Exam 1 - Tonsillopharyngitis Flashcards
Noninfectious causes of pharyngitis
- Acid reflux
- Postnasal drip from allergies
- Canker sores
Infectious causes of pharyngitis: viral
- EBV
- Adenovirus
- Rhinovirus
- Parainfluenza
- CMV
- HSV
Infectious causes of pharyngitis: bacterial
- Streptococcus (groups A, C, G)
- Gonorrhea
- Arcanobacterium haemolyticum
- Fusobacterium necrophorum
Which form, bacterial or viral, is the MCC of infectious pharyngitis?
Viral
Viral pharyngitis symptoms
- Afebrile or low grade temperature
- Malaise
- Fatigue
- Rhinorrhea
- Cough
- Scratchiness in throat
- Pain with swallowing
Viral pharyngitis physical exam findings
Pharynx mild erythema with little to no exudate
Absent painful/tender nodes
How would the provider manage a patient with viral pharyngitis?
Symptomatic management
- Salt water gargles
- Lozenges
- Acetaminophen or ibuprofen
- Hydration
When does viral pharyngitis typically resolve?
Resolves in 5-7 days
What is the incubation period of group a beta-hemolytic strep?
Incubation period of 2-5 days
How is group A beta-hemolytic strep transmitted?
Respiratory secretions
What age range is group A beta-hemolytic strep common?
Ages 5-15 years
Group A beta-hemolytic strep symptoms
Abrupt onset
- Fever
- Malaise
- Headache
- Lymphadenopathy
- Dysphagia
Children: N/V, abdominal pain
Group A beta-hemolytic strep physical exam findings
- Fine, sandpaper-like rash
- Petechiae on soft palate
- Circumoral pallor
- Strawberry tongue
- Odor
- Pastia lines on skin (red lines in skin folds)
- Begins to peel off after several days (not harmful)
What is the centor score used for?
Determining risk of group A beta-hemolytic strep
What is the centor criteria?
- History of fever: +1
- Tonsillar exudate: +1
- Tender anterior cervical lymphadenopathy: +1
- Absence of cough: +1
- Age less than 15: +1
- Age greater than 45: -1
What is the score breakdown for he centor criteria?
Score 0-1: low risk - don’t need rapid
Score 2-3: moderate risk - need rapid and treat if positive
Score 4-5: need rapid, treat if positive
Score 5+: treat empirically with antibiotics
First line treatment for group A beta-hemolytic strep
PCN or amoxicillin
What is second line treatment for gorup A beta hemolytic strep if the patient is allergic to PCN (non-type 1)?
If non-type 1 PCN allergy, cephalexin or cefadroxil
If a patient has a type 1 PCN allergy, what could the provider prescribe for treatment of group A beta hemolytic strep?
- Clindamycin
- Azithromycin
- Clarithromycin
What is the usual course of treatment for group A beta hemolytic strep?
Treat for 10 days (5 days if using azithromycin)
After starting antibiotic therapy to treat group A beta hemolytic strep, how long before patient begins to feel better?
24-48 hours
What conditions would cause the provider to consider a tonsilectomy?
If patient has had 7+ episodes of sore throat in past year OR 5+ episodes of throat infections in past 2 years
What causes acute bacterial rhinosinusitus?
Starts as viral upper respiratory infection
Mucus stagnates within sinuses causing bacterial growth
Acute bacterial rhinosinusitis symptoms
- URI for >10 days with no improvement or only improvement for short period and feeling worse again
- Nasal obstruction/congestion
- Purulent mucous drainage
- Facial pain or pressure
When do the most severe symptoms of acute bacterial rhinosinusitis appear?
Severe symptoms in first 3-4 days
Will feel pressure and fever
How can the provider distinguish between a viral infection and bacterial infection (rhinosinusitis)?
Viral infection if symptoms <10 days, no fever
Acute bacterial rhinosinusitis treatment
Augmentin
