Throat Disorders

Question 1

What is the term for a “sore throat”?

Answer 1

Pharyngitis/tonsillitis

Question 2

What is the most common etiology of pharyngitis/tonsillitis?

Answer 2

viral

Question 3

Which type of pharyngitis/tonsillitis is described below?

Minimal signs and symptoms

Cough

Rhinorrhea

Hoarseness

Minimal exudate (Exception: Mono)

Answer 3

Viral

Question 4

Which type of pharyngitis/tonsillitis is described below?

Symptoms more severe

Fever

Dysphagia/odynophagia

Anterior cervical adenopathy

Tonsillar exudate

Answer 4

Bacterial

Question 5

What is the most common bacterial pathogen in pharyngitis?

Answer 5

Strep

Question 6

Name some conditions in a differential diagnosis of a sore throat?

Answer 6

Viral
Mono
Bacterial
Post nasal drip
Peritonsillar abscess
Retropharyngeal abscess
diphtheria

Question 7

What are some absolute indications for a tonsillectomy?

Answer 7

Obstructive sleep apnea
Cor pulmonale
Tonsillar asymmetry

Question 8

What are some relative indications for a tonsillectomy?

Answer 8

Recurrent streptococcal tonsillitis
Recurrent PTA
Chronic tonsillitis

Question 9

What are some complications of a tonsillectomy?

Answer 9

Post-op bleeding
Airway obstruction
Pain
Protracted emesis and fever

Question 10

In cases of tonsillar asymmetry, what is recommended?

Answer 10

Biopsy for lymphoma

Question 11

What criteria do we use in cases of suspected strep pharyngitis, that when the four features are present, GABHS pharyngitis is strongly suspected?

Answer 11

Centor Criteria

Question 12

List the four features of the Centor Criteria

Answer 12

Fever over 100.4

Tender anterior cervical adenopathy

Lack of cough

Pharyngotonsillar exudate and erythema

Question 13

What are complications/sequela of GABHS Pharyngitis?

Answer 13

Rheumatic fever
Glomeronephritis
Scarlet fever

Question 14

What is the drug of choice for treatment of GABHS Pharyngitis?

Answer 14

Penicillin x 10 days

Question 15

What diagnostic test for GABHS Pharyngitis has 90-99% sensitivity?

Answer 15

Rapid Strep test

Question 16

Can mimic/resemble strep

Characteristic whitish purple exudate extending into the nasopharynx

Typically young patients

Can have marked lymphadenopathy

Answer 16

Mononucleosis

Question 17

What is the virus responsible for mononucleosis?

Answer 17

EBV

Question 18

What cause of pharyngitis is described below?

Shaggy white-purple exudate extending into nasopharynx

Excessive fatigue

Tender posterior and cervical adenopathy

Marked lymphadenopathy

hepatosplenomegaly

Answer 18

Mononucleosis

Question 19

Quinsy Throat

Infection of tonsillar fossa

Suppurative complication of tonsillitis

Typically unilateral

Answer 19

Peritonsillar Abscess

Question 20

What cause of pharyngitis is described below?

Fever, chills, malaise

Odynophagia/dysphagia/otalgia

History of tonsillitis – inadequately treated

“hot potato” voice (muffled)

Trismus (lockjaw)

Drooling (pending airway problems)

Fluctuant peritonsillar fullness

Uvular base deviated away from lesion

Tonsil displaced medially

Cervical lymphadentitis

Answer 20

Peritonsillar Abscess

Question 21

What is the DOC for peritonsillar abscess?

Answer 21

Clindamycin

Question 22

What is the definitive treatment for peritonsillar abscess?

Answer 22

I&D – need to go to OR

Question 23

What are some complications of peritonsillar abscess?

Answer 23

Asphyxia (Laryngeal edema)

Aspiration pneumonia

Retropharygeal abscess

Descending infections

Ascending infections (Brain abscess, Meningitis, Cavernous sinus thrombosis)

Question 24

Most commonly encountered neck space infection

Primarily in anterior neck (worry about compression)

Cellulitis of the sublingual and submaxillary space

Answer 24

Ludwig’s Angina

Question 25

What are some etiologies of ludwig’s angina?

Answer 25

Hx dental abscess Strep infection

Question 26

What cause of pharyngitis is described below? Edema and erythema of upper neck Displacement of tongue up and back (Can occlude airway) Respiratory distress

Answer 26

Ludwig’s Angina

Question 27

What are some complications of Ludwig’s Angina?

Answer 27

Extension to deep neck space Airway compromise

Question 28

Infection due to penetrating trauma or extension from a peritonsillar abscess, dental infection, or lateral space infection This is an emergency! Typically affects children ages 2 and younger

Answer 28

Retropharyngeal Abscess

Question 29

What are some complications of a retropharyngeal abscess that makes it an emergency?

Answer 29

May quickly compromise airway (laryngeal edema) May spread to the mediastinum (Mediastinitis) May cause septicemia Aspiration pneumonia Hemorrhaging (Carotid, internal jugular)

Question 30

What cause of pharyngitis is described below? Fever Dysphagia/ Odynophagia/Drooling May look toxic Asymmetrical swelling in posterior pharynx Pain with neck ROM Anterolateral neck swelling Dyspnea Cervical lymphadentitis Cervical lordosis Tender posterior pharyngeal swelling (50%) Sub-Q emphysema (rare)

Answer 30

Retropharyngeal Abscess

Question 31

What is the mortality rate with a retropharyngeal abscess even despite treatment?

Answer 31

Mortality rate of 25%

Question 32

Syndrome of temporary airway obstruction 90% oropharynx 80% hypopharynx Absolute indication for tonsillectomy

Answer 32

Obstructive Sleep Apnea

Question 33

What condition or disorder is described below? Snoring Excessive daytime sleepiness Falling asleep during normal activities Witnessed apnea

Answer 33

Obstructive Sleep Apnea

Question 34

Patients with obstructive sleep apnea are at risk for what other things?

Answer 34

Accidents HTN IHD Cardiac ectopy CVA

Question 35

What neck radius in men and women is suggestive of obstructive sleep apnea?

Answer 35

Neck >17” – males Neck >15” – females

Question 36

Using polysomnography (sleep study), what reading is diagnostic of obstructive sleep apnea?

Answer 36

AHI >/= 15, desats

Question 37

What is the gold standard treatment for obstructive sleep apnea?

Answer 37

Tracheostomy