Module 3 - Throat Pain

Question 1

Pharyngitis Most Common Causes *

Answer 1

1. Strep group 1 pyogenes
2. Mononucleosis
3. Viral
4. URI
5. Allergic Rhinitis
6. GERD

*** First determine if bacterial or virus
- Typically it’s viral
- Usually adenovirus cause with cold sx and sore throat

• Sometimes rash of trunk and tongue (strawberry tongue) 1-2 days after called scarlet fever

Question 2

4 Point Centor Scale for Strep *****

Answer 2

1. Fever greater than 100.4
2. Absence of cough
3. Tonsillar exudate
4. Tender ANTERIOR cervical lymphadenopathy

** 2-3+ recommends testing and culture
** 4+ is presumptive and doesnt necessarily need testing
3-4 perform RADT

Question 3

Diagnostic Work Up for Strep *

Answer 3

Rapid Antigen Detection Test (RADT)
- Not as sensitive
- Specificity (99%)
Culture (perform if RADT negative)
- Regular medium
- Group A strep medium

** listen to slide again

Question 4

Treatment of GAS (group a strep) *

Answer 4

• Penicillin V 500mg BID/TID x 10 days
• Penicillin G Benzathine 1.2 mil u IM
• Amoxicillin 500mg BID x 10 days OR 1g qd x 10 days

For PCN allergies
- Type IV Reaction:
> Cephalexin 500mg BID x 10 days
- Type I Reaction:
> Azithromycin 500mg x 1day then 250mg qd x 5 days
> Clarithromycin 250mg BID x 10 days
> Clindamycin 300mg TID x 10 days

Question 5

Case Study Examples *

Answer 5

19yo: Fever, Sore Throat, Hoarseness, Neck Swelling
- Rapid (-) and sent home
Back with WORSENING symptoms: severe pharyngitis, fever, large tonsils

Diagnosis: MONO
Hint: symptoms are progressively worse

Question 6

mono vs strep

Answer 6

mono progressively worse symptoms

if you misdiagnose strep (when its actually mono) and give ampicillin or amoxicillin and RASH WILL LIKELY OCCUR

incubation 1-2 mo
lower grade fever

both of tonsilar exudate but mono is gray green

monospot test (may be false neg in first week) test positive for 1 mo to 1 year

Question 7

cold symptoms with a cough and sore throat

Answer 7

viral