19. Sore throat Flashcards by Tegan Turner

sore throat medical term

pharyngitis - inflammation of naso oro or hyopharynx

How well did you know this?

Not at all

Perfectly

Nasopharynx area parts

superior to oral cavity from skull base to soft palate
includes opening eustachian tubes

How well did you know this?

Not at all

Perfectly

Oropharynx parts

area immed visible when pt opens mouth - uvula, hyoid, tonsillar pillars
includes vallecula and epiglottis

How well did you know this?

Not at all

Perfectly

Hypopharynx parts

inferior to epiglottis and terminates at vocal cords

How well did you know this?

Not at all

Perfectly

Pharyngeal tonsillar ring: which lymph tissues are present?

pharyngeal (adenoid), tubal, palatine, and lingual tonsils

How well did you know this?

Not at all

Perfectly

Key signs and symptoms in sore throat

airway assessment
- drooling, muffled voice, neck swelling, stridor

hydration/overall toxicity

How well did you know this?

Not at all

Perfectly

Name 8 critical diagnosis of sore throat

Trauma causing an expanding neck hematoma
Epiglottitis causing airway compromise
Retropharyngeal or parapharyngeal abscess causing airway compromise Peritonsillar abscess causing airway compromise
Ludwig angina
Angioedema
Croup causing stridor at rest
Lemierre syndrome from septic internal jugular thrombophlebitis
Acute coronary syndrome presenting with referred throat pain

How well did you know this?

Not at all

Perfectly

Emergent dx of sore throat

Trauma causing a nonexpanding neck hematoma
Mass lesion in the neck causing sore throat (tongue, larynx, thyroid, leukemia)
Epiglottitis, retropharyngeal, parapharyngeal, or peritonsillar abscess not
causing airway compromise Stevens-Johnson syndrome

How well did you know this?

Not at all

Perfectly

Urgent sore throat diagnoses

Group A streptococcal pharyngitis Retained foreign body
Kawasaki disease
Thyroiditis
Laryngeal fracture
Pericarditis or myocarditis presenting with referred throat pain

How well did you know this?

Not at all

Perfectly

Modified centor criteria/McIsaac score parts

of Criteria Present

fever >38
tonsilar excdate
tensor cervical ln
no cough
age 3-14y is one oint vs age >45 -1

How well did you know this?

Not at all

Perfectly

Modified centor criteria/McIsaac score likelihood of group a beta hemolytic strep if 1 present (percent)

How well did you know this?

Not at all

Perfectly

Modified centor criteria/McIsaac score likelihood of group a beta hemolytic strep if 2 present (percent)

13%

How well did you know this?

Not at all

Perfectly

Modified centor criteria/McIsaac score likelihood of group a beta hemolytic strep if 3 present (percent)

22%

How well did you know this?

Not at all

Perfectly

Modified centor criteria/McIsaac score likelihood of group a beta hemolytic strep if 4 present (percent)

38%

How well did you know this?

Not at all

Perfectly

Modified centor criteria/McIsaac score likelihood of group a beta hemolytic strep if 5 present (percent)

> 50%

How well did you know this?

Not at all

Perfectly

4 original centor score criteria

fever
no cough
cervical LN
tonsilar exudate

What makes a viral pharngitis more likely on exam?

rhinorrhea
hoarse
sneeze
cough
conjunctivits

DDX infectious strep - name 5 viruses

rhino
adeno
corona
influ a or b
hsv 1,2
cmv
ebv
vzv
hepatitis

DDX infectious strep - name 5 aerobic bacteria

gas
coccidiodies
non gas
neisseria gonorrhea or meningitides
mycoplasma pneum
arcanobacterium haemolyticum
chlamydia trachmoatis
staph aures

Name 5 uncommon bacteria causing pharyngitis

h influ
h parainflu
cornyebacterium diptherae
yersinea
treponema
francisella tularensis
legionella
mycobacterium

DDX infectious strep - name 5 anaerobic bacteria

bacteroides
peptococcus
clostridium
prevotella
fusobacterium
peptostreptococcus

DDX infectious strep - name 1 fungal

candida

what is lemierre syndrome

septic thrombophlebitis, can complicate an episode of acute pharyngitis or a peritonsillar abscess, and affects the ipsilateral internal jugular vein.

Ancillary testing for GAS

rapid antigen test only centor >2 and if child >3 with negative rapid, do culture

if adult with centor >/=3 can do rapid test

consider monospit

Thumb sign in what disease on XR?

epiglottis

Tx viral pharyngitis

nsaid or tyl supportive

Name 5 red flags associated with airway compromise in sore throat

stridor drool muffled voice sniffing position hypoxia

Visible mass with signs of airway compromise in sore throat - who to call?

ent

Airway management in sore throat with impending compromise

consider double set up - ent, anesth, surg upright iv o2 monitor empiric steroids/abx to consider

In patients who test + for GAS by rapid test, naat or culture, what to tx?

IM pen G or 10 course oral pen VK

Tx of epiglottis - abx?

predominantly caused by Streptococcus, Staphylococcus, and nontypeable Haemophilus species, and we recommend parenteral treat- ment with ceftriaxone (50 mg/kg or 1000 mg qd), ampicillin/sulbactam (50 mg/kg of ampicillin component or 3000 mg q6h), or levofloxacin (750 mg qd) in penicillin-allergic patients

Tx RPA/PTA and Ludwig angina -abx

ampicillin/sulbactam (50 mg/kg or 3000 mg q6h of penicillin G (4 million units or 50,000 units/kg qid) and met- ronidazole (500 mg or 7.5 mg/kg qid), until culture results are avail- able.

Tx Lemierre disease- abx

piperacillin/ tazobactam (3.375 gm qid) or the combination of ceftriaxone 1000 mg q24h and metronidazole 500 mg q8h.

Name 4 different possible tx regimens for GAS

Benzathine penicillin G, intramuscular, 600,000 U for <27 kg and 1.2 million U for >27 kg Penicillin V, oral, children <27 kg 250 mg 2 to 3 times daily; children ≥27 kg 500 mg 2 times daily; adolescents and adults 250 mg 4 times daily or 500 mg twice daily × 10 days Amoxicillin, oral, 50 mg/kg once daily (max = 1000 mg); or 25 mg/kg (max = 500 mg) twice daily × 10 days If penicillin-allergic: Clindamycin, oral, 7 mg/kg/dose 3 times daily (maximum, 300 mg/dose) × 10 days Cephalexin, oral, 20 mg/kg/dose twice daily (maximum, 500 mg/dose) × 10 days Azithromycin, oral, 12 mg/kg/day × 5 days

A 20-year-old female presents to the emergency department com- plaining of a sore throat. She has a temperature of 39°C, tender cer- vical lymphadenopathy, exudates on exam and denies any history of cough, rhinorrhea, nausea, vomiting or diarrhea. Her modified Centor score is which of the following? a. 2 b. 3 c. 4 d. 5

24-year-old female presents for sore throat, difficulty swallowing, and a muffled voice. On examination, she has fullness, swelling and induration of the left posterior peritonsillar area with uvular devi- ation to the right. What is the next step in the management of this patient? a. Computed tomography imaging b. Discharge with antibiotics, clindamycin 300 mg TID × 10 days c. Drainage either by needle aspiration or incision and drainage d. Rapid Antigen Detection Test for Group A Streptococcus

A 39-year-old male presents to the emergency department com- plaining of a sore throat. He is sitting forward on the stretcher, drooling, with inspiratory stridor. His oropharynx exam shows minimal erythema and no exudate. Which of the following condi- tions is the likely diagnosis? a. Epiglottitis b. Group A streptococcal pharyngitis c. Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome d. Viral pharyngitis

In adult patients who test positive for Group A streptococcal (GAS) pharyngitis who have no allergies, which of the following is the most appropriate antibiotic choice? a. Azithromycin 12 mg/kg/day (max dose, 500 mg) × 5 days b. Clindamycin 7 mg/kg/dose (max dose, 300 mg) TID × 10 days c. Metronidazole 30 mg/kg/day divided TID × 10 days d. Penicillin VK 50 mg/kg/day divided QID × 10 days

In which age group is Group A streptococcal infection most com- mon? a. Age <3 years b. Age 5–15 years c. Age 15–45 years d. Age >45 years