23- sore throat Flashcards
most common cause of sore throat
Viral pharyngitis
Viral pharyngitis viruses involved
rhinovirus, coronavirus, and adenovirus
Viral pharyngitis presentations
It can present with throat irritation, fever, a rash, rhinnorhea, and cough. Viral pharyngitis is often the first symptom of an viral upper respiratory infection. The most common clinical symptoms include cough, congestion and rhinorrhea but sore throat can appear first. Stomatitis and conjunctivitis are also suggestive of a viral etiology. Fever may be present, but it is usually low grade, and children may develop a rash (viral exanthem).
most common bacterial cause of pharyngitis
Group A Beta-hemolytic Streptococcus pharyngitis
the rash in scarlet fever.
“sandpaper texture”
The rash often begins around the neck, axilla, and groin and then spreads over the trunk and extremities.
Do patients with bacterial pharyngitis generally have rhinorrhea, cough, or conjunctivitis
no
Epiglottitis
appear ill and have a high fever (> 103 F).
inspiratory stridor, “hot potato” (muffled) voice, dysphagia, and drooling.
Classically patients will be seated in a “tripod” position.
rapid onset
ages 1-6 generally (but decreasing due to Hib)
Pertussis
initially nonspecific: runny nose, low-grade fever, and mild cough
The diagnosis of pertussis is considered when the cough has worsened and has been present for at least 14 days.
Mononucleosis
triad of fever, pharyngitis, and lymphadenopathy.
Posterior cervical lymphadenopathy is common and specific for mononucleosis.
Palatal petechiae on the posterior oropharynx (similar to GABHS pharnygitis)
HSM
EBV, CMV
Suspicion for mono diagnosis usually occurs after
a negative rapid strep or throat culture in a patient who is ill for more than 7-10 days.
when is monospot test become positive
until at least 7 days into the illness.
rash in mono
Early in the course of mononucleosis, patients may present with a maculopapular generalized rash. The rash is faint, rapidly disappears, and is nonpruritic.
Note that if patients with mononucleosis are misdiagnosed with strep and treated with amoxicillin or ampicillin, 90 percent will develop a classic prolonged, pruritic, maculopapular rash.
Retropharyngeal abscess
presents with fever, difficulty swallowing, neck or ear pain, muffled “hot potato” voice, and asymmetric tonsillar enlargement and/or deviation of the uvula. Patients typically appear ill.
life threatening consequences–> emergency!
is rash common in retropharyngeal abscess
no
unless the abscess and rash of scarlet fever both occurred as complications of GABHS pharyngitis.
Viral croup
prodrome of mild fever, and sore throat.
a barking cough, inspiratory stridor, and hoarse voice
how to diagnose croup
clinically
A Steeple sign on x-ray is suggestive, but is only present in only 50% of children with croup.
Allergic rhinitis/pharyngitis
sore throat, but usually also presents with sneezing, itchy and watery eyes, clear rhinorrhea, and post-nasal drip.
It does not cause fever, and other constitutional symptoms are usually absent.
seasonal.
what happens if suspected person with strep has negative rapid antigen detection test
send throat culture
first-line treatment for strep pharyngitis
Penicillin V- due to low cost, narrow spectrum of activity, safety and effectiveness.
what is an appropriate choice when the patient is otherwise unlikely to finish the entire course of oral antibiotics for strep
Penicillin G IM - injection
why is amox used for kids?
tastes better
what should you use for strep if allergic to PCN but not an immediate-type hypersensitivity. ?
cephalosporins (Cephalexin and Cefadroxil) - broader but same effectiveness
what should you use for strep if allergic to PCN and has an immediate type hypersensitivity?
macrolides
Complications of GABHS Pharyngitis
Even though rheumatic fever and post-streptococcal glomerulonephritis are serious, they are relatively rare.
Other complications include: peri-tonsillar abscess, mastoiditis, meningitis, and bacteremia.
when should vaccines be withheld if pt is temporarily sick?
only moderate to severe illness (including high fever, otitis, diarrhea, and vomiting)
mild sick is ok!
what age can you start influenza vaccine?
6 mo
percentiles of overweight in a child
85 to less than 95th percentile for age
how old is this child? Feed himself, pedal a tricycle, uses three-five word sentences, can be understood by strangers 75% of the time, can copy a square, and engages in fantasy play with his siblings.
3 yo
what is this disease? asymmetric tonsillar enlargement and uvular deviation, fever and difficulty breathing
peri-tonsillar abscess
