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Pharynx and Larynx

Clinical Medicine I

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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