Sore Throat Flashcards

1
Q

Is a sore throat synonymous with pharyngitis?

A

• Sore throat is not always synonymous with pharyngitis

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2
Q

What is usually the problem if examination reveals erythema of the posterior pharynx?

A

infectious pharyngitis is usually the problem

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3
Q

What are some common causes of infectious pharyngitis?

A

1) Group A beta-hemolytic streptococci
2) Non-group A beta-hemolytic streptococci
3) Groups B, C, F, and G streptococci have been implicated
4) Chlamydia trachomatis
5) Mycoplasma pneumoniae
6) Epstein-Barr virus
7) Influenza and parainfluenza
8) Adenovirus

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4
Q

When the patient’s description of sore throat is atypical of infectious pharyngitis, and especially when examination of the pharynx is also completely normal what other causes could it be?

A

1) Head and neck disorders
2) Systemic disease
3) Mediastinal disorders

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5
Q

What are different head and neck disorders that could cause atypical sore throats? (8)

A

1) Otitis
2) Sinusitis
3) Salivary gland infection
4) Thyroiditis
5) Neck muscle strain
6) Epiglottitis
7) Allergy
8) Foreign body

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6
Q

What are different systemic diseases that could cause atypical sore throats? (8)

A

1) Viral hepatitis
2) JRA
3) Rubella
4) Poliomyelitis
5) Acute leukemia
6) Toxic shock syndrome
7) Temporal arteritis
8) AIDS

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7
Q

What are different mediastinal disorders that could cause atypical sore throats? (5)

A

1) Myocardial infarction
2) Aortic dissection
3) Angina pectoris
4) Esophagitis
5) Esophageal spasm

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8
Q

Is infectious mononucleosis a common cause of sore throats in adolescents?

A

No, it is an uncommon cause of sore throat in adolescents

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9
Q

What are some infectious mononucleosis of common clinical findings? (5)

A

1) Pharyngitis
2) Fever
3) Cervical adenopathy (most sensitive)
4) Splenomegaly
5) Palatal petechiae

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10
Q

What tests are performed for infectious mononucleosis? (3)

A
  • WBC count and differential
  • Monospot test (quick test for Heterophile antibody)
  • EBV antibody titers
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11
Q

Should all patients have routine testing for mononucleosis?

A

• Routine testing for mononucleosis in all patients with sore throat is wasteful

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12
Q

What is the rationale for early diagnosis and antibiotic intervention of streptococcal pharyngitis?

A

• Prevention of post-streptococcal glomerulonephritis (PSGN) and acute rheumatic fever (ARF)

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13
Q

What is included in the Reilly Protocol?

A

• Physical findings as a predictive clue of strep specifically:

  • Tonsillar exudate
  • Cervical adenopathy
  • Fever
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14
Q

What are the odds presented by the reilly protocol for the physical findings?

A
  • Tonsillar exudate
  • Cervical adenopathy
  • Fever
    • 2:3 odds of strep with all three
    • 1:6 odds of strep with any findings
    • 1:30 odds of strep with no findings
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15
Q

According to the Reilly protocol, what are the culture and treatment decisions to diagnose strep throat?

A

using classic throat culture and RADT (rapid antigen detection test)

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16
Q

According to the Reilly protocol, what classifies a low risk patients?

A

• No exudate or nodes or fever

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17
Q

According to the Reilly protocol, is testing done on a low risk patients?

A

Yes, RADT on all patients but No cultures necessary. Treat positive patients

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18
Q

According to the Reilly protocol, if testing is negative on a low risk patients what occurs?

A

• If negative, no treatment or cultures necessary

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19
Q

According to the Reilly protocol, what classifies a medium risk patients?

A

1) Exudate or nodes or fever
2) Prior acute rheumatic fever (NARE)
3) Low-risk by physical examination but young (<25 years) with no upper respiratory infection
4) Recent strep exposure

20
Q

According to the Reilly protocol, is testing done on medium risk patients?

A

Yes, RADT all patients
- Treat positive patients
No cultures necessary

21
Q

According to the Reilly protocol, if testing is negative on a medium risk patients what occurs?

A

• Culture negative patients

-Treat if culture-positive

22
Q

According to the Reilly protocol, what classifies a high risk patients?

A
  • Exudate and fever and nodes

* Existing valvular rheumatic heart disease

23
Q

According to the Reilly protocol, is testing done on high risk patients?

A

No, Treat all with antibiotics, No tests (culture or RADT) necessary

24
Q

When must strep throat be presumed in a high risk patient?

A
  • Scarlet fever

* Strep epidemic

25
Q

What is the criteria listed for the modified centor protocol for sore throat management? **

A
Absence of cough (1)
Swollen and tender anterior cervical nodes (1)
Temperature > 100.4 (38 degrees C) (1)
Tonsillar exudates or swelling (1)
Age:
- 3 to 14 years (1)
- 15-44 years (0)
- 45 years or older (-1)
26
Q

With a score of 0 or less on the modified centor protocol, what is the risk of GABHS pharyngitis and what is done as follow-up?

A

Risk of GABHS pharyngitis 1 to 2.5%, No further testing or antibiotics indicated

27
Q

With a score of 1 on the modified centor protocol, what is the risk of GABHS pharyngitis and what is done as follow-up?

A

Risk of GABHS pharyngitis 5 to 10%, No further testing or antibiotics indicated with the option to perform throat culture or RADT if positive, treat with antibiotics

28
Q

With a score of 2 on the modified centor protocol, what is the risk of GABHS pharyngitis and what is done as follow-up?

A

Risk of GABHS pharyngitis 11 to 17%, Perform throat culture or RADT if positive treat with antibiotics

29
Q

With a score of 3 on the modified centor protocol, what is the risk of GABHS pharyngitis and what is done as follow-up?

A

Risk of GABHS pharyngitis 28 to 35%, Perform throat culture or RADT if positive treat with antibiotics

30
Q

With a score of 4 or greater on the modified centor protocol, what is the risk of GABHS pharyngitis and what is done as follow-up?

A

Risk of GABHS pharyngitis 51 to 53%, Consider empiric treatment with antibiotics.

31
Q

What are some suppurative complications of GABHS pharyngitis? (8)

A

1) Bacteremia
2) Cervical lymphadenitis
3) Endocarditis
4) Mastoiditis
5) Meningitis
6) Otitis media
7) Peritonsillar/retropharyngeal abscess
8) Pneumonia

32
Q

What is a complicated sore throat?

A

• A very small minority of patients with sore throat have potentially serious or life-threatening illness

33
Q

What clinical findings are early signs of a complicated sore throat? (5)

A

1) Trismus
2) Drooling
3) Dysphonia
4) Stridor
5) Orthopnea

34
Q

With an examination of the neck what are some signs of a complicated sore throat? (4)

A

1) Bull neck
2) Asymmetric adenopathy
3) Salivary gland abscess
4) Stiff neck

35
Q

With an examination of the pharynx what are some signs of a complicated sore throat? (5)

A

1) Kissing tonsils
2) Asymmetric tonsillar swelling
- Peritonsillar abscess
3) Membrane
- Diphtheria
4) Enlarged epiglottis
- Epiglottitis
5) Bulging posterior pharynx
- Retropharyngeal abscess

36
Q

If the examination of the neck and pharynx are unimpressive but symptoms are severe, what should be done? (4)

A

1) Indirect laryngoscopy
2) Soft tissue neck radiographs
3) Consider referred pain
4) Consider psychogenic cause

37
Q

Is chronic tonsillitis a problem in adults?

A

• Rarely a problem in adults

38
Q

If a patient has enlarged tonsils is it of clinical significance?

A

• Many patient have enlarged tonsils that are of no clinical significance

39
Q

Which is more common, Streptococcal carriers or patients with chronic symptomatic tonsillitis?

A

• Streptococcal carriers are much more common than are patients with chronic symptomatic tonsillitis

40
Q

Is chronic tonsillitis the same as chronic streptococcal pharyngitis?

A

• Chronic tonsillitis is probably not synonymous with chronic streptococcal pharyngitis

41
Q

What is proven to be an effective treatment for recurrent tonsillitis and is it available for everyone?

A

• Tonsillectomy has proved to be an effective treatment for recurrent tonsillitis but only in a very highly selected group of children

42
Q

How does smoking cause a sore throat?

A
  • Not limited to tobacco, but includes marijuana, hashish, and cocaine
  • Sometimes, stopping smoking will cause throat irritation for a few weeks
43
Q

What are two types of postnasal drip that cause a sore throat?

A
  • Chronic sinusitis

* Allergic rhinitis

44
Q

What thyroid disorder can cause a sore throat?

A

• Various forms of thyroiditis

45
Q

When do you test for infectious mononucleosis?

A

• If sore throat persists for more than one or two weeks, test for IM

46
Q

What condition can refer pain to the throat?

A

Angina pectoris

47
Q

What 4 other conditions can cause a sore throat?

A
  • Irritant
  • Allergies
  • Reflux esophagitis
  • Psychogenic pharyngitis