Sore Throat Flashcards
acute vs chronic pharyngitis
acute: less than 2 weeks duration
chronic: more than 2 weeks duration
categories of the causes of pharyngitis
infectious vs non-infectious causes
infectious can be viral or bacterial
what is the most common cause of sore throat?
infection - viral is more common than bacterial
when do we consider fungal causes of pharyngitis? is it common?
it is rare
consider in patients who are immunocompromised, with chronic steriod or antibiotic use
____ and ____ (types of viruses) account for __% of viral pharyngitis cases
rhinoviruses and coronaviruses account for 25% of viral pharyngitis cases
(common cold included in rhinoviruses and coronaviruses)
what viruses can cause viral pharyngitis (10)
rhinovirus
coronavirus
adenovirus
herpes simplex virus (HSV)
influenza A and B
parainfluenza virus
Epstein-Barr virus
cytomegalovirus
human herpesvirus (HHV) 6
HIV
in the adult population, what % of sore throats are caused by viruses?
in the children’s (ages 5-16 and ages <5) population, what % of sore throats are caused by viruses?
adults: 85-85%
children ages 5-16: 70%
children ages <5: 95%
what is the most common cause of bacterial pharyngitis? what % of sore throats does it cause in adults? in children?
Group A beta-hemolytic streprococci (GABHS)
adults: up to 15%
children: about 30%
what bacteria can cause bacterial pharyngitis (7)
GABHS - group A beta-hemolytic streptococci
fusobacterium necrophorum
group C beta-hemolytic streptococci
Neisseria gonorrhoeae
Cornybacterium diptheriae
Mycoplasma pneomoniae
Chlamydophilia pneumoniae
- apart from GABHS, the other causes are quite rare and seen mostly in chronic steroid or antibiotic use
non-infectious causes of sore throat (7)
persistent cough
upper airway cough syndrome (postnasal drip)
GERD
acute thyroiditis
neoplasm
allergies
smoking
when do we consider non-infectious pharyngitis?
- patients with chronic sore throat (>2 weeks)
- patients without signs of infection
- patients who do not respond to treatment
what are some clinical signs of infection (re: pharyngitis)
swollen lymph nodes
fever
- redness is not necessarily a sign of infection, more a sign of irritation
what is the general approach to acute pharyngitis:
- rule out serious diagnoses and red flags that call for urgent/emergent management
- most cases are due to infectious cause - determine if bacterial or viral cause
- identify acute sore throat caused by GABHS, antibiotic Tx may be indicated where viral resolves on its own and we provide supportive therapy
urgent vs emergent situation
emergent is more serious than urgent
red flag definition
what do they prompt us to do?
- definition: signs and symptoms found in the patient history and clinical examination that may indicate possible serious underlying pathology
- they prompt further investigation and/or referral
trismus definition
what does it suggest
lock jaw
inability to open mouth fully
suggests peritonsillar swelling
pls take this opportunity to review the table of red flag findings with acute pharyngitis and what diagnoses they may indicate
pls
suppurative definition
pus-forming
related to infection
what happens in acute epiglottitis
how common is it, how serious is it
what causes it
what population does it mostly affect - has this changed? why?
does it occur more often in a certain time period?
rare but potentially fatal
inflammation of the epiglottis and adjacent tissues
bacterial infectious primarily caused by Haemophilius influenziae
most commonly seen in children ages 2-6 but HiB vaccination in infants has decreased the incidence in children and we see it in adults a little more
most common in winter and spring
a medical emergency -> refer!
diagnostic criteria for acute epiglotitis
positive thumb sign on lateral radiograph of the neck
clinical presentation of acute epiglottitis
- acute onset fever, severe sore throat, toxic appearance
- 4 Ds: dysphagia, drooling, dysphonia, distress (respiratory stridor, tripod position, severe dyspnea, irritability, restless)
tripod position definition
- indicates difficulty breathing
- patients will lean forward so the trunk of their body is one of the limbs of the tripod and their arms are pointed forward so gravity helps them get air into their lungs easier
what should you NOT do when examining someone with suspected acute epiglottitis?
do not use a tongue depressor when examining the oropharynx as it can cause spasm of the tissues in the neck and throat to cause airway obstruction/compromise the airway
what is the medical condition also called Quinsy
peritonsillar abscess
what happens in peritonsillar abscess
what population is most affected?
are there conditions that tend to occur with it or progress to it?
what organism is responsible for causing peritonsillar abscess?
how is it diagnosed?
is the most common deep infection of the head and neck
most common in young adults (20-40 yo) and immunocompromised, and diabetics
usually begins as acute tonsillitis -> cellulitis -> abscess formation
a polymicrobial infection (bacterial)
diagnosis is made clinically without labwork/imaging in patients with the typical presentation - culture from abscess drainage confirms diagnosis
what common organisms can cause peritonsillar abscess?
group A streptococci
staphylococcus aureus
haemophilus influenzae
fosobacterium
peptostreptococcus
pigmented prevatella species
veillonella
clinical presentation of peritonsillar abscess
severe unilateral sore throat, causing dysphagia and odynophagia
fever and malaise
dysphonia - muffled hot potato voice
rancid or fetor breath
otalgia
trismus
oropharyngeal exam shows erythematous enlarged tonsil and bulging soft palate on affected side, uvular deviation to contralateral side
may have severely tender cervical lymphadenopathy
what is typical treatment for peritonsillar abscess?
drainage, antibiotic therapy, supportive care
what happens in a retropharyngeal abscess
what population is most affected
are there conditions that occur before it and lead to retropharyngeal abscess?
what is the course of action?
retropharyngeal edema due to cellulitis and suppurative adenitis of lymph nodes in retropharyngeal space
preceded by upper respiratory infection, pharyngitis, otitis media, wound infection following penetrating injury to posterior pharynx
peak incidence in 3-5 yo (these lymph nodes disappear after age 5 or 6)
treat as impending airway emergency - requires antibiotic therapy, possible surgical consult for needle aspiration or incision and drainage
clinical presentation of retropharyngeal abscess
sore throat and dysphagia
fever
drooling
dysphonia
neck stiffness! limited ROM - especially hyperextension
stridor
may see bulging of posterior wall of oropharynx on clinical exam
what associated symptoms are more likely to present with viral illness (re: pharyngitis)
cough
nasal congestion
conjunctivitis
hoarseness
diarrhea
oropharyngeal lesions (ulcers or vesicles)
what viruses are most likely to cause pharyngitis in children? what are the most common viruses (%)
common cold (50%) - rhinovirus, coronavirus
influenza (5%) - influenza type A and B
mononucleosis (5%) - Epstein-Barr virus
in what cases would viral pharyngitis require antibiotic therapy
only if there is a secondary bacterial infection
streptococcal pharyngitis
what is involved?
what age group is most commonly affected?
risk factors?
infection of pharynx - caused by GABHS bacteria
most common in children ages 5-15
risk factors: exposure to sick contact with GABHS, winter or early spring
typical presentation of streptococcal pharyngitis
acute onset of fever and sore throat
headaches, nausea and vomiting, malaise, dysphagia, abdominal pain
cough and rhinorrhea usually absent! (if present suggests more viral cause)
edema and erythema of tonsils and pharynx
non-adherent tonsillar and/or pharyngeal exudate
enlarged and tender anterior cervical lymph nodes
1 in 10 cases may evolve into scarlet fever
may have palatine petechiae
what is scarlet fever
a scarletiniform rash with a texture like sandpaper; tends to be concentrated in axillary region
strawberry tongue may appear - taste buds become enlarged, tongue is swollen and red
exotoxins cause redness, rashes are small papules, raised red lesions
there is fever associated with this rash - the exotoxins are erythrogenic and leave xanthan (the red rash the develops after the infection)
