23- sore throat

Question 1

most common cause of sore throat

Answer 1

Viral pharyngitis

Question 2

Viral pharyngitis viruses involved

Answer 2

rhinovirus, coronavirus, and adenovirus

Question 3

Viral pharyngitis presentations

Answer 3

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).

Question 4

most common bacterial cause of pharyngitis

Answer 4

Group A Beta-hemolytic Streptococcus pharyngitis

Question 5

the rash in scarlet fever.

Answer 5

“sandpaper texture”

The rash often begins around the neck, axilla, and groin and then spreads over the trunk and extremities.

Question 6

Do patients with bacterial pharyngitis generally have rhinorrhea, cough, or conjunctivitis

Answer 6

no

Question 7

Epiglottitis

Answer 7

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)

Question 8

Pertussis

Answer 8

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.

Question 9

Mononucleosis

Answer 9

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

Question 10

Suspicion for mono diagnosis usually occurs after

Answer 10

a negative rapid strep or throat culture in a patient who is ill for more than 7-10 days.

Question 11

when is monospot test become positive

Answer 11

until at least 7 days into the illness.

Question 12

rash in mono

Answer 12

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.

Question 13

Retropharyngeal abscess

Answer 13

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!

Question 14

is rash common in retropharyngeal abscess

Answer 14

no

unless the abscess and rash of scarlet fever both occurred as complications of GABHS pharyngitis.

Question 15

Viral croup

Answer 15

prodrome of mild fever, and sore throat.

a barking cough, inspiratory stridor, and hoarse voice

Question 16

how to diagnose croup

Answer 16

clinically

A Steeple sign on x-ray is suggestive, but is only present in only 50% of children with croup.

Question 17

Allergic rhinitis/pharyngitis

Answer 17

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.

Question 18

what happens if suspected person with strep has negative rapid antigen detection test

Answer 18

send throat culture

Question 19

first-line treatment for strep pharyngitis

Answer 19

Penicillin V- due to low cost, narrow spectrum of activity, safety and effectiveness.

Question 20

what is an appropriate choice when the patient is otherwise unlikely to finish the entire course of oral antibiotics for strep

Answer 20

Penicillin G IM - injection

Question 21

why is amox used for kids?

Answer 21

tastes better

Question 22

what should you use for strep if allergic to PCN but not an immediate-type hypersensitivity. ?

Answer 22

cephalosporins (Cephalexin and Cefadroxil) - broader but same effectiveness

Question 23

what should you use for strep if allergic to PCN and has an immediate type hypersensitivity?

Answer 23

macrolides

Question 24

Complications of GABHS Pharyngitis

Answer 24

Even though rheumatic fever and post-streptococcal glomerulonephritis are serious, they are relatively rare.

Other complications include: peri-tonsillar abscess, mastoiditis, meningitis, and bacteremia.

Question 25

when should vaccines be withheld if pt is temporarily sick?

Answer 25

only moderate to severe illness (including high fever, otitis, diarrhea, and vomiting)

mild sick is ok!

Question 26

what age can you start influenza vaccine?

Answer 26

6 mo

Question 27

percentiles of overweight in a child

Answer 27

85 to less than 95th percentile for age

Question 28

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.

Answer 28

3 yo

Question 29

what is this disease? asymmetric tonsillar enlargement and uvular deviation, fever and difficulty breathing

Answer 29

peri-tonsillar abscess