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Clinical Year Exams > CAD I SPE (Sore Throat) > Flashcards

CAD I SPE (Sore Throat) Flashcards

(51 cards)

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1
Q

What is the most common etiology and pathogen associated with Common Cold/URI?

A

Viral

- Rhinovirus

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2
Q

What four symptoms are often seen with Common Cold/URI? When is it most contagious?

A
  • Clear/watery rhinorrhea
  • Nasal congestion
  • Sore throat (dry/scratchy)
  • NON-productive cough

First 2-3 days

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3
Q

What three PE findings are often seen with Common Cold/URI? What PE finding is NOT seen?

A
  • Swelling and discharge of nasal mucosa
  • Pharyngeal erythema (mild)
  • Conjunctival injection

NO LAD

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4
Q

What are two possible complications of Common Cold/URI?

A
  • Acute rhinosinusitis

- AOM

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5
Q

What is the typical course of Common Cold/URI, and what is the treatment (2)?

A

SELF-LIMITING (1-2 weeks)

  • NSAIDs/Acetaminophen
  • Antihistamines (Sudafed)
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6
Q

What three symptoms are often seen with Influenza? What is the typical onset, and when is it most contagious?

A

ABRUPT onset of…

  • Fever
  • Myalgias
  • Sore throat

First 2 days

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7
Q

If outpatient, what is the recommended testing for Influenza (3)? If inpatient, what is the recommended testing for Influenza?

What additional test is also often ordered as the gold standard?

A

OP: NOT recommended unless high risk = 65+, children <5 years of IC

IP: ANY patient with sxs upon admission or during admission

Gold standard = viral culture (3-10 days for results)

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8
Q

What is the preferred test for Influenza?

A

NAAT (Rapid Molecular Assay)

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9
Q

What is the recommended treatment for Influenza if severe or high-risk, and what is the window for giving it? How does this affect prognosis (2)?

A

Tamiflu (Oseltamivir) within 48 hours

- Reduces complications and shortens course by 1-2 days

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10
Q

How does Influenza vaccination differ for children 6 months to 8 years vs. 18-64 years vs. 65+ years?

A
  • 6 months-8 years = for first dose, TWO standard dose trivalent IM that are 4+ weeks apart
  • 18-64 years = standard dose trivalent IM
  • 65+ years = HIGH dose trivalent IM
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11
Q

What is the major complication associated with Influenza, and in what population is this a leading cause of mortality?

A

PNA

- Native Americans

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12
Q

What is the most common etiology of Pharyngitis?

A

VIRAL

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13
Q

What is the most common bacterial pathogen associated with Pharyngitis?

A

GAS (Strep pyogenes)

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14
Q

How does viral pharyngitis differ from bacterial pharyngitis on PE? What two viral pathogens are the exception to this?

A

Viral = NO pharyngeal exudate

- Exceptions: Adenovirus, Mononucleosis

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15
Q

What are three complications of GAS Pharyngitis, and when do they typically present?

A

2-3 weeks after illness…

  • Rheumatic fever
  • Peritonsillar abscess
  • Poststreptococcal glomerulonephritis
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16
Q

What three findings are seen with Scarlet Fever, and what is this a possible complication of?

A

Complication of GAS Pharyngitis

  • Scarlantiform rash (sandpaper rash)
  • Strawberry tongue
  • Pastia’s lines
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17
Q

What four symptoms are often seen with GAS Pharyngitis? What two other non-specific sxs may be seen?

A
  • Fever
  • Sore throat
  • Malaise
  • Odynophagia (painful swallowing)

Also N/V and myalgias

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18
Q

What four PE findings are often seen with GAS Pharyngitis?

A
  • Cervical LAD (anterior)
  • Pharyngeal erythema
  • Tonsillar exudate
  • Palatal petechiae
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19
Q

What are the four aspects of the Centor criteria, and what condition is it used for? What are the three possible outcomes?

A

For GAS Pharyngitis

  • Fever
  • Cervical LAD (anterior)
  • Pharyngotonsillar exudate
  • NO cough

If 0-1/4 present = no test, no tx
If 2-3/4 present = test
If 4/4 present = treat empirically (no test necessary)

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20
Q

What are the three possible first line treatments for GAS Pharyngitis? What is the second line treatment?

How long does it typically take to see sxs improvement with abx use?

A
  • Penicillin G Benzathine IM, single dose
  • Penicillin V PO
  • Amoxicillin PO

Second line if PCN allergy = Azithromycin

Sxs improve within 1-3 days on abx

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21
Q

Besides GAS, what other three bacterias may cause Pharyngitis? Give one differentiating finding for each.

Study These Flashcards
A
  • C. diphtheriae = grey tonsillar exudate
  • M. pneumoniae = lower respiratory infection + HA
  • N. gonorrhoeae = common in MSM/oral sex (similar presentation to GAS)
22
Q

What is the typical progression of Mononucleosis (EBV)?

Study These Flashcards
A

Sxs for 2-4 weeks

- Contagious for up to 3 months

23
Q

What three symptoms are often seen with Mononucleosis (EBV)?

Study These Flashcards
A
  • Malaise/fatigue
  • Sore throat
  • Fever
24
Q

What four PE findings are often seen with Mononucleosis (EBV)?

Study These Flashcards
A
  • Pharyngeal erythema
  • Tonsillar exudate
  • Cervical LAD (posterior)
  • Splenomegaly
25
In what age group is Peritonsillar Abscess most common? What is the most common pathogen (2)?
Children/Young adults | - OFTEN POLYMICROBIAL (Strep pyogenes (GAS), Staph aureus)
26
What four symptoms are often seen with Peritonsillar Abscess?
- Severe sore throat (unilateral) - Fever - Trismus - Drooling
27
What four PE findings are often seen with Peritonsillar Abscess?
- "Hot potato" voice - Tonsillar edema - Uvula deviation to opposite side - Cervical LAD, neck swelling
28
What diagnostic test should be used for Peritonsillar Abscess (to R/O other conditions)?
CT WITH contrast - Differentiate cellulitis from abscess - Rule out epiglottitis or retropharyngeal abscess
29
What is the treatment of Peritonsillar Abscess (2)?
I&D Abx - OP = Augmentin or Clindamycin - IP = Unasyn
30
In what age group is Epiglottitis most common (2)? What is the most common pathogen?
Unvaccinated children vs. older adults | - Hib
31
What four symptoms are often seen with Epiglottitis?
RAPID ONSET... - Drooling - Stridor - Severe sore throat - Toxic appearing
32
What should be the initial PE assessment with Epiglottitis? What should NOT be done?
Secure airway | - NO use of tongue blade
33
What diagnostic test should be used for Epiglottitis, and what is the most common finding?
Lateral neck XR | - "Thumb sign"
34
What is the treatment of Epiglottitis (3)?
EMERGENT so... - Hospitalization - Intubation - Abx
35
What three STIs may present with complaints of sore throat?
- Acute HIV (no exudate) - Gonorrhea (exudate, cervical LAD) - Syphilis, secondary stage (mostly oropharyngeal sxs)
36
Besides EBV, what other virus is commonly associated with pharyngitis? What is the treatment?
HSV (Herpes Simplex Virus) - usually HSV-1 | - Tx: Acyclovir
37
What two groups of medications may cause pharyngitis?
- ACE-I | - Chemotherapy
38
When is Coxsackie virus most contagious, and how long does it last for?
Most contagious in 1st week | - Contagious until blisters resolve
39
What four symptoms are often seen with Coxsackie virus?
Hand, Foot, Mouth Disease - Fever - Poor appetite - URI sxs (sore throat, cough, malaise)
40
What three symptoms are often seen with Laryngitis?
- Hoarseness - Dysphonia - URI sxs (sore throat, rhinorrhea, cough)
41
What is the most common etiology associated with Acute Rhinosinusitis? What age group is most often affected?
VIRAL | - Age 45-64 years (mostly female)
42
How is Acute VIRAL Rhinosinusitis typically diagnosed?
Clinically | - <10 days of sxs, NOT worsening
43
What is the most common cause of Acute BACTERIAL Rhinosinusitis?
VIRAL | - Mucosal edema/sinus inflammation causes obstruction with bacteria, leading to secondary bacterial infection
44
When are abx indicated in the treatment of Acute BACTERIAL Rhinosinusitis (3)?
- Persistent sxs for 10+ days, no improvement - Onset of severe sxs - Viral URI that initially improved THEN worsened ("double worsening")
45
What is the first line treatment for Acute BACTERIAL Rhinosinusitis? What if the patient is high risk?
Augmentin for 5-7 days | - High risk = inc. Augmentin dose for 7-10 days
46
What is the gold standard diagnostic test for Acute BACTERIAL Rhinosinusitis?
Sinus Aspirate culture (by ENT)
47
What are the four cardinal symptoms associated with Chronic Rhinosinusitis? How does this differ for children?
- Mucopurulent drainage - Nasal obstruction/congestion - Facial pain/pressure/fullness - Reduced/loss sense of smell In children, cough rather than smell
48
What is the diagnostic criteria for Chronic Rhinosinusitis (3)?
``` - 2/4 cardinal sxs present AND - Sxs for 12+ weeks AND - Disease on CT or Nasal Endoscopy ```
49
What is the pathophysiology of GERD?
Not enough pressure at the LES to prevent reflux | - LES weak or relaxes inappropriately
50
What is the hallmark sxs of GERD, and when does it present? What other sxs may present (3)?
Heartburn (pyrosis) 30-60 min after meal - Sore throat (burning?) - CP - Difficulty swallowing
51
What two medications can be used to treat GERD, and when is each considered?
- <2 episodes/week = Antihistamine (Ranitidine - recently replaced by Famotidine per Colleen) - 2+ episodes/week = PPI (Omeprazole)

Clinical Year Exams (3 decks)

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