5: Throat Flashcards
What are some exam tricks for looking in a child’s throat (6)?
- Use a tongue blade to look into a puppet’s mouth.
- Use a mirror so that the child can look into his or her mouth while being examined.
- Show off missing or new teeth.
- “Open your mouth as big as a lion.”
- “Can you stick out your whole tongue? Can you move it to the left and right?”
- To enlarge your view of the oropharynx, ask the child to stick out the tongue and “pant like a dog.”
What are normal findings of tonsils (2)?
- Same pink as oral mucosa.
2. Surface is peppered with indentations (crypts).
Grade 1, 2, 3, or 4 tonsils?
Visible
1
Grade 1, 2, 3, or 4 tonsils?
Halfway between tonsillar pillars and uvula.
2
Grade 1, 2, 3, or 4 tonsils?
Touching uvula.
3
Grade 1, 2, 3, or 4 tonsils?
Touching each other (“kissing”).
4
T/F Acute viral pharyngitis is often paired with a URI.
True
What are common causative agents of viral pharyngitis (5)?
- Rhinovirus
- RSV
- Adenovirus
- Influenza
- Parainfluenza
How do clinical manifestations in children 3 months-3 years differ from those of older children/adults with viral pharyngitis?
Basically, illness is more severe in infants/children than adults.
Younger:
1. Fevers occur suddenly and are associated with irritability, restlessness, decreased appetite and fluid intake, and decreased activity.
2. Vomiting and diarrhea may also be present.
Older:
1. Low-grade fevers early in illness.
Both:
1. Nasal inflammation may lead to obstruction.
How long does it take for viral pharyngitis to resolve?
4-10 days without complications.
T/F If otitis media occurs after viral pharyngitis, it occurs much later.
False. It may lead to otitis media, which is usually early or after the initial phase of nasopharyngitis is past.
T/F Pharyngitis can lead to pneumonia.
True. Less frequent but may be observed in some infants.
What is the treatment for viral pharyngitis (4)?
- Encourage staying home.
- Antipyretics for mild fever/discomfort.
- Rest until afebrile for at least 1 day.
- Increase fluids but don’t push solids.
What age can use decongestants?
2 years and older. Use with caution in diabetics, as they affect all vascular beds.
Are decongestants more effective PO or nasal?
Nasal
What age can use cough suppressants with dextromethorphan?
4 years and older. Used for dry, hacking cough. Some contain up to 22% alcohol. Be aware of abuse potential. Street names: sizzurp, purple drank, lean, purple jelly, texas tea.
T/F Cough suppressants are effective and should be used for those with cough over the age of 4.
False. Lack of evidence that such medications reduce symptoms. They can help, but not for everyone. Use sparingly.
T/F Antihistamines possess a weak, atropine-like effect that dries secretions.
True. They also cause drowsiness.
T/F Antihistamines can cause hyperactivity.
True. Though mostly they cause drowsiness, some children have a paradoxical reaction and become hyper. So, try a first-time dose in the middle of the day.
What is the best prevention for pharyngitis/URI?
Hygiene. Encourage staying home. Children are so susceptible, b/c they have not yet developed resistance to many of the common viruses. Very young infants are especially susceptible and exposure should be minimized.
What is the rule of thumb for how often a child will be sick?
1 illness/month
T/F Older children often do not present with the “classic” strep symptoms.
False. Younger children often don’t.
_____ should always be on your differential for preschool or school age children with fever.
GABHS
If strep throat isn’t very serious and usually clears on its own, why do we treat with ABX?
It can lead to rheumatic fever about 18 days after. It can lead to AGN about 10 days after.
Clinical symptoms of strep (3)?
- Anterior cervical lymphadenopathy
- Difficulty swallowing s/t pain
- Tonsillar and pharyngeal inflammation and exudate on 2nd day of illness
How long does strep usually last?
3-5 days unless complicated by other issues.
S/S of strep, yes or no?
Scarlatina rash
Yes
S/S of strep, yes or no?
Cough
No
S/S of strep, yes or no?
Fever
Yes
S/S of strep, yes or no?
Hoarseness
No
S/S of strep, yes or no?
Abdominal pain
Yes
S/S of strep, yes or no?
Conjunctivitis
No
S/S of strep, yes or no?
Vomiting
Yes