Pharyngitis

Question 1

Pharyngitis define and classify

Answer 1

Inflammation of pharyngeal mucosa caused by infection of nasopharyngeal and oropharynx
Classify -acute and chronic

Question 2

Etiology include common viral and bacterial causes pharyngitis

Answer 2

Viral-rhinovirus, adenovirus, coronavirus
Bacterial- group A beta hemolytic streptococcus (GABHS) or streptococcus pyogenes
Other pathogens -Neisseria spp ,S.aureus, H. Influenza
Other causes -allergy, trauma, toxin

Question 3

Quick diagnostic measure

Answer 3

GABHS rapid antigen detection test
Preferred in emergency situation due to difficulty follow up of cultures

Question 4

Pathophysiology of pharyngitis

Answer 4

Bacterial and viral infection
Invasion of microbes cause local inflammatory response due to migration of leukocytes leads to increased capillary permeability , increased swelling , erythema, exudate and fever . Streptococcal infections produce toxins and protease

Question 5

Risk factors

Answer 5

Exposure to cigarette smoke
GERD
Frequent common cold /flu

Question 6

Clinical presentation

Answer 6

Dysphagia
Sore throat
Fever
N/V
Erythema
Enlarged lymph nodes
Scarlatiniform rash
Petechia esp on soft palate

Question 7

Which clinical presentation are suggestive of viral

Answer 7

Cough
Conjunctivitis
Coryza (runny nose)

Question 8

Cause of gonococcal pharyngitis

Answer 8

Recent orogenital contact

Question 9

Criteria for GABHS pharyngitis

Answer 9

Fever=1
Anterior cervical lymphadenopathy =1
Tonsillar exudate=1
Absence of cough=1
Predict GABHS pharyngitis in children

Question 10

Complications pharyngitis

Answer 10

Otitis media
Mastoiditis
Acute rheumatic fever

Question 11

Physical exam pharyngitis

Answer 11

Assessment of airway -ability to breath(oral/nasal)
Hydration status( dehydration due to odynophagia)
HEENT-conjunctivitis (adenovirus), rhinorrhea(viral) . Palatal petechiae tonsillopharyngeal exudate (M.pneumoniae ,adenovirus, GABHS)
Lymphadenopathy(streptococcal infection)
Cardiovascular: monitor potential rheumatic fever
Skin : scarlatiniform rash(GABHS )
Pulmonary: Non productive (M.pneumonia/C. Pneumoniae)

Question 12

Differential diagnosis pharyngitis

Answer 12

Allergic rhinitis
Airway obstruction
Neoplasm-head and neck
GERD
Peritonsillar cellulitis
Scarlet fever
Pneumonia

Question 13

Diagnosis pharyngitis

Answer 13

GABHS rapid antigen detection test
Throat culture (less expensive that rapid test)
Clinical presentation

Question 14

Goal of treatment pharyngitis

Answer 14

Improve clinical symptoms
Prevent complications ie mastoiditis, rheumatic fever
Minimize adr
Prevent transmission to close contacts

Question 15

Treatment pharyngitis

Answer 15

Antimicrobial to be used on lab confirmation of GABHS pharyngitis , blood test not required but may give w/in 7 days of onset of symptoms to prevent rheumatic fever
Analgesic and antipyretic ie paracetamol or ibuprofen
1. PenV 250mg q8h child-10days for adult 250mg PO q6h
2. PenG I.M stat
3. Amoxicillin 50mg/kg/d in 2-3 divided doses for 10 days

Question 16

When to consider steroids for pharyngitis

Answer 16

Severe pharyngitis
Airway obtruction
Significant swelling/odynophagia
Ie give prednisolone tabs or dexamethasone I.M stat

Question 17

If allergy to penicillins what can you give

Answer 17

Macrolide
Clindamycin
PO cephalosporins

Question 18

Follow and monitoring parameters
Pharyngitis

Answer 18

Alleviation after 3 days and at end of course of antibiotics
Culture of history of rheumatic fever or if symptoms relapse
Avoid contact sports
Viral pharyngitis doesn’t generally require follow up unless immunosuppressive is suspected