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Clinical Year Exams > CAD I SPE (Sore Throat) > Flashcards

CAD I SPE (Sore Throat) Flashcards

1
Q

What is the most common etiology and pathogen associated with Common Cold/URI?

A

Viral

- Rhinovirus

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2
Q

What four symptoms are often seen with Common Cold/URI? When is it most contagious?

A
  • Clear/watery rhinorrhea
  • Nasal congestion
  • Sore throat (dry/scratchy)
  • NON-productive cough

First 2-3 days

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3
Q

What three PE findings are often seen with Common Cold/URI? What PE finding is NOT seen?

A
  • Swelling and discharge of nasal mucosa
  • Pharyngeal erythema (mild)
  • Conjunctival injection

NO LAD

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4
Q

What are two possible complications of Common Cold/URI?

A
  • Acute rhinosinusitis

- AOM

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5
Q

What is the typical course of Common Cold/URI, and what is the treatment (2)?

A

SELF-LIMITING (1-2 weeks)

  • NSAIDs/Acetaminophen
  • Antihistamines (Sudafed)
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6
Q

What three symptoms are often seen with Influenza? What is the typical onset, and when is it most contagious?

A

ABRUPT onset of…

  • Fever
  • Myalgias
  • Sore throat

First 2 days

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7
Q

If outpatient, what is the recommended testing for Influenza (3)? If inpatient, what is the recommended testing for Influenza?

What additional test is also often ordered as the gold standard?

A

OP: NOT recommended unless high risk = 65+, children <5 years of IC

IP: ANY patient with sxs upon admission or during admission

Gold standard = viral culture (3-10 days for results)

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8
Q

What is the preferred test for Influenza?

A

NAAT (Rapid Molecular Assay)

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9
Q

What is the recommended treatment for Influenza if severe or high-risk, and what is the window for giving it? How does this affect prognosis (2)?

A

Tamiflu (Oseltamivir) within 48 hours

- Reduces complications and shortens course by 1-2 days

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10
Q

How does Influenza vaccination differ for children 6 months to 8 years vs. 18-64 years vs. 65+ years?

A
  • 6 months-8 years = for first dose, TWO standard dose trivalent IM that are 4+ weeks apart
  • 18-64 years = standard dose trivalent IM
  • 65+ years = HIGH dose trivalent IM
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11
Q

What is the major complication associated with Influenza, and in what population is this a leading cause of mortality?

A

PNA

- Native Americans

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12
Q

What is the most common etiology of Pharyngitis?

A

VIRAL

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13
Q

What is the most common bacterial pathogen associated with Pharyngitis?

A

GAS (Strep pyogenes)

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14
Q

How does viral pharyngitis differ from bacterial pharyngitis on PE? What two viral pathogens are the exception to this?

A

Viral = NO pharyngeal exudate

- Exceptions: Adenovirus, Mononucleosis

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15
Q

What are three complications of GAS Pharyngitis, and when do they typically present?

A

2-3 weeks after illness…

  • Rheumatic fever
  • Peritonsillar abscess
  • Poststreptococcal glomerulonephritis
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16
Q

What three findings are seen with Scarlet Fever, and what is this a possible complication of?

A

Complication of GAS Pharyngitis

  • Scarlantiform rash (sandpaper rash)
  • Strawberry tongue
  • Pastia’s lines
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17
Q

What four symptoms are often seen with GAS Pharyngitis? What two other non-specific sxs may be seen?

A
  • Fever
  • Sore throat
  • Malaise
  • Odynophagia (painful swallowing)

Also N/V and myalgias

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18
Q

What four PE findings are often seen with GAS Pharyngitis?

A
  • Cervical LAD (anterior)
  • Pharyngeal erythema
  • Tonsillar exudate
  • Palatal petechiae
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19
Q

What are the four aspects of the Centor criteria, and what condition is it used for? What are the three possible outcomes?

A

For GAS Pharyngitis

  • Fever
  • Cervical LAD (anterior)
  • Pharyngotonsillar exudate
  • NO cough

If 0-1/4 present = no test, no tx
If 2-3/4 present = test
If 4/4 present = treat empirically (no test necessary)

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20
Q

What are the three possible first line treatments for GAS Pharyngitis? What is the second line treatment?

How long does it typically take to see sxs improvement with abx use?

A
  • Penicillin G Benzathine IM, single dose
  • Penicillin V PO
  • Amoxicillin PO

Second line if PCN allergy = Azithromycin

Sxs improve within 1-3 days on abx

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21
Q

Besides GAS, what other three bacterias may cause Pharyngitis? Give one differentiating finding for each.

A
  • C. diphtheriae = grey tonsillar exudate
  • M. pneumoniae = lower respiratory infection + HA
  • N. gonorrhoeae = common in MSM/oral sex (similar presentation to GAS)
22
Q

What is the typical progression of Mononucleosis (EBV)?

A

Sxs for 2-4 weeks

- Contagious for up to 3 months

23
Q

What three symptoms are often seen with Mononucleosis (EBV)?

A
  • Malaise/fatigue
  • Sore throat
  • Fever
24
Q

What four PE findings are often seen with Mononucleosis (EBV)?

A
  • Pharyngeal erythema
  • Tonsillar exudate
  • Cervical LAD (posterior)
  • Splenomegaly
25
Q

In what age group is Peritonsillar Abscess most common? What is the most common pathogen (2)?

A

Children/Young adults

- OFTEN POLYMICROBIAL (Strep pyogenes (GAS), Staph aureus)

26
Q

What four symptoms are often seen with Peritonsillar Abscess?

A
  • Severe sore throat (unilateral)
  • Fever
  • Trismus
  • Drooling
27
Q

What four PE findings are often seen with Peritonsillar Abscess?

A
  • “Hot potato” voice
  • Tonsillar edema
  • Uvula deviation to opposite side
  • Cervical LAD, neck swelling
28
Q

What diagnostic test should be used for Peritonsillar Abscess (to R/O other conditions)?

A

CT WITH contrast

  • Differentiate cellulitis from abscess
  • Rule out epiglottitis or retropharyngeal abscess
29
Q

What is the treatment of Peritonsillar Abscess (2)?

A

I&D

Abx

  • OP = Augmentin or Clindamycin
  • IP = Unasyn
30
Q

In what age group is Epiglottitis most common (2)? What is the most common pathogen?

A

Unvaccinated children vs. older adults

- Hib

31
Q

What four symptoms are often seen with Epiglottitis?

A

RAPID ONSET…

  • Drooling
  • Stridor
  • Severe sore throat
  • Toxic appearing
32
Q

What should be the initial PE assessment with Epiglottitis? What should NOT be done?

A

Secure airway

- NO use of tongue blade

33
Q

What diagnostic test should be used for Epiglottitis, and what is the most common finding?

A

Lateral neck XR

- “Thumb sign”

34
Q

What is the treatment of Epiglottitis (3)?

A

EMERGENT so…

  • Hospitalization
  • Intubation
  • Abx
35
Q

What three STIs may present with complaints of sore throat?

A
  • Acute HIV (no exudate)
  • Gonorrhea (exudate, cervical LAD)
  • Syphilis, secondary stage (mostly oropharyngeal sxs)
36
Q

Besides EBV, what other virus is commonly associated with pharyngitis? What is the treatment?

A

HSV (Herpes Simplex Virus) - usually HSV-1

- Tx: Acyclovir

37
Q

What two groups of medications may cause pharyngitis?

A
  • ACE-I

- Chemotherapy

38
Q

When is Coxsackie virus most contagious, and how long does it last for?

A

Most contagious in 1st week

- Contagious until blisters resolve

39
Q

What four symptoms are often seen with Coxsackie virus?

A

Hand, Foot, Mouth Disease

  • Fever
  • Poor appetite
  • URI sxs (sore throat, cough, malaise)
40
Q

What three symptoms are often seen with Laryngitis?

A
  • Hoarseness
  • Dysphonia
  • URI sxs (sore throat, rhinorrhea, cough)
41
Q

What is the most common etiology associated with Acute Rhinosinusitis? What age group is most often affected?

A

VIRAL

- Age 45-64 years (mostly female)

42
Q

How is Acute VIRAL Rhinosinusitis typically diagnosed?

A

Clinically

- <10 days of sxs, NOT worsening

43
Q

What is the most common cause of Acute BACTERIAL Rhinosinusitis?

A

VIRAL

- Mucosal edema/sinus inflammation causes obstruction with bacteria, leading to secondary bacterial infection

44
Q

When are abx indicated in the treatment of Acute BACTERIAL Rhinosinusitis (3)?

A
  • Persistent sxs for 10+ days, no improvement
  • Onset of severe sxs
  • Viral URI that initially improved THEN worsened (“double worsening”)
45
Q

What is the first line treatment for Acute BACTERIAL Rhinosinusitis? What if the patient is high risk?

A

Augmentin for 5-7 days

- High risk = inc. Augmentin dose for 7-10 days

46
Q

What is the gold standard diagnostic test for Acute BACTERIAL Rhinosinusitis?

A

Sinus Aspirate culture (by ENT)

47
Q

What are the four cardinal symptoms associated with Chronic Rhinosinusitis? How does this differ for children?

A
  • Mucopurulent drainage
  • Nasal obstruction/congestion
  • Facial pain/pressure/fullness
  • Reduced/loss sense of smell

In children, cough rather than smell

48
Q

What is the diagnostic criteria for Chronic Rhinosinusitis (3)?

A 
- 2/4 cardinal sxs present
AND
- Sxs for 12+ weeks
AND
- Disease on CT or Nasal Endoscopy
49
Q

What is the pathophysiology of GERD?

A

Not enough pressure at the LES to prevent reflux

- LES weak or relaxes inappropriately

50
Q

What is the hallmark sxs of GERD, and when does it present? What other sxs may present (3)?

A

Heartburn (pyrosis) 30-60 min after meal

  • Sore throat (burning?)
  • CP
  • Difficulty swallowing
51
Q

What two medications can be used to treat GERD, and when is each considered?

A
  • <2 episodes/week = Antihistamine (Ranitidine - recently replaced by Famotidine per Colleen)
  • 2+ episodes/week = PPI (Omeprazole)

Clinical Year Exams (3 decks)

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