ENT \ Sore Throat Flashcards
What is pharyngitis?
Inflammation of the
- pharynx
- hypopharynx
- uvula or
- tonsils
What are some noninfectious causes of pharyngitis?
- Trauma
- smoke inhalation
- pollutants
- allergies
- gastroesophageal reflux
What is the most common infectious cause of pharyngitis?
Adenovirus
What other viruses can cause pharyngitis?
- Rhinovirus
- coxsackievirus
- herpesvirus
- Epstein-Barr virus
- herpes simplex virus
- varicella virus
Describe hand, foot, and mouth disease (caused by a coxsackievirus).
Erythematous-based small vesicles or ulcers in the pharynx and on the palms and soles
Describe the oral lesions caused by herpes simplex virus.
- Shallow, erythematous-based small vesicles
- ulcers on the
- gingival
- vermillion border and/or
- pharynx
Exudative tonsillitis, pharyngitis (for more than 10-14 days), cervical lymphadenopathy, fever, fatigue, and hepatosplenomegaly are characteristic of what common cause of pharyngitis?
- Infectious mononucleosis.
- It is caused by Epstein-Barr virus but other viruses (cytomegalovirus) may cause a mononucleosis-like syndrome.
What test can be used to diagnose infectious mononucleosis?
Monospot test (detects heterophile antibodies)
What other tests should be performed in patients with infectious mononucleosis?
- Liver function tests
- full blood count (FBC) and platelets
- Coombs test
What are the complications of infectious mononucleosis?
- Hepatitis
- ruptured spleen
- low blood cell counts
- CNS infections
What precaution should patients take to reduce the risk of splenic rupture?
Avoid contact sports and heavy lifting in the first 2-3 weeks of illness
Which antibiotics can cause a rash in patients with infectious mononucleosis?
- Amoxicillin or ampicillin which are often given when a clinician mistakes mononucleosis for a streptococcal throat infection
In patients presenting with mononucleosis-like illness, why is it so important to take a social history?
- 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.
Primary HIV typically presents within how many weeks of initial infection?
2-3 weeks
In primary HIV, how high is the viral load?
HIV viral load is greater than 10,000 copies/mL
Give some examples of nonviral pathogens that can cause pharyngitis?
- Group A beta-hemolytic streptococcus (GABHS)
- Chlamydophila pneumoniae
- Mycoplasma
- Corynebacterium diphtheriae
- Neisseria gonorrhoeae
- Candida
In what season is (Group A beta-hemolytic streptococcus (GABHS))GABHS most common?
Winter and early spring
A sore throat from GABHS infection lasts how long?
Less than a week (longer than that probably means that it is something else)
The Centor criteria are often used to distinguish GABHS from other causes of pharyngitis. What are the Centor criteria?
- Tonsillar exudates
- Tender anterior cervical adenopathy
- Fever
- Absence of cough
https: //www.mdcalc.com/centor-score-modified-mcisaac-strep-pharyngitis
What is the test of choice for diagnosing strep throat?
Rapid streptococcal antigen test
How does the Centor score help determine when a rapid strep test should be ordered and when antibiotics should be given?
- 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
What test should be done if the rapid strep test is negative but clinical suspicion remains high?
Throat culture on blood agar plate (BAP)
What is the preferred treatment for GABHS and why?
- 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.
What is the treatment if the patient has a penicillin allergy?
- Macrolides (eg, azithromycin) or clindamycin
