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Pharynx and Larynx
Clinical Medicine I
| Question | Answer |
|---|---|
| What % of outpatient abx use is for a sore throat? | 50% |
| Most common cause of pharyngitis | Viral |
| Most common bacterial pathogen for pharyngitis age 5-15yo | GABHS |
| How is pharyngitis spread | Via droplet particles |
| MC viral pathogens | Rhinovirus (others: adenovirus, enterovirus, coronavirus) |
| Which virus usually produces exudates and conjunctivitis? | adenovirus |
| DDx viral vs bacterial pharyngitis | based on PE, if viral sxs significant, most likely viral, can do a strep test, culture, monospot, or CBC if looks sick |
| Tx Viral pharyngitis | Antipyretics, warm saline gargles, ^ fluid intake, Rest, soft diet |
| Mono infection characteristics | fever, sore throat, lymphadenopathy (w/ atypical lympocytosis in blood draw) |
| MC cause of Mono | Epstein-Barr virus |
| Systemic sxs of strong mono virus | fatigue, splenomegaly, hepatitis |
| What does the monospot look for? | heterophile ab (if cause by EBV) |
| Why is incidence of mono so low? | Most people exposed to EBV younger and have the ab (won’t develop mono) |
| Transmission of Mono | Saliva (kiss kiss) |
| Key sxs for mono | sore throat, fever, with swollen lymph glands (in POSTERIOR CHAIN!) |
| When testing for mono, should always test what? | Strep! Monospot could be false + d/t recent infection |
| If monospot – but still suspicious what other tests could be done | EBC ab panal test, WBC w/diff (atypical lymphocytes) LFT’s |
| Crucial pt education for those in contact sports and mono? | NO CONTACT SPORTS 1m, splenomegaly could rupture! |
| Centor Criteria for GABHS | fever, tender ant. Cervical nodes, exudate tonsils, lack of cough |
| How can strep present in young kids? | GI sxs, N/V/D, look in their throat |
| Gold standard for strep dx | Throat culture, tx if highly suspicious |
| Tx Strep | Abx, Pen. Or Erythromycin |
| Complications of Strep infx | Scarlet fever, rheumatic fever, glomerulonephritis, chorea, PANDAS |
| Rash presenting 12-24 hrs post strep infxn | Scarlet fever: sandpaper rash/strawberry tongue |
| Sxs Peritonsillar abscess | unilateral severe throat pain, radiate to ear, trismus, odynophagia |
| Signs Peritonsillar abscess | bulging 1 tonsil, deviation of uvula to opposite side, tender cervical adenopathy |
| Tx Peritonsillar abscess | Abx, aspiration, I & D admit depending on pt. Close follow up! |
| Indications for Tonsillectomy | airway obstruction/sleep apnea, recurring infections (paradise criteria) |
| Paradise criteria | 3 or more infx in 3 consecutive yrs, 4 or more infx in 2 cons. Yrs, 7 in 1 yr, PTA unresponsive to tx, chronic tonsillitis |
| Bleeding risks for tonsillectomy | 24 hr post surgery, then 5-8 days post surgery as eschar falls off |
| High-pitched (inspiratory) sounds that results from turbulent airflow from a narrowed glottis | stridor |
| Airway narrowing below vocal folds | expiratory or biphasic stridor |
| MC bacterial pathogens for epiglottitis | H. flu, strep A, strep pneumo, S. aureus |
| Acute, rapidly progressive, potentially fatal airway obstruction | Supraglottitis/Epiglottitis ~24 hr onset |
| 3 d’s and what it represents | Drooling, dysphagia, distress: Epiglottitis Tripod position |
| Enlarged epiglottis on lateral soft tissue XR of neck | Thumbprint sign for Epiglottitis |
| Tx Epiglottitis | protect airway, IV abx/steroids? |
| Laryngotracheitis/laryngotracheobronghicis | Croup |
| MC cause of stridor in children | Croup |
| CP of Croup | prodrome, slower onset, barky cough |
| Croup dx | lateral ap neck XR Steeple sign ~50%, WBC, pulse ox |
| When to refer laryngitis | > 2wks URI sxs, smokers, no obvious cause, pain, hemoptysis, dysphagia, neck mass |
Created by:
becker15
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