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HENT > URI, Pharyngitis, Tonsillitis (guest lecture) > Flashcards

URI, Pharyngitis, Tonsillitis (guest lecture) Flashcards

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1
Q

Some manifestations of URIs

A

-nose: rhinitis, rhinosinusitis -tonsils: tonsillitis -phrynx: phryngitis -often a combination of these

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2
Q

What percentage of URIs is viral?

A

90%

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3
Q

What are examples of viruses that cause URIs

A

“cold viruses” like adenovirus & rhinovirus; -influenza: uncommon, more severe sx’s

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4
Q

What are some bacteria that may cause a URI

A

strep. pnuemo> H. flu > M. cat.

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5
Q

transmission of cold virus

A

air, hand-to-face

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6
Q

prevention of transmission of cold virus

A

wash hands; avoid close contact, mask

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7
Q

Treatment of URIs given percentage that are viral

A

90% viral, so no abx

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8
Q

How many days do you hold off abx with URI

A

hold off 7 days unless strep is suspected

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9
Q

When do bacteria start to accumulate and become a problem with URIs?

A

more than 7 days- then may give abx

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10
Q

Main goal with treatment for URIs

A

treat symptoms so patient feels better

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11
Q

What are sx of URIs you would treat?

A
  • runny nose: OTC antihistatmines; ipratropium spray
  • congestion - decongestants
  • thick secretions- guaifenesin makes more thin and runny
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12
Q

Most common cause of non-infectious rhinitis & characteristics

A

allergies -sneezing itchy, runny nose, nasal congestions -not chronic, no sudden onset, no fever

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13
Q

sx with pregnancy-caused non-infectious rhinitis

A

pregnancy (nasal congestion with or without runny nose, no fever, no purulence)

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14
Q

causes of non-infectious rhinitis

A

allergies and pregnancy

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15
Q

What does Waldeyer’s Ring include?

A

adenoids, palatine tonsils, lingual tonsils

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16
Q

What are tonsils also called and what type of organ are they?

A

tonsils=adenoiods; they are secondary lymphatic organs

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17
Q

What do tonsils do?

A

lymphatic organs; secrete topical IgA, and IgG & IgM in to blood

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18
Q

What are causes of stomatitis (mouth)

A

usually viral - aphthous ulcers, herpangina, herpes simplex -fungal - candida/thrus

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19
Q

What causes herpangina?

A

coxsackievirus A

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20
Q

sx of herpangina

A

fever, sore throat, rash/ulcers on palate –> small vesicles with erythematous base that become ulcers -pain can be severe

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21
Q

What type of tx for herpangina?

A

supportive tx - “stomatitis cocktail”

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22
Q

Pharyngitis causative organism

A

>90% viral

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23
Q

What body part does pharyngitis refer to?

A

internal throat

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24
Q

symptoms of viral pharyngitis

A

runny nose, cough, with/without conjunctivitis, with/without diarrhea

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25
non infectious causes for pharyngitis
-snoring - red uvual -laryngeal acid reflux - chronic pharyngitis/laryngitis, nighttime cough, sensation of something in throat, absence of heartburn irrelevant
26
symptoms of acute tonsillitis
-Odynophagia: pain w/ swallowing -Dysphagia: difficulty swallowing, -fever -enlarged, tender lymph nodes upper neck
27
complications of tonsillitis
-missed work/school -dehydration -abscessess in peritonsillar or deep neck -systemic complications like strep
28
Acute tonsillitis exam reveals
-tonsillar enlargement, erythema, exudate -cervical adenopathy (LN's) anterior
29
tonsil calculi
or tonsilloliths; chronic or recent infections
30
Viral causes of tonsillitis
adenovirus, rhinovirus, influenza, Mono (EBV; has exudate)
31
bacterial tonsillitis often has\_\_\_\_\_\_ which is not diagnostic
exudate
32
types of bacteria causes bacterial tonsillitis
-Group A Beta-hemolytic Streptococcus -Other Strep species like strep. pneuma, staph. arrests, Haemophylus influenza
33
What are rare bacterial tonsillitis causative organisms?
N. gonorrhoeae, Clamydia, Cornebacterium diphtheria
34
What type of organism often causes chronic tonsillitis
Group A Stret - actinomyces
35
Clinical Course of Group A strep
sudden onset \* fever, with or without headache, nausea, swollen LNs,
36
Diagnosis of Group A strep
-bacterial may have purulent exudate with tonsil involvement -rapid strep test & culture; throat swab
37
Treatment for Group A Strep
penixillin (amoxicillin); erythromycin if allergic -2nd line - amox/clavulanate, cephalosporins, clindamycin
38
Local strep complications
-peritonsillar abscess -lymphadenitis (infection within lymph nodes) -deep neck abscess
39
Why treat strep throat?
local complications like abscess, systemic complications, contagious nature, shorten course of illness (self limited an most resolve without antibiotics)
40
Symptoms/Presentations of Peritonsillar abscess
-Unilateral symptoms -tonsil, uvula medially deviated -bulging soft palate -trismus - inability to fully open jaw -dysphagia "hot potato voice"
41
Peritonsillar abscess treatment
abx -can aspirate or I&D if necessary -quinsy tonsillectomy
42
Complications of Peritonsillar Abscesses
spread-retropharyngeal or parapharyngeal abscess \*airway obstruction
43
Systemic complications of Group A Strep
-Rhuematic Fever -scarlet fever -glomerulonephritis
44
Rheumatic Fever does what? What is it a complication of?
-infects heart valves (rheumatic heart disease) -complication of Group A Strep
45
Scarlet fever causes what? What is it a complication of?
-toxin produced -causes nausea, headache -widespread red, punctate rash -strawberry tongue -Group A Strep
46
Glomerulonephritis is characterized by what? What is it a complication of?
"coca-cola" urine -Group A Strep
47
When do you treat asymptomatic strep carriers?
-"ping-pong" infections among family -outbreaks of strep illness in class
48
Chronic strep may occur when? what tx would you consider
may occur after repeated abs; consider tonsillectomy or adenoidectomy
49
Diphtheria occurrence & problems
Rare because of immunization -grey pseudomembrane can obstruct -systemic toxins - cardiac, neurologic
50
Treatment for diphtheria
erythromycin or PCN, antitoxin
51
What causes infectious mononucleosis?
Epstein-Barr virus
52
Sx of infectious mononucleosis
-prolonged malaise, fatigue lasts 1-3 months or more -significant tonsil and lymph node enlargement, including posterior neck nodes -tonsil exudate common
53
\_\_\_\_\_% of people with mono are also infected with what other microorganism?
20-30% also infected with strep
54
complications of mono
-splenomegaly 50%, risk of rupture and hemorrhage -hepatomegaly - 10%, elevated LFT's -hepatosplenomegaly 2nd to 4th week
55
Which complication of mono has risk of rupture and hemorrhage?
splenomegaly -no contact sports
56
Diagnosis of Infectious mononucleosis
-monospot (rapid)-only 60% positive 1st two weeks and 90% after 1 month -WBC: elevated lymphocytes 50% & atypical lymphocytes -mono panel; IgM elevated in acute
57
tx for mono
supportive, maybe steroids -abx if infected but NOT AMOXICILLIN -limit activity because of spleen complications
58
Tonsil & adenoid hypertrophy is the most common cause of what?
childhood obstructive sleep apnea
59
sx of tonsil & adenoid hypertrophy
-snoring, poor sleep, bedwetting, apneas, behavioral problems, hard to awaken -adenoids - otitis media, mouth breathing, chronic rhinorrhea, "nasal" speech
60
tx of tonsil & adenoid hypertrophy
tonsilectomy & adenoidectomy are curative
61
cause of epiglottitis
Hemophilus influenza type B (HIB)
62
What is epiglottis & what does it cause
Airway emergency! Causes epiglottis & supraglottic swelling (above vocal cords)
63
In what population(s) do you see epiglottitis
-rare in children since HIB vaccine -immunocompromised adults (alcoholics)
64
sx of epiglottitis
-sitting forward, drooling, cannot swallow secretions -inspiratory stridor (noise w/inhalation) means it's above vocal cords -fever, "toxic"
65
Tx & special notes for epiglottitis
-Do NOT use tongue blade or scope -IV steroids, ibx, racemic epi -urgent anesthesia & ENT eval -may need intubation vs trach
66
Ankyloglossia
tongue-tie
67
Torus Palatini
68
Ankyloglossia
69
Obstructing tonsils (tonsil hypertrophy)
70
infectious mononucleosis -tonsil enlargement & tonsil exudate common
71
Peritonsillar abscess | (local complication of strep)
72
Acute Tonsillitis (tonsillar enlargement, erythema, exudate)
73
acute tonsillitis (tonsillar enlargement, erythema, exudate)
74
viral pharyngitis/ tonsillitis
75
Candida (Oral Thrush)
76
aphthous ulcers (viral)

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