Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2H Pedia > Pharyngitis > Flashcards

Pharyngitis Flashcards

1
Q

____________
Sore throat: common chief complaint
Majority are non-bacterial/viral: part of the influenza
and common cold syndrome
 Uncommon in children < 1 yr
Peak: 4-7 yrs
 May continue throughout childhood and into adult life

A

Pharyngitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the peak age of pharyngitis?

A

4-7 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Response to antibiotics
Complications of streptococcal infection (Number 1
most dreaded etiology)
 _______________
 Acute streptococcal pharyngitis: warrants accurate
diagnosis and therapy to prevent suppurative and nonsuppurative
complications.
 The life threatening infectious complications of
oropharyngeal infections warrant some discussion.

A

Rheumatic fever
 glomerolonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tonsillitis/Epiglottitis
 Uvulitis
 Peritonsillar abscess __________-
 Retropharyngeal abscess ____________
 Ludwig angina___________-
 Vincent angina__________________

A

(Quinsy)

(prevertebral)

(submandibular)

(mixed anaerobic bacteria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the etiology of pharyngitis?

A

Infection
 Bacterial/Viral/Fungal
 Tonsillitis/Epiglottitis
 Uvulitis
 Peritonsillar abscess (Quinsy)
 Retropharyngeal abscess (prevertebral)
 Ludwig angina (submandibular)
 Vincent angina (mixed anaerobic bacteria)
2. Irritation
 Cigarette smoke/smog
 Inhaled irritants
 Reflux esophagitis
 Chemical toxins
 Dry hot air
 Hot foods, liquids
3. Others
 Tumors
 Granulomatosis
 Foreign body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the viral etiologies?

A

Viral Etiology
 Parainfluenza (types1-4)
 Influenza
 Rhinovirus
 Coronavirus
 RSV
 Adenovirus
 Herpes simplex 1&2
 Epstein-Barr virus
 Adenovirus (types 2,4,7,14,21,others)
 Coxsackie A & B

 CMV
 HIV
 Human Herpesvirus6
 Measles
 Varicella
 Rubella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the bacterial etiology?

A

Bacterial Etiology
S. pyogenes (lives in throat, ↑ if stressed)
 Grp A-β hemolytic strep (GABHS)
 Grp C & G - β hemolytic strep
 Mixed aerobic/anaerobic organisms
 Neisseria gonorrheae
 Corynebacterium diphtheriae
 Yersinia enterocolitis
 Chlamydia pneumonia atypical pneumonia &
 Mycoplasma pneumonia pharyngitis
 Arcanobacterium hemolyticum
 Francisella tularensis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

 ___________________ (lives in throat, ↑ if stressed)

A

S. pyogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Inflammatory mediators generated by viruses
Bradykinin & Lysylbradykinin
 Stimulate pain nerve endings
Direct invasion and colonization of the pharyngeal
mucosa
 Elaboration of virulence factors: exotoxins, hemolysins,
streptokinase, deoxyribonucleases, proteinases,
hyaluronidase – confer resistance to phagocytosis and
destruction.

A

Pharygitis pathophysio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the pathological changes in viral infection?

A

Viral pharyngitis
Edema, hyperemia ( increase blood flow) of tonsils and pharyngeal mucous
membrane
Nasopharyngeal hyperplasia
 Vesiculation and mucosal ulceration
 Herpes simplex & Coxsackie A
 Inflammatory exudate
 Adenovirus & Epstein-Barr virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

__________
 Intense inflammatory response : marked erythema (**redness of the skin)
 Edema of fauces and uvula
 Grayish yellow tonsillar exudate

A

Streptococcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

__________ –drumstick appearance
Fibrous pseudomembrane with necrotic epithelium,
leucocytes, bacterial colonies
 Dislodgement of pseudomembrane provokes bleeding and
aspiration
 Bull Neck ➡ due to swelling

A

Diphtheria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

This is a clinical feature of : ______________

 Mild to moderate pharyngeal discomfort
 Soreness, scratchiness, irritation
Rhinorrhea and post nasal discharge
Low to moderate temperature elevation (38.5C)
 Pharynx may appear normal or with mild edema and
erythema
NO pharyngeal/tonsillar exudates
Complaints subside over 3-4 days

A

Pharyngitis with the common cold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

This is a clinical feature of: ___________

Sorethroat: major complaint
 Myalgia, headache, cough

 Coryzal (acute inflammation of the mucousmembrane of the nasal cavities; cold in the head.) symptoms and cough
Fever - uncommon, if present:early defervescence ( abatement of fever)
 Edema/erythema of pharynx – mild
 NO exudates, NO painful cervical adenopathy

A

Pharyngitis with Influenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pharyngoconjunctival Fever : _________________

Marked sore throat with cough, malaise, myalgia,
headache, chills, dizziness
High grade fever : 5-6 day duration
 Conjunctivitis: follicular type, bilateral
 Pharyngeal erythema, some exudates
 Cervical adenitis

A

Adenoviruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

____________
-marked sore throat, erythematous pharynx, fever, rash
- red peritonsilar area
- Posterior pharynx ➡ Petechiae
** hand foot mouth disease— vesicles not seen in the mucosa

A

Pharyngitis due to Coxsackie Viruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the two syndromes of pharingitis of coxsackie?

A

2 syndromes:
1 Herpangina
2 HandFootMouth disease(

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

1_______________: discrete(1-2mm across) painful graywhite
papulovesicular lesionson thesoft palate,uvula,
ant. tonsillar pillars x 7 days; lesions rupture - ulcerate

A

** Herpangina**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

____________): painful
vesicles in the oropharynx, ulcerative vesicles in the palms
and soles,trunk; not toxic looking; < 7days

A

2 HandFootMouth disease(CoxsackieA16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

_______________
 _______________– oral infections common during childhood and
adolescence
 high fever, gingivostomatitis which become ulcers -
anterior portion of mouth and lips, tongue, palate,
tonsils, pharynx; tender lymphadenopathy; Drooling,
refusal to eat/drink
 Resolves in 7-14 days, even if untreated

A

Pharyngitis and the Herpes simplex virus

HSV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

________________
 “kissing disease”
Epstein-Barr virus found in the oropharynx, spread by
person to person contact/blood transfusion
 Common among adolescents
 With hepatomegaly and splenomegaly ➡ avoid contact
sports
 Incubation: 4-7wks
 Prodome: 2-5 days: chills, sweats,feverishness, malaise
Triad: Severe sore throat, high grade fever,
Lymphadenopathy– cervical,axillary,inguinal
 Tonsillitis in 70-90%; Tonsillar exudates in 30%
 Hepatomegaly in 10-15%;
 Splenomegaly in 50%
 Leucocytosis in 60-70%; lymphocytosis
 10% - atypical lymphocytes by 2nd wk of illness
 Self-limited, resolves in 3 wks
Diagnosis:
- Heterophil antibody test: IgM
85% of older children and adults are positive
2nd wk to illness – 6months
- atypical lymphocytes (periph smears) on 2nd wk of
illness
- specific antibody tests
- viral culture
- DNA PCR
Management: No need for antiviral drugs
- Avoid contact sports until pt is fully recovered and
spleen is not anymore palpable
- Do not give Ampicillin/Amoxicillin: may cause the
appearance of morbilliform rash
- Steroids only for those with airway obstruction,
massive splenomegaly, myocarditis, hemolytic anemia
Viral Pharyngitis
 Symptomatic Treatment
 Relieve pharyngeal discomfort
 Warm saline gargle
 Anesthetic sprays and lozenges (benzocaine)
 Rest, liquids
 Paracetamol/ibuprofen
CLINICAL FEATURE
MANAGEMENT
Infectious

A

Infectious Mononucleosis – Glandular Fever

22
Q

What is the triad in infectious mononucleosis?

A

Severe sorethroat

High grade fever

lymphadenopathy

23
Q

What is the mgt for viral pharyngitis?

A

Viral Pharyngitis
 Symptomatic Treatment
 Relieve pharyngeal discomfort
 Warm saline gargle
 Anesthetic sprays and lozenges (benzocaine)
 Rest, liquids
 Paracetamol/ibuprofen

24
Q

15% of all episodes of pharyngitis
 Prevention of sequelae : (acute rheumatic fever & acute
glomerulonephritis)depends on the timely diagnosis of
Strep pharyngitis and prompt antibiotic tx
 Incubation: 2-5 days; contact with respiratory
secretions of a person with strep pharyngitis
Most common among school-aged & adolescent
 Associated with crowding, close contact in
school/military installations

A

Grp A Streptococcal pharyngitis

25
Q

Colonization of the pharynx : results in asymptomatic
carrier state

A
26
Q

What is the major virulence factor of Group A strep?

A

 Acute infection
 Major virulence factor: M protein – resistance to
phagocytosis by PMNs
 Type specific immunity to specific M serotype develops
after infection

27
Q

 Scarlet fever – GABHS erythrogenic exotoxin (A,B,C)

A

Grp A Streptococcal pharyngitis

28
Q

Sudden onset of fever and sore throat, no cough
 Headache, malaise, abdom pain, nausea, vomiting (in
contrast to viral:cough, rhinorrhea, conjunctivitis,
stridor, diarrhea, hoarseness)
 Marked pharyngeal erythema
 Petechiae on palate(donut lesion), enlarged tonsils with
exudates, strawberry tongue, enlarged cervical lymph
nodes

A

Group A Strep

29
Q

___________: Scarlet fever
- Not everybody gets scarlet fever!
 Pharyngitis with fine diffuse red “sand paper” rash
that blanches with pressure; desquamation follows
after 1 wk
Circumoral pallor: red face with pallor around the
mouth
Pastia’s lines: accentuated erythema over flexor creases
especially on the antecubital

A

**Strep pharyngitis

30
Q

_____________
Signs
 Tonsillar & pharyngeal
erythema and
exudates
Donut lesions – soft
palate
 Beefy red and swollen
uvula
 Anterior cervical
adenitis
Scalatiniform rash

Symptoms
 Sudden onset sore
throat
 Pain on swallowing
 Fever
 Headache
 Abdominal pain
 Nausea
 Vomiting

A

GAS infection

31
Q

signs
Conjunctivitis
 Stomatitis
 Discrete ulcerative
lesions

symptoms
 Coryza
 Hoarseness
 Cough
 Diarrhea

A

Not GAS infection

32
Q

Diagnosis
 Gold standard Group A strep: _________-

A

throat culture

NOTE : Gram stain- more practical (gm + in chain/pair)

 Lab confirmation of GrpA Strep (GAS) pharyngitis
recommended – because it is not possible to clinically
differentiate viral vs GAS pharyngitis
 Swab of tonsil and post pharynx for C/S
– cannot distinguish carrier vs true infection

33
Q

What is being detected in rapid diagnostic test for group A strep?

A

 Rapid test: detect grp A carbohydrate Ag on the cell wall of

34
Q

GAS – latex agglutination test/ optical immunoassay/
chemiluminescent DNA probes
__________________
– Valid for determining past infections

A

 Strep Antibody Tests: (wks after onset)

35
Q

–Tool for evaluating possible post-strep illnesses
_______________________

A

ASO – antistreptolysin O
 antiDNAse B
 antihyaluronidase

36
Q

When to start treatment in Group A strep pharyngitis?
________________

A

Antibiotics should be started within 9th day of onset of Strep
pharyngitis…

NOTE:  to prevent acute rheumatic fever
 To prevent the suppurative sequelae: i.e. peritonsillar
abscess
 To produce a rapid resolution of the signs and symptoms
and to terminate contagiousness within 24 hrs (reduce
transmission)
 To shorten the clinical course of the disease

37
Q

What are the complications of Group A strep pharyngitis?

A

Complications
Otitis media
 Sinusitis
 Acute Glomerulonephritis
 Rheumatic Fever
 Abscess Formation:
-peritonsillar abscess
-retropharyngeal abscess
(both will require intensive antibiotic tx and drainage of
the abscess)

38
Q

 Etiologic agent: GAS/anaerobes
 Occurs in the potential space between the superior
constrictor muscles and the tonsil

 Clinical manifestations:
preceded by acute pharyngitis with fever
severe throat pain, trismus (lock jaw), difficulty
swallowing or speaking, hot potato voice,
torticollis ( also known as wry neck or loxia, is a dystonic condition defined by an abnormal, asymmetrical head or neck position), swollen inflammed tonsils,
displaced uvula

 Treatment:

  • Antibiotic therapy effective vs GABHS
  • Surgical drainage
  • Needle aspiration
  • Incision and drainage
  • Tonsillectomy
A

Peritonsillar Abscess

39
Q

Involves the space between the posterior pharyngeal
walland theprevertebral fascia:has many lymph nodes
which become infected and progress to suppuration.

 Clinical manifestations: abrupt onset of high fever,
difficulty feeding, severe distress with throat pain,
hyperextension of head, noisy gurgling respiration,
stridor, drooling, bulge on the posterior pharyngeal
wall,cervical lymphadenopathy

 Differential dx: epiglottitis/foreign body aspiration,
meningitis, lymphoma, hematoma, vertebral
osteomyelitis
 Diagnosis: I&D with culture of abscessed node
Soft tissue neck films/CT scan

 Most often polymicrobial: GABHS, oropharyngeal
anaerobes, Staph aureus, H.flu, Klebsiella
Retropharyngeal Abscess
 Treatment
- IV antibiotics with or without surgical drainage
- Surgical drainage: for patients in respiratory distress
or unresponsive to IV antibiotics

A

Retropharyngeal Abscess

40
Q

What are the red flags associated with sore throat
___________________________

A

 Fever of > 2 wks
 Duration of sore throat >2wks
 Trismus, drooling, cyanosis
 Hemorrhage
 Assymetric tonsillar swelling
 Respiratory distress (airway obstruction/pneumonia)
 Apnea
 Severe unremitting pain

41
Q

What is the DOC for sorethroat with red flags?

A

Drug of choice Child Adol
Pen V BID/TID x10d PO 250mg 500MG
Pen G OD IM 600,000 U 1.2M U
<25kg >25kg

42
Q
A

Pseudomembrane of Diphteria

43
Q
A

Bull neck: Diptheria

44
Q
A

Herpangina: discrete(1-­‐‑2mm across) painful gray-­‐‑
white papulovesicular lesions on the soft palate,
uvula, ant. tonsillar pillars x 7 days; lesions rupture
-­‐‑ ulcerate

45
Q
A

HFMD

46
Q
A

Pharyngitis and the Herpes simplex virus
• HSV1 – oral infections common during
childhood and adolescence
• high fever, gingivostomatitis which become
ulcers -­‐‑ anterior portion of mouth and lips,
tongue, palate, tonsils, pharynx; tender
lymphadenopathy;Drooling, refusal to eat/
drink
• Resolves in 7-­‐‑14 days, even if untreated

47
Q
A

Infectious Mononucleosis – Glandular
Fever
• Epstein-­‐‑Barr virus found in the
oropharynx, spread by person to person
contact/blood transfusion
• Common among adolescents
• Incubation: 4-­‐‑7wks
• Prodome: 2-­‐‑5 days: chills,
sweats,feverishness, malaise

48
Q
A

Strep Pharyngitis: Clinical Features
• Sudden onset of fever and sore throat, no
cough
• Headache, malaise, abdom pain, nausea,
vomiting (in contrast to viral: cough, rhinorrhea,
conjunctivitis, stridor, diarrhea, hoarseness)
• Marked pharyngeal erythema
• Petechiae on palate, enlarged tonsils with
exudates, strawberry tongue, enlarged
cervical lymph nodesStrep Pharyngitis: Clinical Features
• Sudden onset of fever and sore throat, no
cough
• Headache, malaise, abdom pain, nausea,
vomiting (in contrast to viral: cough, rhinorrhea,
conjunctivitis, stridor, diarrhea, hoarseness)
• Marked pharyngeal erythema
• Petechiae on palate, enlarged tonsils with
exudates, strawberry tongue, enlarged
cervical lymph nodesStrep Pharyngitis: Clinical Features
• Sudden onset of fever and sore throat, no
cough
• Headache, malaise, abdom pain, nausea,
vomiting (in contrast to viral: cough, rhinorrhea,
conjunctivitis, stridor, diarrhea, hoarseness)
• Marked pharyngeal erythema
• Petechiae on palate, enlarged tonsils with
exudates, strawberry tongue, enlarged
cervical lymph nodesStrep Pharyngitis: Clinical Features
• Sudden onset of fever and sore throat, no
cough
• Headache, malaise, abdom pain, nausea,
vomiting (in contrast to viral: cough, rhinorrhea,
conjunctivitis, stridor, diarrhea, hoarseness)
• Marked pharyngeal erythema
• Petechiae on palate, enlarged tonsils with
exudates, strawberry tongue, enlarged
cervical lymph nodesStrep Pharyngitis: Clinical Features
• Sudden onset of fever and sore throat, no
cough
• Headache, malaise, abdom pain, nausea,
vomiting (in contrast to viral: cough, rhinorrhea,
conjunctivitis, stridor, diarrhea, hoarseness)
• Marked pharyngeal erythema
• Petechiae on palate, enlarged tonsils with
exudates, strawberry tongue, enlarged
cervical lymph nodesStrep Pharyngitis: Clinical Features
• Sudden onset of fever and sore throat, no
cough
• Headache, malaise, abdom pain, nausea,
vomiting (in contrast to viral: cough, rhinorrhea,
conjunctivitis, stridor, diarrhea, hoarseness)
• Marked pharyngeal erythema
• Petechiae on palate, enlarged tonsils with
exudates, strawberry tongue, enlarged
cervical lymph nodesStrep Pharyngitis: Clinical Features
• Sudden onset of fever and sore throat, no
cough
• Headache, malaise, abdom pain, nausea,
vomiting (in contrast to viral: cough, rhinorrhea,
conjunctivitis, stridor, diarrhea, hoarseness)
• Marked pharyngeal erythema
• Petechiae on palate, enlarged tonsils with
exudates, strawberry tongue, enlarged
cervical lymph nodesStrep Pharyngitis: Clinical Features
• Sudden onset of fever and sore throat, no
cough
• Headache, malaise, abdom pain, nausea,
vomiting (in contrast to viral: cough, rhinorrhea,
conjunctivitis, stridor, diarrhea, hoarseness)
• Marked pharyngeal erythema
• Petechiae on palate, enlarged tonsils with
exudates, strawberry tongue, enlarged
cervical lymph nodesv

49
Q
A

Peritonsillar Abscess

50
Q
A

Retropharyngeal Abscess

51
Q
A

2H Pedia (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions