Sore Throat Flashcards
Is a sore throat synonymous with pharyngitis?
• Sore throat is not always synonymous with pharyngitis
What is usually the problem if examination reveals erythema of the posterior pharynx?
infectious pharyngitis is usually the problem
What are some common causes of infectious pharyngitis?
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
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?
1) Head and neck disorders
2) Systemic disease
3) Mediastinal disorders
What are different head and neck disorders that could cause atypical sore throats? (8)
1) Otitis
2) Sinusitis
3) Salivary gland infection
4) Thyroiditis
5) Neck muscle strain
6) Epiglottitis
7) Allergy
8) Foreign body
What are different systemic diseases that could cause atypical sore throats? (8)
1) Viral hepatitis
2) JRA
3) Rubella
4) Poliomyelitis
5) Acute leukemia
6) Toxic shock syndrome
7) Temporal arteritis
8) AIDS
What are different mediastinal disorders that could cause atypical sore throats? (5)
1) Myocardial infarction
2) Aortic dissection
3) Angina pectoris
4) Esophagitis
5) Esophageal spasm
Is infectious mononucleosis a common cause of sore throats in adolescents?
No, it is an uncommon cause of sore throat in adolescents
What are some infectious mononucleosis of common clinical findings? (5)
1) Pharyngitis
2) Fever
3) Cervical adenopathy (most sensitive)
4) Splenomegaly
5) Palatal petechiae
What tests are performed for infectious mononucleosis? (3)
- WBC count and differential
- Monospot test (quick test for Heterophile antibody)
- EBV antibody titers
Should all patients have routine testing for mononucleosis?
• Routine testing for mononucleosis in all patients with sore throat is wasteful
What is the rationale for early diagnosis and antibiotic intervention of streptococcal pharyngitis?
• Prevention of post-streptococcal glomerulonephritis (PSGN) and acute rheumatic fever (ARF)
What is included in the Reilly Protocol?
• Physical findings as a predictive clue of strep specifically:
- Tonsillar exudate
- Cervical adenopathy
- Fever
What are the odds presented by the reilly protocol for the physical findings?
- 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
According to the Reilly protocol, what are the culture and treatment decisions to diagnose strep throat?
using classic throat culture and RADT (rapid antigen detection test)
According to the Reilly protocol, what classifies a low risk patients?
• No exudate or nodes or fever
According to the Reilly protocol, is testing done on a low risk patients?
Yes, RADT on all patients but No cultures necessary. Treat positive patients
According to the Reilly protocol, if testing is negative on a low risk patients what occurs?
• If negative, no treatment or cultures necessary
According to the Reilly protocol, what classifies a medium risk patients?
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
According to the Reilly protocol, is testing done on medium risk patients?
Yes, RADT all patients
- Treat positive patients
No cultures necessary
According to the Reilly protocol, if testing is negative on a medium risk patients what occurs?
• Culture negative patients
-Treat if culture-positive
According to the Reilly protocol, what classifies a high risk patients?
- Exudate and fever and nodes
* Existing valvular rheumatic heart disease
According to the Reilly protocol, is testing done on high risk patients?
No, Treat all with antibiotics, No tests (culture or RADT) necessary
When must strep throat be presumed in a high risk patient?
- Scarlet fever
* Strep epidemic
What is the criteria listed for the modified centor protocol for sore throat management? **
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)
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?
Risk of GABHS pharyngitis 1 to 2.5%, No further testing or antibiotics indicated
With a score of 1 on the modified centor protocol, what is the risk of GABHS pharyngitis and what is done as follow-up?
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
With a score of 2 on the modified centor protocol, what is the risk of GABHS pharyngitis and what is done as follow-up?
Risk of GABHS pharyngitis 11 to 17%, Perform throat culture or RADT if positive treat with antibiotics
With a score of 3 on the modified centor protocol, what is the risk of GABHS pharyngitis and what is done as follow-up?
Risk of GABHS pharyngitis 28 to 35%, Perform throat culture or RADT if positive treat with antibiotics
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?
Risk of GABHS pharyngitis 51 to 53%, Consider empiric treatment with antibiotics.
What are some suppurative complications of GABHS pharyngitis? (8)
1) Bacteremia
2) Cervical lymphadenitis
3) Endocarditis
4) Mastoiditis
5) Meningitis
6) Otitis media
7) Peritonsillar/retropharyngeal abscess
8) Pneumonia
What is a complicated sore throat?
• A very small minority of patients with sore throat have potentially serious or life-threatening illness
What clinical findings are early signs of a complicated sore throat? (5)
1) Trismus
2) Drooling
3) Dysphonia
4) Stridor
5) Orthopnea
With an examination of the neck what are some signs of a complicated sore throat? (4)
1) Bull neck
2) Asymmetric adenopathy
3) Salivary gland abscess
4) Stiff neck
With an examination of the pharynx what are some signs of a complicated sore throat? (5)
1) Kissing tonsils
2) Asymmetric tonsillar swelling
- Peritonsillar abscess
3) Membrane
- Diphtheria
4) Enlarged epiglottis
- Epiglottitis
5) Bulging posterior pharynx
- Retropharyngeal abscess
If the examination of the neck and pharynx are unimpressive but symptoms are severe, what should be done? (4)
1) Indirect laryngoscopy
2) Soft tissue neck radiographs
3) Consider referred pain
4) Consider psychogenic cause
Is chronic tonsillitis a problem in adults?
• Rarely a problem in adults
If a patient has enlarged tonsils is it of clinical significance?
• Many patient have enlarged tonsils that are of no clinical significance
Which is more common, Streptococcal carriers or patients with chronic symptomatic tonsillitis?
• Streptococcal carriers are much more common than are patients with chronic symptomatic tonsillitis
Is chronic tonsillitis the same as chronic streptococcal pharyngitis?
• Chronic tonsillitis is probably not synonymous with chronic streptococcal pharyngitis
What is proven to be an effective treatment for recurrent tonsillitis and is it available for everyone?
• Tonsillectomy has proved to be an effective treatment for recurrent tonsillitis but only in a very highly selected group of children
How does smoking cause a sore throat?
- Not limited to tobacco, but includes marijuana, hashish, and cocaine
- Sometimes, stopping smoking will cause throat irritation for a few weeks
What are two types of postnasal drip that cause a sore throat?
- Chronic sinusitis
* Allergic rhinitis
What thyroid disorder can cause a sore throat?
• Various forms of thyroiditis
When do you test for infectious mononucleosis?
• If sore throat persists for more than one or two weeks, test for IM
What condition can refer pain to the throat?
Angina pectoris
What 4 other conditions can cause a sore throat?
- Irritant
- Allergies
- Reflux esophagitis
- Psychogenic pharyngitis
