2: strep pharyngitis or tonsilitis + complications Flashcards Preview

ICM > 2: strep pharyngitis or tonsilitis + complications > Flashcards

Flashcards in 2: strep pharyngitis or tonsilitis + complications Deck (31)
1

most common age for strep

any but most common among school age - 5-15y/o

2

when is strep most common?

late fall, winter, spring

3

incubation period for strep

2-5d

4

history w/ strep

-contact
-sore throat
-headache
-fever
-adenopathy

5

physical exam for strep

-exudative tonsillitis
-petechiae on palate
-strawberry tongue
-fever
-cervical adenopathy
-circumoral pallor

6

other options for strep ddx

-viral pharyngitis - tonsillitis (more common)
-coxsackie
-herpes

7

how do you make the diagnosis for strep?

throat culture
-routine (takes 24h)

also -rapid test (strep serology or strep Ag)

8

describe the rapid strep test

based on nitrous acid extraction of Group A carbohydrate Ag's from bacteria obtained from the throat

9

routine treatment

-pen V (250mgm BID or TID for kids under 60lb; 500 mgm BID or TID for kids over 60lb); adolescents/YA for 10d
-amoxicillin in appropriate dosage may be used 1-3x/d for 10d
-benzathine pen G - IM, single dose long-acting
-erythromycin for penicillin sensitive persons x 10d
-cephalosporins may be used x 10d

10

treatment for carrier state

-benzathine pen G
-clindamycin, cephalosporins, or amoxicillin-clavulanate 10d or azithromycin 5d
-penicillin and rifampin, 10d pen + last 4d add Rifampin

11

list complications of strep

-scarlet fever
-rheumatic fever
-glomerulonephritis
-peritonsillar abscess
-toxic shock syndrome (very rare)

12

etiology of scarlet fever

erythrogenic exotoxin

13

incubation of scarlet fever

1-7d (average 3d)

14

signs and symptoms of scarlet fever

-fever
-vomit
-headache
-pharyngitis-tonsillitis-strep type
-chills
-abdominal pain
-rash
-strawberry tongue

15

describe rash of scarlet fever

first appears in axilla, groin, neck -> becomes generalized in 24h -> begins desquamating at 1w- face first, then trunk, hands, and feet

16

treatment for scarlet fever

penicillin x 10d
symptomatic treatment

17

etiology of rheumatic fever

GABHS pharyngitis - especially M types (1,3,5,6,18,19, and 24) extracellular toxin

18

incidence of rheumatic fever

as high as 3% of untreated patients infects w/ Group B beta hemolytic strep

19

diagnosis of rheumatic fever

-2 major or 1 major + 2 minor symptoms of Jones criteria for diagnosis
-supporting evidence of preceding strep infection 1-3w prior

20

describe major and minor Jones criteria

Major:
-carditis
-polyarthritis-migratory
-erythema marginatum (frequently missed)
-chorea (involuntary movements)
-subQ nodules (medial aspect of elbow usually)

Minor:
-fever
-arthralgia
-elevated APR (ESR, CRP)
-prolonged PR interval on EKG

21

treatment of rheumatic fever

-treat strep infection
-salicylates (90-120mgm/kgm/24h x 3-4w) -but Reye's syndrome
-corticosteroids (2-3w)
-bed rest
-treat chorea w:
-diazepam (mild) or haloperidol (severe)
-treat CHF w:
-bed rest, digitalis, diuretics

22

prevention of rheumatic fever

-bicillin injected 1/mo
-daily oral pen

23

duration of treatment for prevention of rheumatic fever

-RhF w/o carditis: 5y or until age 21 (whichever is longer)
-RhF w/ carditis, but no residual: 10y or well into adulthood (whichever is longer)
-RhF w/ residual: at least 10y and at least to age 40

24

etiology of PSGN

GABHS strep throat or skin infection 1-2w prior
-throat serotypes 1,6,12
-skin serotypes 49,55,57,59

25

incidence of PSGN

-rare
usually after age 3

26

how do you make the diagnosis of PSGN

-hematuria (RBC casts)
-malaise
-lethargy
-abdominal or flank pain
-fever

27

signs of renal failure with PSGN

-edema (may have proteinuria)
-oliguria
-HTN
-CHF
-encephalopathy

28

other labs to look at for PSGN

-positive Strep culture
-serum C3
-Ab's to streotolysin O

29

treatment for PSGN

-treat for strep (pen x 10d)
-treat complications

30

how does peritonsillar abscess present?

-drooling child - means throat is so swollen and painful that they can't swallow their own saliva
-on throat inspection: bulging abscess on one side
-needs to be seen in ER now b/c don't want abscess to rupture (they could aspirate that shit, then get pneumonia)

31

what can erythema marginatum be confused with?

if you can see it in the scarlet fever patient, it looks similar to spread out target lesions (similar to RMSF)