19. Sore throat Flashcards
sore throat medical term
pharyngitis - inflammation of naso oro or hyopharynx
Nasopharynx area parts
superior to oral cavity from skull base to soft palate
includes opening eustachian tubes
Oropharynx parts
area immed visible when pt opens mouth - uvula, hyoid, tonsillar pillars
includes vallecula and epiglottis
Hypopharynx parts
inferior to epiglottis and terminates at vocal cords
Pharyngeal tonsillar ring: which lymph tissues are present?
pharyngeal (adenoid), tubal, palatine, and lingual tonsils
Key signs and symptoms in sore throat
airway assessment
- drooling, muffled voice, neck swelling, stridor
hydration/overall toxicity
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
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
Urgent sore throat diagnoses
Group A streptococcal pharyngitis Retained foreign body
Kawasaki disease
Thyroiditis
Laryngeal fracture
Pericarditis or myocarditis presenting with referred throat pain
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
Modified centor criteria/McIsaac score likelihood of group a beta hemolytic strep if 1 present (percent)
7%
Modified centor criteria/McIsaac score likelihood of group a beta hemolytic strep if 2 present (percent)
13%
Modified centor criteria/McIsaac score likelihood of group a beta hemolytic strep if 3 present (percent)
22%
Modified centor criteria/McIsaac score likelihood of group a beta hemolytic strep if 4 present (percent)
38%
Modified centor criteria/McIsaac score likelihood of group a beta hemolytic strep if 5 present (percent)
> 50%
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
c
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
c
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
a
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
d
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
b
