Pharyngitis Lecture Powerpoint

Question 1

Pharyngitis definition

Answer 1

Inflammation of the pharynx or tonsils (tonsilitis)

Question 2

Pharyngitis vs dysphagia

Answer 2

Pharyngitis is a sore throat, dysphagia is difficulty swallowing

Question 3

Why are children predisposed to recurrent strep throats?

Answer 3

The most active phase for immune function of the tonsils and adenoids is between 3-10 years

Question 4

Common pathogen etiologies of pharyngitis (5)

Answer 4

• Group A strep
• adenovirus
• gonococcus (sexually active)
• EBV/CMV (mono)
• coxsackie virus

Question 5

Wegner’s granulomatosis and how does it relate to pharyngitis

Answer 5

Inflammatory dz of the blood vessels that if left untreated can be fatal, has subtle onset and is caused by autoantibodies against proteinase 3, often have sore eye, ear, and stuffy nose and SORE THROAT (keep it on differential for pharyngitis)** as well as microscopic hematuria

Question 6

The most common cause of acute pharyngitis

Answer 6

Respiratory viruses

Question 7

Respiratory syncytial virus

Answer 7

Common cause of pediatric URI that is self limiting but can cause apnea in infants or immunocompromised patients

Question 8

Common signs and symptoms of mononucleosis (5)

Answer 8

• Fatigue and weakness***
• sore throat
• fever, night sweats
• swollen lymph nodes
• swollen spleen

Question 9

Mononucleosis diagnosis (3)

Answer 9

• look for “kissing” tonsils (can compromise airway)
• monospot (rapid in clinic or draw blood in hospital)
• lymphocytosis on CBC

Question 10

Mononucleosis/other viral pharyngitis treatment options (3)

Answer 10

• symptomatic treatment (alternating acetaminophen (tylenol) and ibuprofen (advil))
• avoid contact sports 4 weeks
• anti inflammatory NSAID or steroid if severe airway obstruction

Question 11

Risk factors for fungal opportunistic infections (4)

Answer 11

• new born
• immunosuppressed (HIV or elderly or cancer treatment)
• after antibiotics
• oral or inhaled steroid

Question 12

First line and second line agent for oropharyngeal candidiasis

Answer 12

• Topical antifungal (mycostatin - swish and swallow nystatin 400k-600k units 4x daily)
• fluconazole (200mg loading dose then 100-200 daily)

Question 13

Why is azithromycin 1g preferred to doxy for chlamydia treatment?

Answer 13

It is 1g 1 time so it has better compliance, availability, and expense compared to doxy which is 100mg twice daily for 7 days

Question 14

“bull neck” is a common finding of what condition?

Answer 14

Diptheria

Question 15

Diptheria signs and symptoms (3)

Answer 15

• sore throat, malaise
• spots of gray and white exudate pseudomembrane
• bull neck

Question 16

Diptheria treatment (2)

Answer 16

• diptheria antitoxin

- erythromycin 500mg 4x daily for 14 days

Question 17

Most common bacterial cause of acute pharyngitis

Answer 17

Strep pharyngitis

Question 18

Red pharynx with petechiae on soft palate is a common finding of….

Answer 18

….strep pharyngitis

Question 19

Scarlet fever as a result of strep pharyngitis infection signs and symptoms (3)

Answer 19

• sandpapery red reash
• strawberry tongue
• pastia lines in the antecubital fossa

Question 20

Rapid strep test

Answer 20

High specificity 95% so if positive almost guaranteed to be strep and can treat with antibiotics, however if negative require culture to determine need of antibiotics

Question 21

Are carriers of GABHS in their throats contagious or at risk for acute rheumatic fever when not symptomatic?

Answer 21

No

Question 22

Centor score

Answer 22

Addition of 4 variables to determine likelihood of follow up for culture to confirm suspected positive, with higher scores increasing probability of positive culture and 1-2 variables only requiring rapid strep initially

Question 23

Treatment options of strep pharyngitis

Answer 23

• oral penV 500mg BID or TID for 10 days
• clindamycin 300mg TID for 10 days
• azithromycin (last line, most resistance exists)

Question 24

When can a patient with GABHS return to school?

Answer 24

When a patient is no longer contagious 24 hours after starting therapy they may return to school

Question 25

Complications of strep pharyngitis (3)

Answer 25

• acute rheumatic fever
• post streptococcal reactive arthritis
• scarlet fever

Question 26

Acute rheumatic fever signs and symptoms( 3)

Answer 26

• Endocarditis/valvulitis
• polyarthritis
• chorea

Question 27

Acute rheumatic fever diagnostic criterria (3)

Answer 27

• increased streptolycin O
• positive throat culture
• rapid GABHS antigen

Question 28

Recurrent acute tonsillitis is associated with ___ which can indicate a patient needs to undergo surgery to remove it

Answer 28

Cardiac valvular disease

Question 29

Indications for tonsillectomy (3)

Answer 29

• dysphagia
• speech abnormalities
• suspected neoplacia