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Pharyngitis Causes

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3161. Mitral Stenosis (Treatment)

, and prevent thromboembolic complications. [ ] Because rheumatic fever is the primary cause of mitral stenosis, secondary prophylaxis against group A beta-hemolytic streptococci (GAS) is recommended. [ ] Duration of prophylaxis depends on the number of previous attacks, the time elapsed since the last attack, the risk of exposure to GAS infections, the age of the patient, and the presence or absence of cardiac involvement. Penicillin is the agent of choice for secondary prophylaxis, but sulfadiazine (...) by diuretics. Dietary sodium restriction and nitrates decrease preload and can be of additional benefit. Careful use of beta-blockers in patients with a normal sinus rhythm can prolong the diastolic filling time and thus decrease in left atrial pressure. In general, afterload reduction should be avoided as it can cause hypotension. In a randomized crossover study, Saggu et al investigated the comparative efficacy of ivabradine and metoprolol on symptoms, hemodynamics, and exercise parameters in 33 patients

2014 eMedicine.com

3162. Intravenous Immunoglobulin (Treatment)

(PIDs) that have a common set of features (including hypogammaglobulinemia) but that have different underlying causes Chronic inflammatory demyelinating polyneuropathy (CIDP) - Solely Gamunex Primary immunodeficiency disorders associated with defects in humoral immunity. Immune-mediated thrombocytopenia Kawasaki disease (see the calculator) Multifocal motor neuropathy Its reported uses have been outlined by the National Guideline Clearinghouse, including the following (off-label) applications (...) to blood products or transfusion reactions, is prudent. Laboratory tests may include the following: Liver function tests Renal function tests CBC count with differential Hepatitis screen to assess for possible disease transmission by IVIG Immunoglobulin levels to exclude IgA deficiency: If no IgA antibodies are found, then anti-IgA antibody titers should be obtained. Rheumatoid and cryoglobulin levels, because IVIG can cause hematological complications Finally, store a small amount of serum used before

2014 eMedicine.com

3163. Rhinoscleroma (Treatment)

lesions respond well to treatment with ciprofloxacin. Long-term antibiotic therapy often eradicates this infection. [ ] The choice of long-term antibiotic therapy should be guided by the patient's age and sex. Repeat biopsy can be performed to help determine the appropriate duration of the antibiotic therapy. Next: Surgical Care Surgery combined with antibiotic therapy is beneficial in patients with granulomatous disease and nasal or pharyngeal obstruction or nasal sinus involvement due (...) to the proliferation of lesions. Tracheotomy should be considered in patients with laryngeal obstruction of the second degree (granulomatous stage) and above (sclerotic stage). Plastic surgery is necessary in patients with cicatricial stenosis or when imperforation remains in the nasal cavity, pharynx, larynx, or trachea. [ ] Extensive granulomatous lesions are treated by means of open excision by using the laryngofissure approach, which is the best method for a quick recovery in patients without evidence

2014 eMedicine.com

3164. Rhinoviruses (Treatment)

taken within 24 hours of onset of common cold symptoms reduced duration of illness in adults when high doses (at least 75 mg of elemental zinc per day) were used. Unfortunately, the same benefit was not seen in the subgroup analysis among children, nor in trials that used low doses of zinc. In addition, zinc has also been associated with faster resolution of nasal congestion, nasal drainage, and sore throat, as well as improvement of cough (in terms of cough score). [ ] Although heterogeneity (...) concluded that heated and humidified air did not improve outcomes. [ ] Hot chicken soup is often recommended on the grounds that it causes a temperature increase that accelerates nasal drainage. Be alert for possible hypernatremia. Some practitioners have considered the use of aroma rubs, [ ] homeopathic or herbal remedies, and ultrafine high-volume filtration systems. However, these treatment options have yet to be studied. Previous Next: Pharmacologic Therapy Symptomatic treatment Symptomatic

2014 eMedicine.com

3165. Wasp Stings (Treatment)

to force the epinephrine into the terminal bronchioles and alveoli. Vasopressin 40 IU has also been used for refractory hypotension. Hypotension The cause of hypotension is multifactorial. Histamine, prostaglandin, and leukotriene can reduce the systemic vascular resistance by vasodilating the peripheral vessels and increase the capillary endothelial permeability, allowing extravasation of fluid into the third space. The net effect of both of these processes increases the vascular bed and decreases (...) epinephrine. Pregnancy Envenomations can cause miscarriage, stillbirth, placenta abruptio, and preterm birth. Current literature suggests that the best approach to improve fetal output is to optimize the maternal health by treating hypotension and anaphylaxis in the mother. Observation and fetal monitoring are mandatory in severe envenomations with viable fetuses. [ ] All patients who present with a moderate-to-severe reaction to a wasp sting that required treatment should be observed. A rebound

2014 eMedicine.com

3166. Warts, Genital (Treatment)

. In more than one half of children with anogenital warts, the lesions are a manifestation either of viral inoculation at birth or of incidental spread of cutaneous warts. Such cases often are caused by nongenital HPV types. The diagnosis of genital warts in a child requires that the clinician report suspected abuse to begin an evaluation process that may or may not confirm sexual abuse. [ , ] Neonates and infants with laryngeal papillomatosis Pregnant women with genital warts can transmit the virus (...) and preferences, previous therapy, and provider experience. The treatment of most HPV infections involves agents that directly ablate the lesions (eg, surgical excision, chemical ablation, and cryotherapy). Inappropriate use of these agents may cause extensive and unnecessary tissue injury and loss. Most patients with warts require multiple treatments over a course of several weeks or months. If substantial improvements have not occurred after 3 physician-administered treatments or if complete clearance has

2014 eMedicine.com

3167. Vocal Cord Dysfunction (Treatment)

. 1998 Oct. 53(10):1006-11. . Newman KB, Dubester SN. Vocal Cord Dysfunction: Masquerader of Asthma. Semin Resp Crit Care Med . 1994. 15:161-167. O'Connell MA, Sklarew PR, Goodman DL. Spectrum of presentation of paradoxical vocal cord motion in ambulatory patients. Ann Allergy Asthma Immunol . 1995 Apr. 74(4):341-4. . O'Hollaren MT. Masqueraders in clinical allergy: laryngeal dysfunction causing dyspnea. Ann Allergy . 1990 Nov. 65(5):351-6. . Paparella MM, Shumrick D, Gluckman J, Meyerhoff W (...) . . Media Gallery Flow volume loops. Laryngoscopic views of the vocal cords. Vocal cord dysfunction treatment plan. Relaxed throat breathing exercises. of 4 Tables , , ] Table 1. Differential diagnosis of laryngeal movement disorders [ , , ] VCD Psychogenic Somatoform disorder, conversion disorder, abuse, anxiety disorder, depression, Munchausen syndrome, malingering Exercise Exercise Irritant Extrinsic (chemical irritants, olfactory stimuli) Intrinsic (GERD, laryngopharyngeal reflux rhinits/post nasal

2014 eMedicine.com

3168. Viral Infections of the Mouth (Treatment)

Background HHV infections are common in the oral cavity. They may be primary or recurrent infections. Eight types of HHV have been linked with oral disease. These types have different disease patterns in their hosts. HHV-1, also known as herpes simplex virus (HSV)–1, causes primary herpetic gingivostomatitis, or oral herpes. In some hosts, it becomes latent and may periodically recur as a common cold sore. HHV-2, also known as HSV-2, causes genital herpes and occasionally causes oral disease (...) , A10, and A22. Acute lymphonodular pharyngitis is associated with the A10 subgroup. Pathophysiology Enteroviruses infect humans mainly via the fecal-oral route. Spread of the disease can also occur via direct contact with nasal and throat secretions from individuals who are infected. The virus attaches and replicates in susceptible areas of the pharynx or in the distal part of the GI tract. After multiplying in the submucosal lymphoid tissues, enteroviruses move to the regional lymph nodes

2014 eMedicine.com

3169. Varicocele (Treatment)

after the procedure. Advise patients to keep the area clean and dry. A sore throat, headache, nausea, constipation, and general body ache occur because of the surgical procedure and anesthetic. Advise patients that these problems resolve within 24 hours. Postoperative complications that require prompt medical attention If wounds become infected (usually 3-5 d after surgery), antibiotics may be necessary. Infected wounds can become warm, swollen, red, and painful, with significant drainage from (...) is preferable to lifelong testosterone therapy with laboratory monitoring. [ ] Next: Surgical Therapy The primary form of treatment for varicoceles is surgery. Because of the potential to cause significant testicular damage, evaluate the varicocele during the physical examination. The presence of a varicocele does not in itself mean surgical correction is necessary. The ultimate goals of varicocele repair should include occlusion of the offending varicosity, preservation of arterial flow to the testis

2014 eMedicine.com

3170. Ventilation, Mechanical (Treatment)

. However, this heroic intervention required the continuous activity of 1400 medical students recruited from the universities. The overwhelming manpower needed, coupled with a decrease in mortality rate from 80% to 25%, led to the adaptation of the positive-pressure machines used in the operating room for use in the ICU. Positive-pressure ventilation means that airway pressure is applied at the patient's airway through an endotracheal or tracheostomy tube. The positive nature of the pressure causes (...) with implementation of GI prophylaxis with histamine-2 blocking agents or proton-pump inhibitors, as well as deep vein thrombosis prophylaxis. Each of these measures should be undertaken in all patients receiving mechanical ventilation unless a contraindication is present. PEEP adjustment A PEEP level of less than 10 cm water rarely causes hemodynamic problems in the absence of intravascular volume depletion. The cardiodepressant effects of PEEP are often minimized with judicious intravascular volume support

2014 eMedicine.com

3171. Urticaria (Treatment)

be required rarely if the urticaria is severe and does not respond to antihistamine therapy, or if the patient's condition progresses to laryngeal angioedema and/or anaphylactic shock. The EAACI/GA2LEN/EDF/WAO panel consensus released an updated guideline in 2013 on the management of urticaria including a treatment algorithm for symptomatic management of chronic spontaneous urticaria. [ , , ] Next: Pharmacologic Therapies As advised in the 2013 EAACI/GA2LEN/EDF/WAO management guideline, due (...) -generation antihistamines are nonsedating in most patients, with very few adverse effects reported (cetirizine can cause drowsiness in up to 10% of patients). [ , , ] Therefore, many specialists prefer the use of these agents for chronic urticaria, with first-generation agents reserved for acute or refractory cases. Commonly used second-generation antihistamines are cetirizine, levocetirizine, desloratadine, loratadine, and fexofenadine. Four times the approved doses can be used if needed in cases where

2014 eMedicine.com

3172. Urticaria, Acute (Treatment)

therapy may be required rarely if the urticaria is severe and does not respond to antihistamine therapy, or if the patient's condition progresses to laryngeal angioedema and/or anaphylactic shock. The EAACI/GA2LEN/EDF/WAO panel consensus released an updated guideline in 2013 on the management of urticaria including a treatment algorithm for symptomatic management of chronic spontaneous urticaria. [ , , ] Next: Pharmacologic Therapies As advised in the 2013 EAACI/GA2LEN/EDF/WAO management guideline (...) antihistamines) The newer second-generation antihistamines are nonsedating in most patients, with very few adverse effects reported (cetirizine can cause drowsiness in up to 10% of patients). [ , , ] Therefore, many specialists prefer the use of these agents for chronic urticaria, with first-generation agents reserved for acute or refractory cases. Commonly used second-generation antihistamines are cetirizine, levocetirizine, desloratadine, loratadine, and fexofenadine. Four times the approved doses can

2014 eMedicine.com

3173. Vertebrobasilar Stroke (Treatment)

systems join to form a circle of large, communicating arteries known as the circle of Willis. Because of this arrangement of collateral vessels, even when one of the main arteries is occluded, adequate perfusion of the brain still may be possible. [ ] Previous Next: Pathophysiology of Vertebrobasilar Stroke The most common vascular condition affecting the vertebrobasilar system is atherosclerosis, in which plaques cause narrowing and occlusion of the large vessels. The pathology of small vessel (...) be caused by a number of mechanisms, including thrombus, embolism, and hemorrhage (secondary to aneurysm or trauma). [ ] In general, strokes occur because of ischemic events (80-85% of patients) or hemorrhage (15-20% of patients). A number of risk factors are associated with stroke, such as the following: Increasing age Family history Race Prior history of stroke Coronary artery disease Physical inactivity A prospective study by Amin-Hanjani et al indicated that in patients with symptomatic

2014 eMedicine.com

3174. Viral Infections and Pregnancy (Treatment)

from the head downward to cover most of the body. LCMV This infection may also present as nonspecific flulike symptoms, including fever, malaise, myalgias, and headache. It may progress to aseptic meningitis in adults but is usually self-limited in nonpregnant adults, with resolution within 2-3 weeks. Influenza Pregnant women with influenza present with symptoms that are similar to those in the general population, including fever, cough, rhinorrhea, headache, sore throat, myalgia, and shortness (...) and thrombocytopenia. Influenza Like the general population, pregnant women with influenza may exhibit fever, runny nose, cough, sore throat, and myalgias. It remains unclear whether influenza has any effect on the fetus and whether there is a risk of congenital abnormalities, although transplacental transmission of influenza appears to be rare. Hyperthermia associated with influenza, particularly in the first trimester, may increase the risk of certain birth defects. [ ] Ebola Ebola infection should be suspected

2014 eMedicine.com

3175. Hyperthyroidism (Treatment)

before starting therapy is important; accordingly, patients should be given written or documented verbal instruction to the effect that if they develop high fever (>100.5°F) or a severe sore throat, they should stop the medication and seek medical attention. Guidelines for the management of hyperthyroidism and other causes of thyrotoxicosis were developed by the American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists; [ ] these were updated in 2016. [ ] Next (...) , operative stress was the most common cause of thyroid storm, a physiologic decompensation in patients who are severely thyrotoxic, with a mortality of about 50%. Adverse effects of thyroidectomy include recurrent laryngeal nerve damage and hypoparathyroidism from damage to local structures during the procedure. A literature review by Zhang et al comparing endoscopic with conventional open thyroidectomy for Graves disease reported that the endoscopic technique offers better cosmetic satisfaction and less

2014 eMedicine.com

3176. Leishmaniasis (Treatment)

: Craig G Stark, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD Share Email Print Feedback Close Sections Sections Leishmaniasis Overview Practice Essentials Leishmaniasis is a disease caused by an intracellular protozoan parasite (genus Leishmania ) transmitted by the bite of a female phlebotomine sandfly. The clinical spectrum of leishmaniasis ranges from a self-resolving cutaneous ulcer to a mutilating mucocutaneous disease and even to a lethal systemic illness. Therapy has long been (...) simplest and most widely used systems for categorizing leishmaniasis are as follows: Categorization by clinical disease: In this system, leishmaniasis is divided into 3 primary clinical forms: cutaneous (localized, diffuse (disseminated), leishmaniasis recidivans, post–kala-azar dermal leishmaniasis), mucocutaneous, visceral (kala-azar or black-fever in hindi ), and viscerotropic Categorization by geographic occurrence: In this system, disease is divided into (1) Old World leishmaniasis (caused

2014 eMedicine.com

3177. Infectious Mononucleosis (Treatment)

Fatigue +++ + +/- + Malaise ++ + - + Mild sore throat + + +/- +/- Early maculopapular rash ± - - +/- Signs Early bilateral upper eyelid edema ± - - - Unilateral localized adenopathy - - + - Bilateral posterior cervical adenopathy + + - +/- Tender hepatomegaly +/- +/- - + Splenomegaly + +/- +/- - Laboratory abnormalities WBC count N*/- N/- N ¯ Elevated SGOT † /SGPT ‡ ++ + +/- +++ Atypical lymphocytes (≥ 10%) + + - - Thrombocytopenia +/- +/- - +/- Elevated IgM § CMV titer - + - - Elevated IgM EBV VCA II (...) are present (eg, in anemia to determine the cause of the patient's anemia). Consulting a neurologist is advised for patients with potential CNS involvement. Consultation with a cardiologist is advised for the rare patients with EBV infectious mononucleosis who have presumed myocarditis. Consult a gastroenterologist for patients with EBV-induced acalculous cholecystitis or if anicteric hepatitis is in the differential diagnoses. Previous Next: Diet Normal diet is appropriate. Previous Next: Activity

2014 eMedicine.com

3178. Polyglandular Autoimmune Syndrome, Type II (Treatment)

that uses the hormonal product of the affected organ to influence autoimmune activity. Such therapies are believed to cause a bystander suppression of the prevailing autoimmune activity and/or induction of immunologic tolerance to the relevant hormone, while simultaneous negative feedback of the target organ occurs. T4 therapy can precipitate life-threatening adrenal insufficiency. However, before thyroid replacement therapy can be instituted in patients who are hypothyroid, assess adrenal function (...) dysfunction. This can occur before the development of hyperpigmentation or electrolyte abnormalities. For Hashimoto thyroiditis (Hashimoto disease), note the following: Approximately 90% of hypothyroidism cases are due to Hashimoto disease. Treatment of hypothyroidism remains independent of its cause. The aim is to achieve euthyroidism. Comorbidity (cardiac disease and advanced age) necessitates smaller initial doses, usually 12.5-25 mcg/d. This view has been questioned by some. States such as pregnancy

2014 eMedicine.com

3179. Polychondritis (Treatment)

risk regarding complications resulting from tracheal intubation and extubation. Previous Next: Consultations Relapsing polychondritis is a complex condition that requires a team approach for patient care, as follows: Dermatologists or specialists in infectious diseases are often involved early in the course of the disease to evaluate the patient for infectious causes of or perichondritis. Rheumatologists usually become the primary care provider and should be involved early in patient care (...) -Wartenhorst R. Polychondropathia. Wien Arch F Inn Med . 1923. 6:93-100. Pearson CM, Kline HM, Newcomer VD. Relapsing polychondritis. N Engl J Med . 1960 Jul 14. 263:51-8. . Childs LF, Rickert S, Wengerman OC, Lebovics R, Blitzer A. Laryngeal Manifestations of Relapsing Polychondritis and a Novel Treatment Option. J Voice . 2011 Nov 12. . Arnaud L, Mathian A, Haroche J, Gorochov G, Amoura Z. Pathogenesis of relapsing polychondritis: a 2013 update. Autoimmun Rev . 2014 Feb. 13(2):90-5. . Foidart JM, Abe S

2014 eMedicine.com

3180. Pleurodynia (Treatment)

severe systemic infection in the neonate, such as aseptic meningitis, hepatitis, gastroenteritis, and viral pneumonitis. [ ] Next: Activity Activity is as tolerated. Previous Next: Complications Direct complications of pleurodynia are rare. Splinting from pain may result in atelectasis and shortness of breath. A postviral syndrome, also called fatigue-dysphoria syndrome, is described in children who were seropositive for coxsackievirus B and who complained of fatigue, weakness, sore throats (...) gestation. IgM antibody against coxsackie virus B1-5 or semi-nested RT-PCR positive for coxsackievirus B3 in the placental tissue were significantly higher, by 42% and 57.1%, respectively, than in women in the control group. [ , ] It may also be related to increased incidence of congenital heart defects, and early-onset insulin-dependent diabetes mellitus. Transmission of ECHO virus to neonates has also been reported during delivery, by an orofecal route. Similarly to coxsackievirus B, it may cause

2014 eMedicine.com

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