Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
124 Cards in this Set
- Front
- Back
|
what are the 3 divisions of the pharynx
|
1. nasopharynx 2. oropharynx 3. laryngopharynx
|
|
|
what are the essentials of Dx of pharyngitis
|
sore throat, fever, anterior cervical adenopathy, tonsillar exudate
|
|
|
what is the focus treatment of pharyngitis
|
to treat GABHS infection to prevent rheumatic sequelae
|
|
|
what is pharyngitis
|
infection or irritation of the pharynx and/or tonsils
|
|
|
what is the pathophysiology of pharyngitis
|
Bacteria or viruses may directly invade the pharyngeal mucosa, causing a local inflammatory response
|
|
|
streptococcal infections due to pharyngitis are characterized by what
|
local invasion and release of extracellular toxins and proteases
|
|
|
true or false; pharyngitis is usually not infectious
|
flase, typically is infectious
|
|
|
what % of cases of pharygitis are viral in origin
|
40-60%
|
|
|
what % of cases of pharygitis are bacterial in origin
|
5-40%
|
|
|
what are the viruses associated w/ viral pharyngitis
|
adenovirus, rhinovirus parainflu, coxsackie, HSV, EBV, CMV, RSV
|
|
|
what are pathogens associated w/ bacterial pharyngitis
|
group A beta-hemolytic strep, Neisseria gonorrhoeae, C. diphtheriae, H. flu, Moraxella catarrhalis,
|
|
|
immunocompromised individuals are subjected to what type of pharyngitis
|
fungal
|
|
|
fungal pharyngitis is associated w/ what species
|
candida
|
|
|
what are some other causes of pharyngitis
|
allergy, trauma, toxins, neoplasia
|
|
|
group A beta hemolytic strep is the same as what
|
strep pyogens
|
|
|
what acounts for approx 12 million annual ambulatory care visits in the US
|
acute pharyngitis
|
|
|
Strep infection predominantly between what ages
|
5-18
|
|
|
true or false: Pharyngitis under 3 years of age is uncommon but possible; it is nearly always due to ?
|
true/viral etiologies
|
|
|
GABHS causes what % of all adult pharyngitis and about what % of pediatric cases
|
15%/30%
|
|
|
what causes 15% of all adult pharyngitis and about 30% of pediatric cases
|
GABHS
|
|
|
what are the symptoms of pharygitis
|
Sore throat
Odynophagia Fever / Chills Malaise Headache Anorexia Abdominal pain |
|
|
what is odynophagia
|
painful swallowing
|
|
|
what are the signs of pharygitis in the PE
|
Fever
Tonsillopharyngeal erythema Exudates (patchy and discrete) Beefy red swollen uvula Lymphadenopathy (tender anterior cervical nodes) Petechiae on the palate Rash – sandpaper-like scarlatiniform rash is seen in GABHS infection |
|
|
what are the Ddx of pharygitis
|
Thrush
Mononucleosis (EB Virus) Epiglottitis |
|
|
what are the diagnostics done for pharyngitis
|
GABHS rapid antigen detection test,Throat culture, Antistreptolysin-O(ASO) is a highly sensitive test
Mono spot- up to 95% sensitive in children (EBV) |
|
|
what test is the GOLD standard for diagnosis of GABHS infection (90-99% sensitive).
|
throat culture
|
|
|
Viral pharyngitis is treated how
|
systematically w/ Acetaminophen,Ibuprofen
Saltwater gargling, Soft, cool foods |
|
|
how should pharyngitis due to GABHS treated
|
Pen VK (Beepen-VK) - DOC
500 mg PO QID F10 Pen G benzathine (Bicillin LA) 1.2 million Units IM (single dose) Amoxicillin: 500 mg PO TID F7 Erythromycin: 500 mg PO QID F10 |
|
|
what are potential complications associated w/ pharygitis
|
Rheumatic fever, Glomerulonephritis, Abscess of the throat and tonsils, Scarlet fever
|
|
|
rhematic fever associated w/ pharygitis is also associated w/ what
|
heart valve Dz
|
|
|
glomerulonephritis associated w/ pharygitis is also associated w/ what
|
kidney Dz
|
|
|
if GABHS test is negative what has to be done
|
culture
|
|
|
Abscess of the throat and tonsils associated w/ pharygitis is also associated w/ what
|
Spread of the infection into the deep tissues of the throat which could require surgical drainage
|
|
|
scarlet fever associated w/ pharygitis is also associated w/ what
|
skin Dz
|
|
|
when should you NEVER attempt to examine the throat and why
|
when epiglottitis is suspected because of risk of precipitating respiratory obstruction
|
|
|
when and in whom should you not use aspirin to treat fever/why
|
in children or teenagers because of risk of Reye's syndrome
|
|
|
what is the DOC for strep pharyngitis
|
Pcn
|
|
|
what can you give a child in replacement of Pcn if child does not like taste of pcn
|
amoxicillin/Pcn shots
|
|
|
what warrants urgent evaluation by a specialist, likely including inpatient care in pharyngitis
|
Appearance of stridor or total dysphagia
|
|
|
what should be done when streptococcal infections recur and tonsils are intact
|
consult with an ENT specialist to consider tonsillectomy
|
|
|
strep must be treated w/in how many days
|
9
|
|
|
what is Peritonsillar abscess (PTA)
|
suppurative infection of the tissues adjacent to the palatine tonsil that develops from the direct spread of an inadequately treated bacterial tonsillitis
|
|
|
what is the estimated incidence of Peritonsillar abscess
|
45,000 new cases annually in US
|
|
|
what is the predominant age of Peritonsillar abscess
|
greatest incidence in adolescents and young adults age 15-35
|
|
|
what is the sex predominance of Peritonsillar abscess
|
Male = Female
|
|
|
what are the symptoms of a Peritonsillar abscess
|
Unilateral, severe throat pain
Dysphagia Odynophagia Trismus (difficulty opening the mouth wide) Neck pain Referred ear pain Drooling Muffled ('hot potato') voice Fever (>38.0C) |
|
|
what are the signs in the PE of a Peritonsillar abscess
|
Febrile
Difficulty opening mouth (trismus) Oropharynx Cervical adenopathy Halitosis |
|
|
what is the mose common abscess of the head and neck region
|
peritonsillar abscess
|
|
|
what is oropharynx
|
Asymmetric swelling of the soft tissues is lateral and superior to the affected tonsil with displacement of the affected tonsil medially and anteriorly.
Uvula is displaced to the contralateral side. Fluctuant area is palpable |
|
|
what are the Ddx of peritonsillar abscesses
|
Peritonsillar cellulitis
Infectiousmononucleosis Diphtheria Dental abscess Epiglottitis Extranodal non-Hodgkin's lymphoma of the parapharyngeal space |
|
|
what diagnosticcs need to be done for peritonsillar abscess
|
CBC c DIFF
Culture and sensitivity of purulent material from needle aspiration Ultrasonography, CT |
|
|
what will an ultrasonography of a peritonsillar abscess show
|
discrete abscess cavity if present
|
|
|
what are the Tx of a peritonsillar abscess
|
combination of intravenous antibiotics, rehydration, and evacuation of the pus collection: Needle aspiration
Incision and drainage Tonsillectomy |
|
|
when should a tonsillectomy be perfomed in treating peritonsillar abscesses
|
in patients with a history of frequent previous tonsillar infections. This is usually performed after the infection has resolved because of the increased risk for complications if performed in the acute setting.
|
|
|
Any person who has had a peritonsillar abscess is at risk for what
|
a recurrence, both immediately (within 4 days) and long-term (2-3 years).
|
|
|
what should be sure to examine in a peritonsillar abscess
|
anterior peritonsillar pillar - a well defined pillar speaks against the possibility of peritonsillar abscess
|
|
|
what is the sole reservoir for B pertussis and B parapertussis.
|
humans
|
|
|
humans are the sole reservoir for what
|
B pertussis and B parapertussis.
|
|
|
what is a gram-negative, non-motile pleomorphic bacillus (short rod) that spreads via aerosolized droplets from coughing of infected individuals
|
B pertussis
|
|
|
what attaches to and causes damage to ciliated respiratory epithelium
|
B pertussis
|
|
|
B pertussis attaches to and causes damage to what
|
ciliated respiratory epithelium
|
|
|
A mucopurulosanguineous exudate forms where
|
respiratory tract
|
|
|
what exudate compromises the small airways (especially those of infants) and predisposes the affected individual to atelectasis, cough, cyanosis, and pneumonia.
|
mucopurulosanguineous exudate
|
|
|
what are the contributing factors of pertussis
|
Non-Immunization
Partial immunization Waning of immune status, as in older individuals Pregnancy Contact with an infected person Epidemic exposure |
|
|
what is pertussis
|
endemic disease occurring in 2-5 yr cycles with most cases occurring in late summer and early fall
|
|
|
what is a whooping cough
|
pertussis
|
|
|
when did the rate of pertussis peak
|
1930's- 265,269 cases and 7518 deaths reported in the U.S.
|
|
|
when did pertussis decrease
|
1976, when 1010 cases and 4 deaths occurred
|
|
|
true or false: The rate recently peaked to 25,616 cases reported to the CDC in 2005 and 15,632 reported in 2006
|
true
|
|
|
what remains the most commonly reported vaccine-preventable disease in the United States in children younger than 5 years
|
pertussis
|
|
|
pertussis occurs in what age group
|
3 mths-5 yrs - >70% of cases reported in children younger than 5 years.
|
|
|
what is the sex prevalance of pertussis
|
girls more than boys
|
|
|
what does pertussis present w/
|
3 distinct stages, after infection of the host's respiratory tract with B. pertussis and a 3-12 day incubation period
|
|
|
what is the name of stage 1 of pertussis
|
catarrhal
|
|
|
what is the name of stage 2 of pertussis
|
paroxymal
|
|
|
what are the characteristics of stage 1 of pertussis
|
indistinguishable from common URI’s with nasal congestion, rhinorrhea, sneezing, low-grade fever, tearing, conjunctival suffusion and a hacking night cough that becomes diurnal
|
|
|
when is pertussis most contagious
|
catarrhal/ stage 1
|
|
|
what will pts in stage 2 of pertussis present w/
|
paroxysms of intense coughing lasting up to several minutes
|
|
|
what are the characteristics of stage 2 of pertussis
|
In older infants and toddlers, the paroxysms sometimes are followed by a loud whoop as inspired air goes through a still partially closed airway (obstructed subglottis).
Infants younger than 6 months do not have the characteristic whoop but may have apneic episodes and are at risk for exhaustion. Paroxysms of coughing, often provoked by feeding (in infants) and exertion Paroxysms may be more frequent at night Posttussive vomiting and turning red with coughing are common in affected children. |
|
|
what is the name of stage 3 of pertussis
|
convalescent
|
|
|
what stage of pertussis will you see fits of coughing
|
stage 2
|
|
|
what are the characteristics of stage 3 of pertussis
|
a chronic cough, which may last for weeks.
Fatigue, weakness, and weight loss may occur, followed by delayed recovery of body weight |
|
|
what are the signs in the PE of catarrhal pertussis
|
Cory and rhinorrhea
Lacrimation Mild conjunctival injection Low-grade or no fever Mild, dry, unproductive cough Inflamed mucous membranes |
|
|
what are the signs in the PE of paroxymal stage or pertussis
|
Face may become suffused or cyanotic during an episode
Fever absent or minimal |
|
|
what are the signs in the PE of convalescent stage of pertussis
|
Paroxysmal cough not as frequent or severe as in the paroxysmal phase
May be triggered by an upper respiratory infection or a sudden stimulus like a blast of cold air |
|
|
what are the Ddx of pertussis
|
Bronchiolitis
Bacterial pneumonia Croup Cystic fibrosis Tuberculosis Foreign body aspiration Chlamydia trachomatis respiratory infection |
|
|
what are the diagnostic studies done for pertussis
|
Recovery of B. pertussis from nasopharyngeal secretions provides a definitive diagnosis.
Peripheral lymphocytosis, (ELISA) for IgG, IgM, and IgA antibodies to B. pertussis, culture and PCR tests if a patient has a cough lasting longer than 3 weeks |
|
|
when does Peripheral lymphocytosis develop in pertussis and to what degree
|
>30,000cells/mm3, develops late in the catarrhal phase and continues into the paroxysmal phase. This is a characteristic finding
|
|
|
CDC recommends both culture and PCR tests for who in diagnosis pertussis
|
tests if a patient has a cough lasting longer than 3 weeks
|
|
|
diagnosis of pertussis is made presumptively in patients with what
|
with a history of intense paroxysmal coughing with or without whooping, color changes, posttussive vomiting, incomplete or absent pertussis vaccination, and finding of lymphocytosis on laboratory examination.
|
|
|
A clinical case of pertussis is defined as what
|
An acute coughing illness that lasts at least 14 days in a person with at least one characteristic pertussis symptom (ie, paroxysmal cough, posttussive vomiting, or inspiratory whoop) or
A cough that lasts at least 14 days in an outbreak setting |
|
|
A confirmed case is defined as what
|
Any cough illness in which B pertussis is isolated and cultured or
A case consistent with the clinical case definition confirmed by PCR findings or epidemiologic linkage to a laboratory-confirmed case |
|
|
The criterion standard for diagnosis is what
|
isolation of B pertussis in culture
|
|
|
The pertussis vaccine confers full immunity for how long
|
3 years, but immunity wanes after 12 years
|
|
|
what is the vaccine for pertussis
|
Pertussis vaccination is combined with diphtheria and tetanus (DTaP) in five doses given at 2, 4 and 6 months of age, 15 to 18 months of age and 4 to 6 years of age.
|
|
|
what is the Tx of pertussis for adults
|
Erythromycin (Base) 500mg qid x 14d rapidly eliminates viable organisms
|
|
|
what is the Tx of pertussis for peds
|
Erythromycin (Base): 40 mg/kg/d PO qid x 14d not to exceed 2 g/d
|
|
|
what renders the patient noncontagious in pertussis Tx and may abort disease if administered during the incubation period or the catarrhal stage.
|
antibiotics
|
|
|
what is a highly communicable bacterial infectious disease with a significant morbidity rate in infants and young children.
|
pertussis
|
|
|
true or false: Pertussis is most infectious when patients are in the catarrhal phase, but pertussis may continue to be communicable for 3 or more weeks after the onset of cough
|
true
|
|
|
what is another term for Acute epiglottitis
|
supraglottitis
|
|
|
what is acute epiglottitis
|
acute, rapidly progressive cellulitis/inflammation of the epiglottis and adjacent structures that can result in complete and potentially fatal airway obstruction in both children and adults.
|
|
|
what is the most common site of swelling
|
epiglotis
|
|
|
epiglottitis is cause by what
|
bacterial infection
|
|
|
where is the epiglotis located and what is its fx
|
covers the entrance of the larynx when the individual swallows, thus preventing food or liquids from entering the airway
|
|
|
what pathogens cause epiglotitis
|
h flu type b (Hib), h parainfluenza, strep pneumoniae, group A strep, s. aureas, gram + strep/staph
|
|
|
what are the noninfectious causes of epiglotits
|
thermal causes
|
|
|
what pathogen is mostly responsible for epiglotits cases in immunized children
|
gram + strep/staph
|
|
|
what is annual incidence of epiglotitis
|
1/100,000
|
|
|
true or false: Historically, in children from 3-7 years old, with the success of H. flu vaccination, the incidence in adults > pediatrics
|
true
|
|
|
who represents 60% of epiglotitis cases
|
males
|
|
|
which population is epiglotits seen in more
|
African- and Hispanic-Americans, perhaps due to vaccination differences
|
|
|
what are the classic symtoms of epiglotits
|
abrupt onset over several hours: Fever - high in children (40°C) ; adults may be afebrile
Sore throat Difficult and labored breathing (stridor) Dysphagia Drooling Cough |
|
|
what are the signs in the PE of epiglotits
|
a toxic- appearing, apprehensive child with an ashen-gray color: The initial CC: sore throat, later odynophagia, muffled voice (54%
Triad: of fever, stridor, and drooling present. The child often sits in a tripod position, or the "sniffing" position, with the neck slightly extended and the chin forward. No cough. As opposed to the child with croup, Cyanosis, pallor, or bradycardia are late signs of severe airway obstruction that signal the urgent need to establish an artificial airway |
|
|
what are the Ddx of epiglotits
|
Pharyngitis
Croup Peritonsillar or Retropharyngeal abscess Anaphylaxis Foreign body aspiration Diphtheria Caustic ingestions |
|
|
what may be suspected when symptoms appear suddenly and the patient presents with a muffled voice, drooling, dysphagia, high fever, and inspiratory stridor, and prefers sitting in the tripod position
|
epiglotits
|
|
|
which pts often have rather toxic appearance
|
epiglotits
|
|
|
how is epiglottitis is differentiated from croup
|
by the absence of a barking cough
|
|
|
what are the diagnostics done for epiglottitis
|
CBC c DIFF, B cultures, Epiglottic swab C&S, Nasopharyngoscopy
|
|
|
what will be seen on the CBC c DIFF in epiglottitis
|
leukocytosis w/ left shift (immature WBC)
|
|
|
what is seen on the b cultures of epiglottitis
|
positive >90% of cases
|
|
|
what is seen in epiglottic swab C&S in epiglottits
|
positive 70% cases
|
|
|
what does inextremous mean
|
dying, on their last breath
|
|
|
who does the Nasopharyngoscopy and why
|
performed by ENT because it may precipitate complete airway obstruction
|
