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ICM > 2: strep pharyngitis or tonsilitis + complications > Flashcards

2: strep pharyngitis or tonsilitis + complications Flashcards

1
Q

most common age for strep

A

any but most common among school age - 5-15y/o

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2
Q

when is strep most common?

A

late fall, winter, spring

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3
Q

incubation period for strep

A

2-5d

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4
Q

history w/ strep

A
  • contact
  • sore throat
  • headache
  • fever
  • adenopathy
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5
Q

physical exam for strep

A
  • exudative tonsillitis
  • petechiae on palate
  • strawberry tongue
  • fever
  • cervical adenopathy
  • circumoral pallor
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6
Q

other options for strep ddx

A
  • viral pharyngitis - tonsillitis (more common)
  • coxsackie
  • herpes
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7
Q

how do you make the diagnosis for strep?

A

throat culture
-routine (takes 24h)

also -rapid test (strep serology or strep Ag)

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8
Q

describe the rapid strep test

A

based on nitrous acid extraction of Group A carbohydrate Ag’s from bacteria obtained from the throat

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9
Q

routine treatment

A
  • pen V (250mgm BID or TID for kids under 60lb; 500 mgm BID or TID for kids over 60lb); adolescents/YA for 10d
  • amoxicillin in appropriate dosage may be used 1-3x/d for 10d
  • benzathine pen G - IM, single dose long-acting
  • erythromycin for penicillin sensitive persons x 10d
  • cephalosporins may be used x 10d
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10
Q

treatment for carrier state

A
  • benzathine pen G
  • clindamycin, cephalosporins, or amoxicillin-clavulanate 10d or azithromycin 5d
  • penicillin and rifampin, 10d pen + last 4d add Rifampin
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11
Q

list complications of strep

A
  • scarlet fever
  • rheumatic fever
  • glomerulonephritis
  • peritonsillar abscess
  • toxic shock syndrome (very rare)
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12
Q

etiology of scarlet fever

A

erythrogenic exotoxin

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13
Q

incubation of scarlet fever

A

1-7d (average 3d)

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14
Q

signs and symptoms of scarlet fever

A
  • fever
  • vomit
  • headache
  • pharyngitis-tonsillitis-strep type
  • chills
  • abdominal pain
  • rash
  • strawberry tongue
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15
Q

describe rash of scarlet fever

A

first appears in axilla, groin, neck -> becomes generalized in 24h -> begins desquamating at 1w- face first, then trunk, hands, and feet

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16
Q

treatment for scarlet fever

A

penicillin x 10d

symptomatic treatment

17
Q

etiology of rheumatic fever

A

GABHS pharyngitis - especially M types (1,3,5,6,18,19, and 24) extracellular toxin

18
Q

incidence of rheumatic fever

A

as high as 3% of untreated patients infects w/ Group B beta hemolytic strep

19
Q

diagnosis of rheumatic fever

A
  • 2 major or 1 major + 2 minor symptoms of Jones criteria for diagnosis
  • supporting evidence of preceding strep infection 1-3w prior
20
Q

describe major and minor Jones criteria

A

Major:

  • carditis
  • polyarthritis-migratory
  • erythema marginatum (frequently missed)
  • chorea (involuntary movements)
  • subQ nodules (medial aspect of elbow usually)

Minor:

  • fever
  • arthralgia
  • elevated APR (ESR, CRP)
  • prolonged PR interval on EKG
21
Q

treatment of rheumatic fever

A
  • treat strep infection
  • salicylates (90-120mgm/kgm/24h x 3-4w) -but Reye’s syndrome
  • corticosteroids (2-3w)
  • bed rest
  • treat chorea w:
    • diazepam (mild) or haloperidol (severe)
  • treat CHF w:
    • bed rest, digitalis, diuretics
22
Q

prevention of rheumatic fever

A
  • bicillin injected 1/mo

- daily oral pen

23
Q

duration of treatment for prevention of rheumatic fever

A
  • RhF w/o carditis: 5y or until age 21 (whichever is longer)
  • RhF w/ carditis, but no residual: 10y or well into adulthood (whichever is longer)
  • RhF w/ residual: at least 10y and at least to age 40
24
Q

etiology of PSGN

A

GABHS strep throat or skin infection 1-2w prior

  • throat serotypes 1,6,12
  • skin serotypes 49,55,57,59
25
Q

incidence of PSGN

A

-rare

usually after age 3

26
Q

how do you make the diagnosis of PSGN

A
  • hematuria (RBC casts)
  • malaise
  • lethargy
  • abdominal or flank pain
  • fever
27
Q

signs of renal failure with PSGN

A
  • edema (may have proteinuria)
  • oliguria
  • HTN
  • CHF
  • encephalopathy
28
Q

other labs to look at for PSGN

A
  • positive Strep culture
  • serum C3
  • Ab’s to streotolysin O
29
Q

treatment for PSGN

A
  • treat for strep (pen x 10d)

- treat complications

30
Q

how does peritonsillar abscess present?

A
  • drooling child - means throat is so swollen and painful that they can’t swallow their own saliva
  • on throat inspection: bulging abscess on one side
  • needs to be seen in ER now b/c don’t want abscess to rupture (they could aspirate that shit, then get pneumonia)
31
Q

what can erythema marginatum be confused with?

A

if you can see it in the scarlet fever patient, it looks similar to spread out target lesions (similar to RMSF)

ICM (26 decks)

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