Sore throat Flashcards
(23 cards)
are sore throat and pharyngitis always synonymous?
no
if there is posterior pharynx erythema what is usually the problem?
infectious pharyngitis
common causes of infectious pharyngitis
- -group A beta-hemolytic strep
- -non-group A beta-hemolytic strep
- -groups B, C, F, & G strep
- -chlamydia trachomatis
- -mycoplasma pneumoniae
- -epstein-barr virus
- -influenza & para-influenza
- -adenovirus
when sore throat is atypical of infectious pharyngitis & pharynx is normal DDX =
- -Head & neck disorders
- -Systemic disease
- -Mediastinal disorders
head & neck disorders can entail:
- -Otitis
- -Sinusitis
- -Salivary gland infection
- -Thyroiditis
- -Neck muscle strain
- -Epiglottitis
- -Allergy
- -Foreign body
systemic diseases can entail:
- -viral hepatitis
- -JRA
- -rubella
- -poliomyelitis
- -acute leukemia
- -toxic shock syndrome
- -temporal arteritis
- -AIDS
mediastinal disorders can entail:
- -myocardial infarction
- -aortic dissection
- -angina pectoris
- -esophagitis
- -esophageal spasm
Infectious mononucleosis
–clinical findings
non an uncommon cause of sore throat in adolescents
- -Pharyngitis
- -Fever
- -Cervical adenopathy (most sensitive)
- -Splenomegaly
- -Palatal petechiae
Tests for infectious mononucleosis
- -WBC count & differential
- -Monospot test (quick test for heterophile anti-body)
- -EBV anti-body titers
- routine testing for mono in all patients w/ sore throat is wasteful*
Rational for early Dx & anti-biotic intervention of Strep pharyngitis
prevent post-strep glomerulonephritis (PSGN)
and acute rheumatic fever (ARF)
REILLY PROTOCOL
- -Tonsillary exudate
- -Cervical adenopathy
- -Fever
2: 3 odds of strep with all 3
1: 6 odds of strep w. any finding
1: 30 odds of strep w. no findings
REILLY PROTOCOL
–Low risk
= no exudates or nodes or fever
–RADT on all patients
(+) = Tx & no cultures
(-) = no Tx OR cultures
REILLY PROTOCOL
–Medium risk
–exudate OR nodes OR fever
–Prior acute rheumatic fever (NARE)
–low-risk by physical exam but young (<25years) with no upper respirtatory infection
–recent strep exposure
=RADT ALL patients
(+) = Tx
(-) = get cultures
REILLY PROTOCOL
–high risk
–exudate & fever & nodes
–existing valvular rheumatic heart disease
Tx ALL w. anti-biotics
No tests needed
–must presume strep throat if
Scarlet fever
Strep epidemic
Modified centor protocol
clinical decision rule for management of sore throat
you get points from a criteria chart in notes
Score 0 = no testing or anti-biotics
Score 1 = (follow score of 0 or 2 for Tx)
Score 2 = throat culture OR RADT
Score 3 = throat culture OR RADT
Score >4 = consider anti-biotics
complications of GABHS pharyngitis
–suppurative
- -bacteremia
- -cervical lymphadenitis
- -endocarditis
- -mastoiditis
- -meningitis
- -otitis media
- -peritonsillar/retropharyngeal
- -abscess
- -pneumonia
complicated sore throat
- -trismus (aka: lock jaw caused by tetanus)
- -drooling
- -dysphonia
- -stridor
- -orthopnea (lymph nodes are swollen that they have shortness of breath when on their back)
examination of the neck for a sore throat
- -bull neck
- -asymmetric adenopathy
- -salivary gland abscess
- -stiff neck
examination of pharynx
–kissing tonsils
–asymmetric tonsillar swelling (peritonsillar abscess)
–membrance (diphtheria)
–enlarged epiglottis
–epiglottitis
–bulging posterior pharynx
(retropharyngeal abscess)
examination of neck & pharynx unimpressive
- -indirect laryngoscopy
- -soft tissue neck radiographs
- -consider referred pain
- -consider psychogenic cause
chronic tonsillitis
- -rare in adults
- -many pt have enlarged tonsils = no clin sig
- -Strep carriers = MC w. chronic symptomatic tonsillitis
- -tonsillectomy is good Tx for recurrent but only in some kids
postnasal drip is due to:
- -chronic sinusitis
- -allergic rhinitis
Walter Schmitt said what?
the single most important part in Tx patients is to improve their elimination
(lemon colonoscopy)
