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PHAR152 > Pharyngitis > Flashcards

Pharyngitis Flashcards

1
Q

What is pharyngitis?

A

inflammation in the back of the throat

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2
Q

What are the many causes of sore throats?

A

allergies
medications (ex: steroid nasal spray)
irritating substance (hot, cold, smoke)
trauma
tumors
infection

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3
Q

What percentage of pharyngitis cases are caused by a virus in adults? What about children?

A

adults: 80-90%
children: >70%

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4
Q

True or false: pharyngitis is usually not a self-limited disease

A

false
pharyngitis is usually self-limited

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5
Q

What are the usual causes of pharyngitis?

A

rhinovirus (most common)
coronavirus
influenza

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6
Q

What are all viral causes of acute pharyngitis?

A

rhinovirus, coronavirus-common cold
adenovirus-pharyngoconjunctival fever
herpes simplex 1 & 2-pharyngitis, gingivostomatitis
parainfluenzae-cold symptoms, croup
coxsackie A-herpangina, HFM
epstein-barr virus: mononucleosis
influenza A and B-influenza
cytomegalovirus-CMV mononucleosis
HIV-primary HIV infection

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7
Q

True or false: when pharyngitis is bacterial, it is still self-limited

A

true

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8
Q

What is the most common bacterial cause of pharyngitis in adults?

A

group A streptococci (5-15%)

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9
Q

What are other bacterial causes of pharyngitis, but dont require treatment?

A

group C streptococci
group G streptococci

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10
Q

Antibiotics are prescribed in up to __% of adult patients with acute pharyngitis. However, at most __% of cases are bacterial.

A

75%
20%

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11
Q

What is the epidemiology of pharyngitis?

A

most cases during winter months (late winter-early spring)
-viral organisms usually peak in fall to spring
-strep also peaks at this time
spread is usually among close contacts with kids being the major reservoir
-may also see “ping-pong spread”

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12
Q

What is the only commonly occurring cause of sore throat that antibiotics are indicated for?

A

group A strep

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13
Q

What are the signs and symptoms of group A strep infection in the throat?

A

painful swallowing
exudates
enlarged lymph nodes
fever
increased WBCs
nausea and vomiting (NOT DIARRHEA)
scarlatiniform rash

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14
Q

What are the criteria in the pharyngitis modified centor score?

A

age 3-14: +1
age 15-45: 0
age >45: -1
exudate or swelling on tonsils: +1
fever (>38): +1
no cough: +1
swollen cervical nodes: +1

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15
Q

How do we interpret the scores of the pharyngitis modified centor score?

A

-1-0:
-risk of strep infection=2-5%
-symptomatic treatment
-no RADT, no culture, NO ANTIBIOTICS
1:
-risk of strep infection=5-10%
-same as above (symp tx, no RADT, no culture, no ABX)
2:
-risk of strep infection=11-17%
-RADT or throat swab for culture, if + for GAS–>antibiotics
3:
-risk of strep infection=28-36%
-same as above
4:
-risk of strep infection=51-53%
-same as above (consider empiric antibiotics)

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16
Q

What are the two ways to diagnose GAS pharyngitis?

A

culture (gold standard)
->90% sensitivity, may take 1-2 days for results
rapid antigen detection test (RADT)
-takes minutes, 70-90% sensitivity

17
Q

True or false: you can diagnose GAS pharyngitis from symptoms alone

A

false
cannot diagnose from symptoms alone

18
Q

How long does pharyngitis last if left untreated?

A

4-5 days

19
Q

What are the reasons to treat GAS pharyngitis?

A

decrease severity and duration of symptoms
reduce risk of transmission to others
reduce complications
prevent rheumatic heart disease

20
Q

When is the best time frame to start antibiotics for GAS pharyngitis? How much does it improvement the healing time frame?

A

antibiotics started within 2-3 days of symptoms can hasten improvement by 1-2 days

21
Q

What are the complications of GAS pharyngitis?

A

peritonsillar abscess
lymph adenitis
otitis media
sinusitis

22
Q

What is effective treatment for strep pharyngitis in preventing acute rheumatic fever and RHD?

A

penicillins

23
Q

What is a rare disease that can develop after GAS pharyngitis infections and cannot be prevented by antibiotics?

A

post-strep glomerulonephritis

24
Q

Treatment of GAS pharyngitis must be provided within how many days of onset to prevent acute rheumatic fever?

A

9 days

25
Q

What is the DOC for GAS pharyngitis?

A

penicillin V
-narrow spectrum of activity
-safe, effective, cheap

26
Q

What is the dosing of PenV in adult for GAS pharyngitis?

A

300mg TID or 600mg BID

27
Q

What is the pediatric dosing of PenV for GAS pharyngitis?

A

40mg/kg/d BID or TID

28
Q

What is the duration of therapy for GAS pharyngitis?

A

10 days

29
Q

True or false: PenV is taken with food

A

false
should be taken on an empty stomach

30
Q

Which class of antibiotics have shown efficacy against GAS pharyngitis?

A

all beta-lactams, so amoxicillin can be used

31
Q

What is a situation where it would be appropriate to use amoxicillin for GAS pharyngitis?

A

using the suspension for kids

32
Q

What is the dosing of amoxicillin in adults for GAS pharyngitis?

A

500mg BID

33
Q

What is the dosing of amoxicillin in pediatrics for GAS pharyngitis?

A

40-50mg/kg/d OD or BID
max 1g/day

34
Q

What is the dosage regimen of amoxicillin for GAS pharyngitis?

A

take with food
10 days

35
Q

What is the DOC for GAS pharyngitis when the patient is allergic to penicillin? What is the dosing of these drugs

A

macrolides are DOC
erythromycin: 10 days
-base: 250-500mg BID to QID
-ethylsuccinate: 40mg/kg/d BID to QID
-estolate: 40mg/kg/d BID to QID
clarithromycin: 15mg/kg/d BID (max 500mg/d)
azithromycin: 12mg/kg/d x 5 days (max 500mg/d)

36
Q

What are the second line (or tx failure) antibiotics for GAS pharyngitis?

A

2nd gen cephalosporin
clindamycin
intramuscular penicillin

37
Q

True or false: SMX/TMP does not eradicate GAS from the throat

A

true

38
Q

What is GAS carriage?

A

people who carry GAS in the throat with no symptoms
does not require treatment
difficult to separate from viral sore throat

39
Q

What is the symptomatic treatment for GAS pharyngitis?

A

oral analgesics
topical analgesics
lozenges
salt water gargle
fluids
rest

PHAR152 (21 decks)

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