Pharyngitis

Question 1

What is the nickname for pharyngitis?

Answer 1

sore throat

Question 2

What is pharyngitis?

Answer 2

inflammation of the pharynx

Question 3

What is the most common cause of pharyngitis?

Answer 3

viral

Question 4

What type of pharyngitis infection is more serious and why?

Answer 4

group A beta hemolytic strep (GAS) due to risk of rheumatic fever and glomerulonephritis

Question 5

What do you do for GAS?

Answer 5

give ABX

Question 6

What are the signs and symptoms of pharyngitis?

Answer 6

throat pain, enlarged tonsils, pharyngeal erythema, soft palate petechia, anterior cervical adenopathy, painful swallowing, high fever, odynophagia, chills, malaise, headache, anorexia, abdominal pain

Question 7

What are the most common viral cause of pharyngitis?

Answer 7

rhinovirus, adenovirus, parainfluenza virus, coxsacheivirus, HSV, EBV, CMV, RSV

Question 8

What bacteria causes pharyngitis?

Answer 8

strep pyogenes, n. gonorrhea, corynebacterium diptheriae, h. flu, m. cat

Question 9

What is the fungal cause of pharyngitis?

Answer 9

candida in immunocompromised

Question 10

What are some less common cause of pharyngitis?

Answer 10

chemical, GERD, postnasal drip, neoplasms, m. pneumoniae, chlamydia pneumoniae

Question 11

What are serious causes of pharynigitis?

Answer 11

GAS, corynebacterium diptheria - myocarditis and peripheral neuritis

Question 12

What are some predisposing factors to pharyngitis?

Answer 12

epidemics, recent family hx, close quarters, immunosuppression, oral sex, recent illness

Question 13

What is the age range for streptococcal infections?

Answer 13

5-18 yo mainly

Question 14

What do you think if there is pharyngitis in

Answer 14

viral and other people in the household have this?

Question 15

What is the dx for pharyngitis?

Answer 15

rapid strep antigen test (RADT)
Throat culture
CBC with diff
EBV serology

Question 16

What is RADT?

Answer 16

strep test - latex agglutination or enzyme linked immunoassay, fast results, ELISA better than latex

Question 17

What is a disadvantage of RADT?

Answer 17

high false negatives, follow up with throat culture

Question 18

How do you treat high risk pt with pharyngitis?

Answer 18

start ab immediately, throat culture neg then stop ABX

Question 19

What are complications of pharyngitis?

Answer 19

rheumatic fever, acute glomerulonephritis, supprative conditions

Question 20

What are some supprative conditions?

Answer 20

peritonsillar abscess, otitis media, mastoiditis, sinusitis, bacteremia, pneumonia

Question 21

What do you suspect if pt has sore throat and appears ill and drooling?

Answer 21

epiglottitis

Question 22

What do you suspect if patient has dysphagia and develops rash on amoxicillin?

Answer 22

mononucleosis - stop ABX

Question 23

What is the criteria for non-high risk strep pharyngitis?

Answer 23

Absence of cough, rhinorrhea, and conjunctivitis
Fever at least 38.3 degrees C (100.9 degrees F) within last 24 hours
Erythema, swelling, or exudates of tonsils or pharynx
Tender anterior cervical nodes = 1cm
Age 5 to 15 years
Season is November to May

Question 24

What do you do for pt with 0-1 points?

Answer 24

no abx or throat culture necessary

Question 25

What do you do for pt with 2-3 points?

Answer 25

throat culture and treat with ABX if culture positive

Question 26

What do you do for pt with 4-5 pt?

Answer 26

treat w/ ABX empirically

Question 27

When do most pharyngitis resolve?

Answer 27

3-4 self limited

Question 28

What is the key for tx of pharyngitis?

Answer 28

shorten duration if within 48 h and prevent rheumatic fever (within 9 days)

Question 29

What do you treat pharyngitis with?

Answer 29

``` Penicillin VK, 500 mg PO bid for 10 d or Cephalexin, 250 mg PO qid for 10 d or Erythromycin, 250 mg PO qid for 10 d or Benzathine penicillin G, single dose of 1.2 million units IM or Clindamycin, 300 mg PO tid for 10 d ```

Question 30

What is the drug of choice for pharyngitis?

Answer 30

penicillin VK or amoxicillin

Question 31

What do you use if pencillin allergy in pharyngitis?

Answer 31

clindamycin or cephalexin

Question 32

What is the dosing for amoxicillin kids?

Answer 32

once a day for 10 days

Question 33

What do you give if pt has recent abx with pharyngitis?

Answer 33

macro, clinda, augmentin

Question 34

What is indicated for pt at risk of recurrent rheumatic fever?

Answer 34

penicillin G IM q3-4 wks

Question 35

How do you treat GAS carriers?

Answer 35

clindamycin if have recurrent episodes

Question 36

What causes viral pharyngitis?

Answer 36

HSV or influenza virus

Question 37

How do you treat viral pharyngitis?

Answer 37

oseltamivir and zanamivir start tx 36-48 hrs of onset

Question 38

What is symptomatic tx?

Answer 38

acetaminophen, ibuprofen, saltwater gargling, soft and cool food