Localised swelling
    ▫ Difficulty breathing
    ▫ Bleeding
    ▫ Changes to eating or speaking
    ▫ Lymphadenopathy
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12
Q

Head and neck cancer investigations

A

Consider 2ww referral for
Laryngeal cancer if:
- Age ≥45 with
- Persistent unexplained hoarseness
- Unexplained neck mass
Oral cancer
- Unexplained oral ulceration >3 weeks
- Persistent unexplained neck mass

Ix
- Ultrasound of neck
- Nasendoscopy
- Laryngoscopy
- MRI or CT scan head/sinuses
- Biopsy

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13
Q

Tonsillitis aetiology (cause)

A

Viral (most common) - Influenza, parainfluenza, EBV, acute HIV
Bacterial - Group A Streptococcus (GAS), Neisseria gonorrhoeae

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14
Q

Tonsillitis signs and symptoms

A

Sore throat
▫ Acute – bacterial
▫ Progressive – viral
Odynophagia
Headache
Abdominal pain
Nausea, vomiting
Cough - viral
Rhinorrhoea - viral
Fever
Tonsillar exudate - bacterial
Tonsillar hypertrophy
Tonsillar erythema

Cervical lymphadenopathy
▫ Anterior – GAS
▫ Posterior – EBV

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15
Q

Tonsillitis investigations and diagnosis

A

Clinical diagnosis - Centor criteria, FeverPAIN for Group A strep

Throat culture - definitive diagnosis for bacterial

Rapid streptococcal antigen test
HIV viral load assay

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16
Q

Factors in Centor criteria

A

Fever >38°C
Tonsillar exudate
Absence of cough
Tender anterior cervical lymphadenopathy
Score ≥3 high probability Group A streptococcus

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17
Q

Factors in FeverPAIN

A

Fever >38°C
Purulence (tonsillar exudate)
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza

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18
Q

Tonsillitis management

A

Supportive care - Paracetamol, NSAIDs, Fluids, Topical lidocaine, Throat lozenges

Antibiotics - Use Centor (3 or 4) or FeverPAIN (4 or 5) scoring
- 1st line phenoxymethylpenicillin
- 2nd line clarithromycin
- Erythromycin if pregnant

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19
Q

Group A strep complications

A

Scarlett fever (presents with strawberry tongue)
Rheumatic fever (autoimmune response following group A strep)

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20
Q

Rheumatic fever sx

A

Fever
extreme arthralgias
recent sore throat/scarlet fever
chest pain
dyspnoea
heart murmur
pericardial rub

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21
Q

Rheumatic fever complications

A

Affects joints, heart, brain, skin
Potential permanent damage to heart valves (rheumatic heart disease)

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22
Q

What is quinsy

A

Abscess between the wall of the tonsil and wall of the pharynx

Peritonsillar abscess

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23
Q

What are the signs and symptoms of quinsy?

Study These Flashcards
A

UNILATERAL throat pain
Dysphagia
Odynophagia
Unilateral otalgia (earache)
Drooling
Fever
Erythematous, oedematous tonsil with contralateral UVULAR DEVIATION
Tonsillar exudate
Trismus
Muffled “HOT POTATO” voice
Cervical lymphadenopathy

24
Q

Quinsy diagnosis and investigations

Study These Flashcards
A

Clinical diagnosis
can do CT Head

25
Quinsy tx
Admit to hospital Abscess drainage IV antibiotics IV fluids
26
Why would someone present with red rash on chest and torso following antimicrobial treatment for suspected Group A strep tonsillitis?
If misdiagnosed and it's actually glandular fever, abx (ampicillin / amoxcillin) increases occurence of rash!!!!
27
What is glandular fever?
Infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV) infection
28
How is glandular fever tramsitted?
EBV infection via saliva, genital secretions
29
Complications of glandular fever?
Splenic rupture Hepatitis Severe thrombocytopenia Haemolytic anaemia
30
Glandular fever symptoms and signs
Sore throat Malaise Fatigue Myalgias Fever Tonsillar hypertrophy Tonsillar exudate Erythematous pharynx - red inside throat Soft palate petechiae - red spots Cervical lymphadenopathy - typically posterior - and occipital? Splenomegaly Hepatomegaly Maculopapular rash
31
Glandular fever investigations?
Blood tests Monospot test (heterophile antibodies) Can have false negative within 2 weeks symptom onset so repeat in 5-7 days if negative FBC for Lymphocytosis (More than 10% atypical lymphocytes) LFTs - AST/ALT elevated 2-3x ULN
32
Glandular fever management?
Supportive care Symptoms expected for 2-4 weeks with fatigue lasting longer Avoid kissing, sharing eating/drinking utensils Avoid heavy lifting and contact/collision sports for 1st month of illness - to prevent splenic rupture
33
What is an aphthous ulcer?
Ulceration of the oral mucosa - Painful, clearly defined shallow ulceration with grey base
34
Causes of aphthous ulcers?
Emotional stress Local injury Zinc, vitamin B-12, folate or iron deficiency Food sensitivities HIV infection Crohn’s disease Celiac disease
35
Investigations and diagnosis of aphthous ulcers?
Clinical diagnosis If recurrent consider testing for systemic cause e.g. HIV, celiac disease, Crohn’s, vitamin deficiency etc
36
Management of aphthous ulcers?
Supportive ▫ Saline mouth rinsing ▫ Topical corticosteroid - If started immediately upon symptoms to reduce inflammation ▫ Milk of Magnesia - apply topically to soothe and heal faster (not ingest thats used as laxative) If ulceration >21 days 2WW referral ? cancer
37
What is oral candidiasis and what is it caused by?
Oral overgrowth of the normal GI flora yeast-like fungus Candida species - Most commonly Candida albicans
38
Risk factors of oral candidiasis?
Extremes of ages Immunosuppression Medication - Broad-spectrum antibiotics or oral/inhaled steroids Diabetes Poor dental hygiene Smoking Nutritional deficiency
39
Symptoms and signs of oral candidiasis?
Local burning, soreness or itching Odynophagia or chest pain if candida spreads down throat (oesophageal candidiasis) Signs Dependent upon thrush subtype ▫ Oral thrush - Patches of curd-like yellow/white plaques on tongue, palate or pharynx that CAN BE EASILY SCRAPED OFF REVEALING ERYTHEMATOUS BASE ▫ Acute erythematous/atrophic - Erythematous palate or dorsal tongue ▫ Angular cheilitis - Erythema, fissuring angle of mouth
40
Diagnosis and investigations for oral candidiasis?
Clinical - Swabs unhelpful * Consider testing for systemic causes (HIV, DM, iron/vitamin B12 deficiencies) if recurrent, severe or treatment-resistant
41
Oral candidiasis treatment?
Treat underlying disease, if applicable e.g. DM Mild or localised infection use antifungal - Topical miconazole gel or nystatin suspension Severe or extensive infection use stronger antifungal - Oral fluconazole Advise patients if taking inhaled steroids to rinse mouth after each use to prevent thrush
42
What is oral leukoplakia?
Predominantly white plaque of oral mucosa - Pre-malignant lesion
43
Risk factors of oral leukoplakia?
Alcohol Tobacco Immunosuppression Chronic candidiasis
44
Symptoms and signs of oral leukoplakia?
Asymptomatic Bright white, sharply defined patches on the oral mucosa Slightly raised above surrounding mucosa CANNOT BE RUBBED AWAY
45
Diagnosis and management of oral leukoplakia?
Refer to ENT for biopsy to confirm diagnosis and management
46
What is oral herpes and what is organism is it caused by?
Oral herpes simplex virus (HSV) - cold sores 90% HSV-1
47
How is oral herpes transmitted?
Transmitted via direct contact of skin or mucous membranes with infected secretions ▫ Kissing, sharing utensils ▫ Rarely orogenital sex (HSV-2) Latent herpes can also reactivate to cause symptoms or asymptomatic shedding
48
Oral herpes presentation
Prodrome x6-48h (Pain, burning, tingling, pruritus, paraesthesia) Painful blisters (erythematous vesicles) on mouth nose or chin in clusters that eventually crust over and heal Fever, malaise, sore throat if primary infection Cervical lymphadenopathy
49
Oral herpes diagnosis/investigations
Clinical Swab for HSV PCR if diagnosis uncertain - may have to rupture lesion
50
Oral herpes diagnosis management?
Topical antiviral OTC Oral antiviral if primary infection, severe, recurrent or immunocompromised Minimise transmission risk - Avoid kissing or oral sex until healed - Do not share items that come in contact with lesions (e.g. lipstick) - Avoid touching lesions - Wash hands with soap and water
51
What is sialadenitis?
Infection of the major salivary glands by retrograde transmission of bacteria from oral cavity via the salivary duct
52
Signs and symptoms of sialadenitis
Enlarged painful salivary gland, purulent drainage from duct orifice, red/painful duct, fever , decreased salivary secretion
53
Management of sialadenitis
Heat/cold compresses with massage Aggressive hydration Lemon drops or citrus juice to promote salivary flow Analgesia medication
54
What is Sialolithiasis?
Salivary calculus
55
Presentation of Sialolithiasis
Pain and swelling associated with eating
56
Management of Sialolithiasis
May be removed intra-orally Lemon drops or citrus juice to promote salivary flow

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