Pharyngitis

Question 0

Facial n. peripheral vs central

Answer 0

Peripheral: Forehead muscles
Central: Indicative of stroke

Question 1

Name Trigeminal nerve Motor and Sensory

Answer 1

Motor: Muscles of Mastication
Sensory: Ophthalmic, maxillary, mandibular

Question 2

Name 2 Common infectious forms of pharyngitis

Answer 2

-Viral– Mono

Bacterial- Streptococcal

Question 3

Name 3 uncommon bacterial forms of Pharyngitis

Answer 3

Gonnorhea
Diptheria
Anaerboes

Question 4

What is the biggest concern with infectious pharyngitis

Answer 4

Group A-beta hemolytic streptococcal infection ( GABHS)

Question 5

What % of Pharyngitis is viral vs bateral?

Answer 5

Viral 80%

Bacterial: 20%

Question 6

Name 4 common viral infections.

Answer 6

Rhinovirus- “common cold”
Adenovirus- associated conjunctivits
Epstein-Barr virus- infectious mono * higher fever, sicker longer
Influenza- illl, high fever, fewer cold symptoms

Question 7

Name Common symptoms of pharyngitis. (7)

Answer 7

sore throat
malaise/fatigue
HORSENESS
low grade temp
minimal anterior cervical lymphadenopathy
possible conjuctivitis

Question 8

Dx for viral pharyngitis

Answer 8

• rapid strep test
• throat culture
• mono spot
• WBC not a good measurement

Question 9

Tx for Viral pharyngitis

Answer 9

acteaminophen, Advil
decongestants
fluids
rest
look for signs of secondary infection

Question 10

Mononucleosis Presentation

Answer 10

Adults 10-35
Spread through saliva
Fever, sore throat, malaise
POSTERIOR CERVICAL LYMPH
Abdominal pain
3-6 week course
* Can have maculopapular rash- DO NOT GIVE AMOXICILLIN

Question 11

Dx of Mono

Answer 11

Initially decrease is WBC, then an increase in WBC, then atypical (large) WBC.
Presence of external (heterophile) Antigens- “mono spot”
( May not be positive for 2-3 weeks)

Question 12

Tx of Mono

Answer 12

Pain relievers
corticosteriods not advised
splenic rupter- no activity x 6 months

Question 13

Name 2 diseases associated with the Coxsackie virus

Answer 13

Herpangina

Hand-foot-mouth disease

Question 14

Herpangina Presentation

Answer 14

High fever, sore throat
Vessicles/ulcers in throat
* more common in summer

Question 15

Hand-foot-mouth disease presentation

Answer 15

Macular, maculopapular rash resembling scarlet fever (Scarlitinerm)
Vessicles/papules on mouth, foot, hands
Fever, sore throat, malaise

Question 16

Herpes Simplex Gingivastomatitis Presentation

Answer 16

Initial burning
small vessicles the erupt and form scabs
common on lips, gingiva, tongue and buccal mucosa

Question 17

Tx for Herpes Simplex Ging.

Answer 17

None

-May use Acyclovir to shorten symptoms

Question 18

HIV Presentation

Answer 18

Mono-like
Rash on 40-80%
Mucho cutaneous ulceration
Occurs around 5-30 days after exposure

Question 19

Name 4 common bacteria pharyngitis pathogens

Answer 19

Group A beta hemolytic streptococcal
Gonnorhea
Anaerobes
Diptheria

Question 20

GABHS presentation

Answer 20

School-aged children
Absence of couch, rhinorrhea, HORSENESS, diarrhea, conjunctivitis
Tender ANTERIOR cervical

Question 21

Name the 4 criteria of symptoms for GABHS

Answer 21

Fever >100.4
Anterior cervical
No cough
Phayngotonsillar exudate

Question 22

Dx of GABHS

Answer 22

Postive strep test
Positive throat culture
WBC not indicative

Question 23

Tx of GABHS

Answer 23

1 PCN -10 d

Amoxicillin 10 d—- avoid if not positive
allergy: Clindamycin-10d
Azithromycin 5d

Question 24

When to refer (3)

Answer 24

Unilateral swelling Airway obstruction Persistent dysphasia with large tonsils

Question 25

Name 3 complications of strep

Answer 25

Rheumatic fever Sydenham's chorea Acute glomerulonephritis

Question 26

Rheumatic Fever Major manifestations

Answer 26

``` Carditis polyarthritis Sydenham's Chorea Erythema marginatum Subcutaneous nodeules ```

Question 27

Rheumatic Fever minor manifestations

Answer 27

Fever arthralgia increase acute phase reactors Prolonged PR interval

Question 28

Syndenham's chorea

Answer 28

Affects Nervous system; irregular, jerky movements

Question 29

Name 2 common complications of rheumatic fever

Answer 29

Syndenham's Chorea | Acute glomerulonephritis

Question 30

Acute Glomerulonephritis

Answer 30

Blood in urine? | "Tea-colored urine" occurs 5-21 days after pharyngitis

Question 31

What drug is less effective in treating acute glomerulonephritis if previous pharyngitis was treated.

Answer 31

PCN

Question 32

Epiglotitis Symptoms

Answer 32

3 D's: Dysphagia, drooling, distress | - stridor, difficulty breathing

Question 33

What is the most common pathogen of Epiglottitis

Answer 33

Haemophulis influenzae

Question 34

Dx of Epiglottitis

Answer 34

Need lateral chest X-ray to determine a positive thumb sign

Question 35

TX of Epiglottitis

Answer 35

Cephalosporins- monitor airway

Question 36

Diptheria pathogen

Answer 36

Gram positive cornyebacterium diptheriae

Question 37

Diptheria Presentation and transmission

Answer 37

Leathery pharyngeal membrane that blocks airway | Transmitted through air

Question 38

Peritonsillar Abcess presentation

Answer 38

Uvula is displaced away from abcess caused from strep/staph/anaerobes usually unilateral

Question 39

Tx: Peritonsillar abscess

Answer 39

Surgical drainage ampicillin-sulbactam IV amoxixillin- caluvlante oral clindamyocin oral/IV

Question 40

Scarlet Fever Presentation

Answer 40

Strep throat with out a rash: spares soles, palms, face Pastia lines Strawberry tongue

Question 41

Scarlet Fever Tx

Answer 41

PCN

Question 42

Kawaski disease Dx

Answer 42

Must have 4 of the following - painless bilateral conjuctivitis - LIP CRACKING/FISSURES - Cerival lympadenopathy - polymorphous rash - Extremity changes- swelling

Question 43

Common complications of Kawasaki disease

Answer 43

Myocarditis, pericarditis-- basically the heart

Question 44

TX: Kawasaki disease

Answer 44

IV immunoglobin | High dose ASA

Question 45

Common problems of voice horseness

Answer 45

``` Acute laryngitis - lesion of left recurrent laryngeal n/ vagus nerve Painless/breif -GERD- morning Persistant -Carcinoma -Mediastinum tumor True vocal chord nodules -ALS ```