7. Sore Throat and Rhinorrhea Flashcards
Name all factors that should increase suspicion for Group A streptococcal (GAS) pharyngitis (5)
- fever > 38°C
- absence of cough
- tonsillar exudates
- tender anterior cervical lymphadenopathy
- patient age (3–14 yr)
Describe tests for DX of GAS pharyngitis (2)
- A rapid strep antigen test can assist in making a Dx of GAS pharyngitis
- while a throat culture is the gold standard.
GAS pharyngitis can be treated with what? (1)
a 10-d course of penicillin or amoxicillin.
Name causal conditions of sore throat and rhinorrhea (5)
- Bacteria: for example, GAS
- Viral: for example, EBV, adenovirus, influenza, parainfluenza, coxsackie A virus
- Fungal: for example, C. albicans in immunosuppressed patients
- Allergic: for example, chronic allergic rhinosinusitis
- Other: for example, Kawasaki disease, foreign body, irritative pharyngitis
Describe approach: Sore Throat and Rhinorrhea (5)
- Fever
- Respiratory distress—may suggest epiglottitis or peritonsillar/Retropharyngeal Abscess
- Immunization status—higher likelihood of serious bacterial pathology, such as epiglottitis, in an unimmunized child
- Viral Upper Respiratory Tract Infection (URTI) symptoms (cough, rhinorrhea)
- Diagnostic criteria for Kawasaki disease
Describe physical exam: Sore Throat and Rhinorrhea (9)
- General: if the child is unwell with stridor or drooling, must rule out airway obstruction (i.e., epiglottitis, foreign body, RPA)
- Lips: red/cracked lips may be a sign of Kawasaki disease.
- Oropharynx: erythematous, palatal petechiae
- Uvula: if deviated, may suggest presence of peritonsillar abscess
- Tonsils: presence of exudates, vesicles
- Lymph nodes: cervical LN enlarged, tender
- Must palpate for splenomegaly and hepatomegaly if suspicious of EBV
- Extremity changes: erythema/swelling/peeling are signs of Kawasaki disease.
- Remainder of HEENT exam and systemic exam
What can help with the decision to do a throat swab for culture? (1)
McIsaac criteria
Describe: McIsaac criteria (5)
- Age 3 to 14 yr (1 point)
- Fever > 38°C (1 point)
- Absence of cough (1 point)
- Anterior cervical lymphadenopathy, tender on palpation (1 point)
- Tonsillar exudates/erythema (1 point)
1 to 1 points: no culture; 2 to 3 points: culture but only tx if positive; 4 points tx with atbs
Name investigations: Sore Throat and Rhinorrhea (2)
- McIsaac criteria can help with the decision to do a throat swab for culture.
- Other investigations to consider:
- rapid strep antigen test
- heterophil antibody test (Monospot test), EBV titers, CBC + differential (presence of lymphocytosis in keeping with EBV)
Describe dx: Sore Throat and Rhinorrhea (3)
- A throat swab should always be obtained prior to starting treatment with antibi ti s.
- Rapid strep antigen test is 70% to 90% sensitive; therefore, throat culture is still the gold standard.
- Differentiation of bacterial versus viral pharyngitis is significant because inappropriate use of antibiotics to treat viral pharyngitis can contribute to atb resistance.
Name complications GAS pharyngitis (4)
- Rheumati fever
- Post-Streptococcal Glomerulonephritis
- Retro pharyngeal/peritonsillar abssess
- Scarlet fever.
Name: Upper airway disorders (5)
- Croup
- Bacterial tracheitis
- Epiglottitis
- Retropharyngeal Abscess (RPA)
- Peritonsillar abscess
Name sx: Croup (4)
- URTI
- Hoarse voice + barking cough
- Fever
- Stridor
Describe dx: Croup (2)
- Lateral neck x-ray: subglottic narrowing
- Frontal (AP) neck film findings: classic “steeple sign” in subglottic region
Describe tx: Croup (3)
- Supportive
- Nebulized racemic epinephrine for stridor
- Single-dose systemic steroid
Name sx: Bacterial tracheitis (6)
- Preceding URTI
- High fever
- Stridor, retractions
- Dysphagia
- Muffled, suppressed cough
- Toxic child
Name sx: Epiglottitis (7)
- Rapid evolution symptoms:
- fever
- sore throat irritability
- lethargy
- drooling
- Dysphagia
- Severe stridor, airway obstruction
- Toxic child
