URTI (Sore Throat) Flashcards
(38 cards)
What is your pharynx and how is it divided up?
12cm flattened tube extending from base of skull (occipitus) to oesophagus (C6) which bears the inner longitudinal layer, outer circular layer made up of superior, middle and inferior constrictor muscles; pharynx is divided up into nasopharynx (base of skull to soft palate), oropharynx (soft palate to floor of vallecula), hypopharynx/laryngopharynx (floor of vallecula to oesophagus (C6)
What is the function of the pharynx?
respiratory (condition inspired air + propagate into larynx) + immune defence (adenoid tonsils)
What are the tonsils?
sub-epithelial lymphoid tissue collections, of which in throat, they are situated in the pharynx - classified by location. Oropharynx bears tonsils (adenoid, lingual + palatine + tubal + ) which form Waldeyer’s Ring
What is the larynx?
organ located in anterior neck suspended from hyoid bone spanning C3-C6 which is continuous inferiorly with the trachea and opens superiorly into the laryngopharynx. Laryngeal muscles act to move larynx components for phonation + breathing
What is the function of the larynx?
Protect lower respiratory tract (trachea + bronchi) + Assist respiration + Phonation + Effort closure (tighter occlusion of laryngeal inlet as aryeepiglottic muscles contract ≈ as sphincter)
What are the worrying signs of a lymph node examination?
rough + hard + fixed
List 3 common causes of a sore throat.
Tonsilitis
Infectious Mononucleosis
Croup
Supraglottitis (Epiglottitis)
Deep Neck Space Infections
Diptheria
Burns
Reflux (GORD)
A 13 year old girl presents with dysphagia and a cough.
O/E you notice fever, exudate on her tonsils and lymphadenopathy.
What is her CENTOR score?
What is your Differential Diagnosis?
Tonsilitis
CENTOR: 3
Exudate
Nodes
Temperature
thus 3/5
Unlikely to be GABHS thus infects agent likely to be Rhinovirus/Coronavirus/Adenovirus/Influenza/Herpes viruses/EBV/Mycoplasma pneumoniae/Neisseria Gonorrhoea
List 5 pathogens which may cause Tonsillitis.
- Rhinovirus
- Coronavirus
- Adenovirus
- Influenza
- Herpes viruses
- Epstein-Barr Virus (Infectious Mononucleosis)
- Group A ß-haemolytic streptococci
- Group C ß-haemolytic streptococci (GCBHS)
- Mycoplasma pneumoniae
- Neisseria gonorrhoea
List 3 clinical features of tonsillitis.
- Dysphagia
- Fever
- Exudate
- Cough (absence is Centor criteria)
- Lymphodenpathy
A 13 year old girl presents with dysphagia and a cough.
O/E you notice fever, exudate on her tonsils and lymphadenopathy. She has no PMHx and no allergies.
What is her CENTOR score?
What is your Differential Diagnosis?
Outline your management plan.
Tonsillitis - non-streptococcus
Phenoxymethylpenicillin (Penicillin V) 500mg QDS 5-10 days
A 15 year old girl presents with dysphagia and a cough.
O/E you notice fever, exudate on her tonsils and lymphadenopathy. She has no PMHx and is allergic to penicillin.
What is her CENTOR score?
What is your Differential Diagnosis?
Outline your management plan.
Clarithromycin 500mg BDS 5 days
OR
Erythromycin 500mg QDS 5 days
State the main pathogen causing Infectious Mononucleosis.
EBV (90%)
List 3 pathogens which can cause Infectious Mononucleosis.
- EBV (90%)
- HHV
- CMV
- HSV-1
- Measles
An 18 year old university student, Harry, presents with a sore throat, weakness and a fever. He is a healthy weight, socially active going out clubbing three times a week and has no partner. He has had numerous sexual relationships in the last 2 weeks.
O/E you notice petechiae on his soft palate and splenomegaly.
What is the likely diagnosis?
Infectious Mononucleosis
An 18 year old university student, Harry, presents with a sore throat, weakness and a fever. He is a healthy weight, socially active going out clubbing three times a week and has no partner. He has had numerous sexual relationships in the last 2 weeks.
O/E you notice petechiae on his soft palate and splenomegaly.
What is the likely diagnosis?
Outline the investigations you may want to carry out.
- Clinical diagnosis
- FBC: lymphocytosis, atypical lymphocytosis
- Monospot test: Positive for heterophile antibodies
- Serology: EBV-specific antibodies. VCA-IgM, VCA-IgG, EA, EBV EBNA
An 18 year old university student, Harry, presents with a sore throat, weakness and a fever. He is a healthy weight, socially active going out clubbing three times a week and has no partner. He has had numerous sexual relationships in the last 2 weeks.
O/E you notice petechiae on his soft palate and splenomegaly.
What is the likely diagnosis?
Outline the management for Harry.
• Supportive care
(+ Upper airway obstruction/haemolytic anaemia)
• Corticosteroid: Prednisolone
(+ Thrombocytopenia)
Which patient is most likely at risk of Laryngotracheobronchitis?
A. Elderly patient
B. University student
C. Toddler
D. Middle aged woman
C. Toddler
List 3 pathogens which can cause Croup.
- Influenza A/B
- Respiratory syncytial virus
- Adenovirus
- Coronavirus
- Measles
A 5 year old, Jimmy, presents with agitation, fever and coryza. O/E you notice a barking cough, stridor and a hoarse voice (dysphonia).
What is your differential diagnosis?
Croup (laryngotracheobronchitis)
A 5 year old, Jimmy, presents with agitation, fever and coryza. O/E you notice a barking cough, stridor and a hoarse voice (dysphonia).
Outline your investigations you may order.
• Clinical exam = diagnosis
• XR of AP/lateral neck
- Steeple sign (narrowed trachea)
A 5 year old, Jimmy, presents with agitation, fever and coryza. O/E you notice a barking cough, stridor and a hoarse voice (dysphonia).
Outline your management plan.
• Corticosteroids
- Dexamethasone
• Supportive care
- Fluids
- Rest
- Adrenaline nebulised
- Supplemental oxygen
(Respiratory failure)
• Intubation
List the risk factors for Epiglottitis.
- Unvaccinated for Hib
- Immunocompromised
- Middle-aged
Give 3 pathogens which can cause Epiglottitis.
- Haemophilus influenzae
- Streptococcus pneumoniae
- Staphylococcus aureus / MRSA
- Traumatic insult to epiglottis
