Sore throat Flashcards
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
