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Now we will explore some
common throat conditions.
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First is pharyngitis.
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This is inflammation of the mucous membranes
that line the pharynx of the throat.
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This is a symptom, this is
what the patient feels.
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They're gonna feel
a sore throat.
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That's in contrast to tonsilitis which
is just inflammation of the tonsils.
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This is an objective finding and this
may or may not be associated with pain.
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Pharyngitis and tonsillitis can be
caused by many things, including:
viral infections, bacterial infections,
fungal infections, seasonal allergies,
just general inflammation and malignancies, although
this is uncommon in the pediatric population.
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Bacteria and viruses can cause direct
invasion of the pharyngeal mucosa.
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The body's gonna react by intiating the inflammatory
process that results in irritation, pain and edema.
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Sometimes the irritation is secondary to
nasal secretions contacting the tissue
Such as with the rhinovirus
or the common cold.
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When the patient has a runny nose, some of
that's gonna run down the back of the throat
and can irritate the local
tissues quite easily.
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Let's explore the signs and
symptoms of pharyngitis.
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The patient is gonna have pain
in the pharynx or in the throat.
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They may have a dry throat
and a scratchy throat.
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They may have tender or enlarged
lymph nodes in the neck.
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When a patient has tonsillitis, they're
going to have enlarged, swollen tonsils.
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Remember, -itis means
inflammation of, tonsils.
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They may have a sore throat
and difficulty swallowing
and this can be a mechanical problem
due to the enlarged tonsillar size.
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They may have changes in their voice,
they may sound like Kermit the frog,
and they'll also have tender or
enlarged lymph nodes in the neck.
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These patients, depending on the source of their
tonsillitis may also have foul breath or halitosis.
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On the left you'll
see a normal throat.
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The uvula is pink, it's
midline, it's non-edematous.
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The pharynx is clear, the soft palate is without any
discoloration and the patient has a normally sized tonsil.
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On the right, on the abnormal throat, the
patient may have throat redness or erythema,
White spots on their tonsils called exudate
and their tonsils may be enlarged.
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In the exam, we look in the throat and you see that
the patient may have pharyngeal mucosal congestion.
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They may have swelling present,
and the uvula may be edematous
as well as the soft palate.
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You're looking for redness and you're
feeling for swollen and tender lymph nodes.
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When you look in, the
tonsils will be enlarged.
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So how do we diagnose this?
We need to have a way to
describe tonsillar size.
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We can't just say that a patient has small
tonsils, or medium tonsils or large size tonsils.
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So there's a grading system.
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Grade 0 tonsils are tonsils that are
fully inside the tonsillar pillars.
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Grade 1 tonsils are hidden
within the tonsillar pillars.
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Grade 2 is pretty typical tonsils,
these are extending to the pillars.
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Grade 3 tonsils extend
beyond the pillars,
and grade 4, this is a problem.
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This is where tonsils
extend to midline.
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Sometimes they impinge on the uvula,
and sometimes these are
referred to as kissing tonsils.
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Now let's say your patient
has had a tonsillectomy.
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They don't have tonsils anymore.
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The nurse can document that the
tonsils are surgically absent.
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Remember, pharyngitis is a symptom.
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And tonsilitis is an objective finding
that you see when you look in the throat.
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So how do we manage
pharyngitis and tonsilitis?
Well, sometimes it hurts, right?
So over the counter analgesics, this
includes acetaminophen or NSAIDS.
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I find that my patients get more relief when they take
NSAIDS because this also has anti-inflammatory properties
and a lot of the pain is
caused by the inflammation.
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Patients can also suck on
throat lozenges or hard candy.
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And this can help increase the salivary production
and help wash away some of that irritation.
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Patients can also mix up warm salt
water and gargle it in their throat.
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And I just tell patients, take a small cup
of water, add some salt and stir it up.
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Gargle it in the back of their
throat and spit it out.
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They can do this as
many times as needed.
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How do we treat different conditions
that cause pharyngitis and tonsilitis?
Well, it depends on what's
causing the problem.
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If it's a bacterial problem like strep throat,
we do need to treat these with antibiotics.
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If the patient has a viral sore throat, they're
just gonna need rest, time and symptomatic care.
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This will be self limiting.
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If the patient's sore throat is caused by
allergies, we'll place them on antihistamines.
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If the patient has fungal sore throat called
thrush, they're gonna need anti fungal therapy.
04:40
So patients can become dehydrated from both
the sore throat and the increased tonsil size
but these are for
different reasons.
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In patients with pharyngitis
or sore throat,
they're gonna have pain with eating and
drinking, so they're going to avoid it.
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And this is especially prevalent
in the pediatric population.
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If you have a baby or a young child
then their throat is really hurting,
they're not going
to want to drink.
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You have to treat their pain.
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In tonsillitis, the pain can be involved,
but really, it's a mechanical issue.
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Because food and fluid sometimes
can't pass beyond the tonsils.
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In strep throat, the patients can
develop plenty of complications.
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And in viral infections,
the patients have few.
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So what are signs and
symptoms of dehydration?
Well in adults, they can
experience headache or dizziness.
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They may feel faint and tired
and they may feel thirsty.
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Their muscles may feel weak,
they may have dark yellow urine
and they may have a
decreased urinary output.
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Kids can look pretty different
when they're dehydrated.
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Sometimes they're usually
sleepy or drowsy,
They may cry but not produce tears, and
this is actually a late sign of dehydration
They may have a dry mouth or mucous
membranes and a dry or sticky tongue.
05:50
A high fever can
contribute to dehydration
and the patient may have a
decrease in wet diapers.
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I always ask parents, "How many wet diapers
has your child made in the last 24 hours?"
And I use this to discern
if the child is dry.