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General Medicine & Family Medicine > ENT \ Sore Throat > Flashcards

ENT \ Sore Throat Flashcards

1
Q

What is pharyngitis?

A

Inflammation of the

  • pharynx
  • hypopharynx
  • uvula or
  • tonsils
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2
Q

What are some noninfectious causes of pharyngitis?

A
  • Trauma
  • smoke inhalation
  • pollutants
  • allergies
  • gastroesophageal reflux
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3
Q

What is the most common infectious cause of pharyngitis?

A

Adenovirus

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4
Q

What other viruses can cause pharyngitis?

A
  • Rhinovirus
  • coxsackievirus
  • herpesvirus
    • Epstein-Barr virus
    • herpes simplex virus
    • varicella virus
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5
Q

Describe hand, foot, and mouth disease (caused by a coxsackievirus).

A

Erythematous-based small vesicles or ulcers in the pharynx and on the palms and soles

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6
Q

Describe the oral lesions caused by herpes simplex virus.

A
  • Shallow, erythematous-based small vesicles
  • ulcers on the
    • gingival
    • vermillion border and/or
    • pharynx
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7
Q

Exudative tonsillitis, pharyngitis (for more than 10-14 days), cervical lymphadenopathy, fever, fatigue, and hepatosplenomegaly are characteristic of what common cause of pharyngitis?

A
  • Infectious mononucleosis.
  • It is caused by Epstein-Barr virus but other viruses (cytomegalovirus) may cause a mononucleosis-like syndrome.
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8
Q

What test can be used to diagnose infectious mononucleosis?

A

Monospot test (detects heterophile antibodies)

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9
Q

What other tests should be performed in patients with infectious mononucleosis?

A
  • Liver function tests
  • full blood count (FBC) and platelets
  • Coombs test
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10
Q

What are the complications of infectious mononucleosis?

A
  • Hepatitis
  • ruptured spleen
  • low blood cell counts
  • CNS infections
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11
Q

What precaution should patients take to reduce the risk of splenic rupture?

A

Avoid contact sports and heavy lifting in the first 2-3 weeks of illness

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12
Q

Which antibiotics can cause a rash in patients with infectious mononucleosis?

A
  • Amoxicillin or ampicillin which are often given when a clinician mistakes mononucleosis for a streptococcal throat infection
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13
Q

In patients presenting with mononucleosis-like illness, why is it so important to take a social history?

A
  • Sexually transmitted infections (gonorrhea, chlamydia, HIV) may present with pharyngitis.
  • Recognizing the similarities between primary HIV (acute retroviral syndrome) and infectious mononucleosis is particularly important since it increases the rate of early HIV detection.
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14
Q

Primary HIV typically presents within how many weeks of initial infection?

A

2-3 weeks

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15
Q

In primary HIV, how high is the viral load?

A

HIV viral load is greater than 10,000 copies/mL

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16
Q

Give some examples of nonviral pathogens that can cause pharyngitis?

A
  • Group A beta-hemolytic streptococcus (GABHS)
  • Chlamydophila pneumoniae
  • Mycoplasma
  • Corynebacterium diphtheriae
  • Neisseria gonorrhoeae
  • Candida
17
Q

In what season is (Group A beta-hemolytic streptococcus (GABHS))GABHS most common?

A

Winter and early spring

18
Q

A sore throat from GABHS infection lasts how long?

A

Less than a week (longer than that probably means that it is something else)

19
Q

The Centor criteria are often used to distinguish GABHS from other causes of pharyngitis. What are the Centor criteria?

A
  1. Tonsillar exudates
  2. Tender anterior cervical adenopathy
  3. Fever
  4. Absence of cough
    https: //www.mdcalc.com/centor-score-modified-mcisaac-strep-pharyngitis
20
Q

What is the test of choice for diagnosing strep throat?

A

Rapid streptococcal antigen test

21
Q

How does the Centor score help determine when a rapid strep test should be ordered and when antibiotics should be given?

A
  • A rapid strep test should be done when the Centor score is 2 or 3 and antibiotics should be used if the test is positive.
  • A score of 4 or 5 should be treated with empiric antibiotics.
  • A score of 0 or 1 does not need rapid strep testing or antibiotics.

see: https://www.mdcalc.com/centor-score-modified-mcisaac-strep-pharyngitis

22
Q

What test should be done if the rapid strep test is negative but clinical suspicion remains high?

A

Throat culture on blood agar plate (BAP)

23
Q

What is the preferred treatment for GABHS and why?

A
  • Oral penicillin V potassium for 10 days or a one-time dose of intramuscular penicillin G benzathine.
  • Penicillin is a low-cost, narrow-spectrum antibiotic, with long-proven efficacy.
24
Q

What is the treatment if the patient has a penicillin allergy?

A
  • Macrolides (eg, azithromycin) or clindamycin
25
Q

What is the rationale for treating GABHS?

A

Treatment can shorten illness duration (although usually only by one day), prevent rheumatic fever, and prevent peritonsillar abscess.

26
Q

What are the complications of GABHS?

A
  • Rheumatic fever (and subsequent heart valve damage)
  • peritonsillar abscess
  • acute poststreptococcal glomerulonephritis(APSGN)
27
Q

What are some signs and symptoms of rheumatic fever?

A
  • Carditis
  • erythema marginatum
  • migratory polyarthritis
  • subcutaneous skin nodules
  • chorea
  • fever
28
Q

What are the signs and symptoms of peritonsillar abscess?

A
  • Worsening sore throat
  • fever
  • odynophagia/dysphagia
  • difficulty speaking
  • large tonsils
  • displaced palate
  • deviated uvula
  • difficulty in neck extension
  • limited jaw movement
29
Q

How is peritonsillar abscess treated?

A
  • Drainage (with 18-gauge needle or surgically) and antibiotics (clindamycin or second- or third-generation cephalosporin)
30
Q

What are signs and symptoms of APSGN?

A
  • Edema
  • hypertension
  • gross hematuria
  • oliguria
  • At least half of the patients are asymptomatic
31
Q

Can antibiotic treatment for GABHS prevent APSGN?

A
  • Evidence has not shown that antibiotic treatment can reduce the incidence of APSGN.
32
Q

What is the typical latent period between GABHS infection and APSGN?

A

7-21 days (average = 10)

33
Q
A

General Medicine & Family Medicine (150 decks)

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