Acute viral and bacterial pharyngitis

Question 1

Grading of tonsils….0 to +4

If tonsils are absent?

Answer 1

0

Question 2

If tonsils are touching each other “kissing tonsils”

Answer 2

+4

Question 3

If tonsils are visible

Answer 3

+1

Question 4

If tonsils are halfway between tonsillar pillars and uvula

Answer 4

+2

Question 5

If the Tonsils are touching the uvula

Answer 5

+3

Question 6

Acute viral pharyngitis is usually accompanied with?

Answer 6

Upper respiratory infection

Question 7

Causative agents of viral pharyngitis are?

Answer 7

rhinoviruses
RSV
adenovirus
influenza virus
parainfluenza virus

Question 8

What is the typical course of viral pharyngitis illness?

Answer 8

self limiting and usually resolves within 4-10 days without complications.

Question 9

What antibiotics do you give to treat this condition?

Answer 9

NO ANTIBIOTICS ARE INDICATED

Question 10

what are appropriate supportive care measures for viral pharyngitis?

Answer 10

antipyretics for mild fever and discomfort
rest is recommended until child is free of fever for 1 day
increase PO fluids
decongestants and cough suppressants may be given

Question 11

Which medication is ineffective in relieving symptoms of viral pharyngitis?

Answer 11

Antihistamines are ineffective

Question 12

Is cough, rhinorrhea, coryza, hoarseness, conjunctivitis, diarrhea symptoms seen with viral or bacterial pharyngitis?

Answer 12

VIRAL

Question 13

What are the symptoms seen with Group A beta hemolytic strep pharyngitis?

Answer 13

history of strept A exposure or being around kids
occurs in winter or early spring
sudden onset of sore throat, severe pain with swallowing
headache, nausea, vomiting, abdominal pain more common in kids
tonsillopharyngeal erythema with or without exudate
tender, enlarged anterior cervical lymph nodes
red, beefy swollen uvula
petichiae on palate, scarlatiniform rash

Question 14

What is the modified Centor Criteria?

Answer 14

Used for decision making of pharyngitis
fever +1
absence of cough +1
tender anterior cervical adenopathy +1
tonsillar swelling or exudates +1
age 
younger than 15 years +1
15-45 years 0
older than 45 years -1

Question 15

If patient scores 2-3 points with Modified Centor criteria what interventions are done?

Answer 15

order rapid test and throat culture

treat with antibiotics if positive

Question 16

If patient scores 0-1 points on centor criteria what interventions are done?

Answer 16

no testing or antibiotics are warranted

Question 17

If patient scores 4+ points with Modified Centor Criteria what interventions are done?

Answer 17

No testing warranted

treat empirically with antibiotics

Question 18

T/F Children with Group A Beta hemolytic strept do not present with similar symptoms as adults

Answer 18

True

sometimes they only present with fever

Question 19

What are clinical manifestations of bacterial pharyngitis (strept throat)?

Answer 19

abrupt onset
pharyngitis
headache
fever 
abdominal pain
tender anterior cervical lymphadenopathy
tonsillar and pharyngeal inflammation and exudate (day 2 of illness)
difficulty swallowing due to pain
scarlatina rash (sand paper rash)

Question 20

What are two serious conditions that can occur after Group A Beta Hemolytic strep (GABHS) infection?

Answer 20

Rheumatic fever (scarlet fever) about 18 days after
Acute glomerulonephritis about 10 days after

Question 21

T/F if patient has cough it is unlikely that the patient has GABHS?

Answer 21

TRUE

Question 22

When does Scarlet fever show up?

Answer 22

usually get rash 24 hours after onset of GABHS

Question 23

What ages do you typically see scarlet fever?

Answer 23

less than 3 years old and in adults

Question 24

What are signs and symptoms of scarlet fever

Answer 24

scarlatina rash (sand paper rash) on trunk that blanches
Pastias line
circumolar palor
desquamation 7-10 days after start of rash on hands and feet and trunk and abdomen
strawberry tongue

Question 25

Is ASO testing helpful for diagnosis of strept?

Answer 25

NO

only used for retrospective diagnosis related to acute glomerulonephritis.

Question 26

What is treatment for GABHS?

Answer 26

if 60 pounds (27 kg) give Penicillin V 250 mg two or three times a day for 10 days
if >60 lbs. then given Penicillin V 500 mg PO BID x 10 days

Question 27

If patient is allergic to beta lactams what antibiotics are used to treat strept throat?

Answer 27

Clindamycin
Clarithromycin
Azithromycin

Question 28

What antibiotic has recently been associated with cardiac pathology (causing arrhythmias)

Answer 28

Clarithromycin

Question 29

When can kids return to school and no longer contagious?

Answer 29

After being on antibiotics for 24 hours

Question 30

What is the treatment for patients that have carrier state of GABHS (have the bacteria show up on culture swab but patient exhibits no immunologic response)?

Answer 30

Clindamycin or Rifampin plus Benzathine penicillin

Penicillin V plus Rifampin