Allergic Rhinitis pathophysiology - ANSWER IgE mediated reactivity to airborne allergies
Allergic Rhinitis etiology - ANSWER Common in people with other atopic disease:
Atopic Triad: allergic rhinitis, asthma, atopic dermatitis (eczema)
Allergic Rhinitis signs and symptoms - ANSWER Allergic Shiners
Dennie lines
Rhinorrhea
watery/itchy eyes
sneezing
nasal congestion
dry cough
pale, boggy, blue mucosa
horizontal nasal crease (from allergic salute)
Allergic Rhinitis treatment - ANSWER **Intranasal Glucocorticoid
Oral antihistamines
Cromolyn sodium
Nasal saline
Immunotherapy (last resort)
Acute pharyngitis pathophysiology - ANSWER sore throat
Commonly viral but need to distinguish from Group A beta hemolytic streptococcus
1
,Viral causes are self limited- supportive treatment
Signs and symptoms of GABHS pharyngitis - ANSWER Fever >38/100.4
Tender anterior cervical adenopathy
Lack of cough
Pharyngotonsillar exudate
Diagnostic test for GABHS pharyngitis - ANSWER Rapid Strep Test 90-99 sensitivity
Confirmation with throat culture
Treatment for GABHS pharyngitis - ANSWER Oral PCN
2nd generation cephalosporin
macrolide (erythromycin) for PCN allergy
PCN IM if concern for patient compliance
*inadequate tx can lead to scarlet fever, glomerulonephritis, and abscess formation
Peritonsillar abscess pathophysiology - ANSWER penetration of infection through the
tonsillar capsule
Peritonsillar abscess signs and symptoms - ANSWER **always assess airway**
sore throat
odynophagia
trismus
deviation of soft palate/uvula
"hot potato" voice
**deviation of and asymmetrical rise of soft palate/uvula are HIGHLY suggestive of abscess
2
,Peritonsillar abscess treatment - ANSWER aspiration, I&D, abx, tonsillectomy
abx used= IV amoxicillin, amoxicillin-sulbactam, clindamycin, augmentin
Laryngitis etiology - ANSWER Usually viral (resolves in 1-3 weeks)
Bacterial = M. catarrhalis & H. influenza
Often follows URI
Signs and symptoms of laryngitis - ANSWER hoarseness*
cough may be present
pain is atypical
Treatment of laryngitis - ANSWER supportive therapy: voice rest
bacterial= erythromycin, ceftin, augmentin (decreases hoarseness/cough)
Can use PO/IM corticosteroids to hasten recovery for performers but requires vocal cord
evaluation
Aphthous ulcers etiology - ANSWER unclear. possible involvement of herpes 6 virus
Signs and symptoms of aphthous ulcers - ANSWER single or multiple painful, round
ulcers with yellow-gray centers and red halos on non-keratinized mucosa. They are usually
recurrent.
Treatment of aphthous ulcers - ANSWER non-specific
topical corticosteroids
1 week oral prednisone taper
cimetidine (anti ulcer & H2 antagonist)
3
, Acute sinusitis pathophysiology - ANSWER inflammation of osteomeatal complex,
differentiates between allergic or viral
Acute sinusitis risk factors - ANSWER Cigarette smoke
Nasal foreign body
Trauma
Signs and symptoms of acute sinusitis - ANSWER purulent nasal discharge
facial pain
facial pressure
nasal obstruction or congestion
fever
tender to palpation
decreased transillumination
Diagnostics of acute sinusitis - ANSWER Usually a clinical diagnosis
X-ray used when presentation unclear, treatment failure, or indication of more serious
infection
Acute sinusitis treatment - ANSWER NSAIDs for pain
Saline washes/steam
Oral/nasal decongestants
Intranasal corticosteroids
Antibiotics used if 10-14 days of symptoms present, or more significant symptoms such as
fever, facial pain, or swelling
4
Allergic Rhinitis etiology - ANSWER Common in people with other atopic disease:
Atopic Triad: allergic rhinitis, asthma, atopic dermatitis (eczema)
Allergic Rhinitis signs and symptoms - ANSWER Allergic Shiners
Dennie lines
Rhinorrhea
watery/itchy eyes
sneezing
nasal congestion
dry cough
pale, boggy, blue mucosa
horizontal nasal crease (from allergic salute)
Allergic Rhinitis treatment - ANSWER **Intranasal Glucocorticoid
Oral antihistamines
Cromolyn sodium
Nasal saline
Immunotherapy (last resort)
Acute pharyngitis pathophysiology - ANSWER sore throat
Commonly viral but need to distinguish from Group A beta hemolytic streptococcus
1
,Viral causes are self limited- supportive treatment
Signs and symptoms of GABHS pharyngitis - ANSWER Fever >38/100.4
Tender anterior cervical adenopathy
Lack of cough
Pharyngotonsillar exudate
Diagnostic test for GABHS pharyngitis - ANSWER Rapid Strep Test 90-99 sensitivity
Confirmation with throat culture
Treatment for GABHS pharyngitis - ANSWER Oral PCN
2nd generation cephalosporin
macrolide (erythromycin) for PCN allergy
PCN IM if concern for patient compliance
*inadequate tx can lead to scarlet fever, glomerulonephritis, and abscess formation
Peritonsillar abscess pathophysiology - ANSWER penetration of infection through the
tonsillar capsule
Peritonsillar abscess signs and symptoms - ANSWER **always assess airway**
sore throat
odynophagia
trismus
deviation of soft palate/uvula
"hot potato" voice
**deviation of and asymmetrical rise of soft palate/uvula are HIGHLY suggestive of abscess
2
,Peritonsillar abscess treatment - ANSWER aspiration, I&D, abx, tonsillectomy
abx used= IV amoxicillin, amoxicillin-sulbactam, clindamycin, augmentin
Laryngitis etiology - ANSWER Usually viral (resolves in 1-3 weeks)
Bacterial = M. catarrhalis & H. influenza
Often follows URI
Signs and symptoms of laryngitis - ANSWER hoarseness*
cough may be present
pain is atypical
Treatment of laryngitis - ANSWER supportive therapy: voice rest
bacterial= erythromycin, ceftin, augmentin (decreases hoarseness/cough)
Can use PO/IM corticosteroids to hasten recovery for performers but requires vocal cord
evaluation
Aphthous ulcers etiology - ANSWER unclear. possible involvement of herpes 6 virus
Signs and symptoms of aphthous ulcers - ANSWER single or multiple painful, round
ulcers with yellow-gray centers and red halos on non-keratinized mucosa. They are usually
recurrent.
Treatment of aphthous ulcers - ANSWER non-specific
topical corticosteroids
1 week oral prednisone taper
cimetidine (anti ulcer & H2 antagonist)
3
, Acute sinusitis pathophysiology - ANSWER inflammation of osteomeatal complex,
differentiates between allergic or viral
Acute sinusitis risk factors - ANSWER Cigarette smoke
Nasal foreign body
Trauma
Signs and symptoms of acute sinusitis - ANSWER purulent nasal discharge
facial pain
facial pressure
nasal obstruction or congestion
fever
tender to palpation
decreased transillumination
Diagnostics of acute sinusitis - ANSWER Usually a clinical diagnosis
X-ray used when presentation unclear, treatment failure, or indication of more serious
infection
Acute sinusitis treatment - ANSWER NSAIDs for pain
Saline washes/steam
Oral/nasal decongestants
Intranasal corticosteroids
Antibiotics used if 10-14 days of symptoms present, or more significant symptoms such as
fever, facial pain, or swelling
4
