Pharyngitis Flashcards

1
Q

Pharyngitis define and classify

A

Inflammation of pharyngeal mucosa caused by infection of nasopharyngeal and oropharynx
Classify -acute and chronic

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2
Q

Etiology include common viral and bacterial causes pharyngitis

A

Viral-rhinovirus, adenovirus, coronavirus
Bacterial- group A beta hemolytic streptococcus (GABHS) or streptococcus pyogenes
Other pathogens -Neisseria spp ,S.aureus, H. Influenza
Other causes -allergy, trauma, toxin

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3
Q

Quick diagnostic measure

A

GABHS rapid antigen detection test
Preferred in emergency situation due to difficulty follow up of cultures

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4
Q

Pathophysiology of pharyngitis

A

Bacterial and viral infection
Invasion of microbes cause local inflammatory response due to migration of leukocytes leads to increased capillary permeability , increased swelling , erythema, exudate and fever . Streptococcal infections produce toxins and protease

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5
Q

Risk factors

A

Exposure to cigarette smoke
GERD
Frequent common cold /flu

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6
Q

Clinical presentation

A

Dysphagia
Sore throat
Fever
N/V
Erythema
Enlarged lymph nodes
Scarlatiniform rash
Petechia esp on soft palate

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7
Q

Which clinical presentation are suggestive of viral

A

Cough
Conjunctivitis
Coryza (runny nose)

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8
Q

Cause of gonococcal pharyngitis

A

Recent orogenital contact

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9
Q

Criteria for GABHS pharyngitis

A

Fever=1
Anterior cervical lymphadenopathy =1
Tonsillar exudate=1
Absence of cough=1
Predict GABHS pharyngitis in children

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10
Q

Complications pharyngitis

A

Otitis media
Mastoiditis
Acute rheumatic fever

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11
Q

Physical exam pharyngitis

A

Assessment of airway -ability to breath(oral/nasal)
Hydration status( dehydration due to odynophagia)
HEENT-conjunctivitis (adenovirus), rhinorrhea(viral) . Palatal petechiae tonsillopharyngeal exudate (M.pneumoniae ,adenovirus, GABHS)
Lymphadenopathy(streptococcal infection)
Cardiovascular: monitor potential rheumatic fever
Skin : scarlatiniform rash(GABHS )
Pulmonary: Non productive (M.pneumonia/C. Pneumoniae)

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12
Q

Differential diagnosis pharyngitis

A

Allergic rhinitis
Airway obstruction
Neoplasm-head and neck
GERD
Peritonsillar cellulitis
Scarlet fever
Pneumonia

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13
Q

Diagnosis pharyngitis

A

GABHS rapid antigen detection test
Throat culture (less expensive that rapid test)
Clinical presentation

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14
Q

Goal of treatment pharyngitis

A

Improve clinical symptoms
Prevent complications ie mastoiditis, rheumatic fever
Minimize adr
Prevent transmission to close contacts

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15
Q

Treatment pharyngitis

A

Antimicrobial to be used on lab confirmation of GABHS pharyngitis , blood test not required but may give w/in 7 days of onset of symptoms to prevent rheumatic fever
Analgesic and antipyretic ie paracetamol or ibuprofen
1. PenV 250mg q8h child-10days for adult 250mg PO q6h
2. PenG I.M stat
3. Amoxicillin 50mg/kg/d in 2-3 divided doses for 10 days

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16
Q

When to consider steroids for pharyngitis

A

Severe pharyngitis
Airway obtruction
Significant swelling/odynophagia
Ie give prednisolone tabs or dexamethasone I.M stat

17
Q

If allergy to penicillins what can you give

A

Macrolide
Clindamycin
PO cephalosporins

18
Q

Follow and monitoring parameters
Pharyngitis

A

Alleviation after 3 days and at end of course of antibiotics
Culture of history of rheumatic fever or if symptoms relapse
Avoid contact sports
Viral pharyngitis doesn’t generally require follow up unless immunosuppressive is suspected