Sore Throat Flashcards
Best LRS for diagnosing strep
Tonsillar exudates
pharyngeal exudates
exposure to strep in last 2 weeks
other good ones : scarletiform rash palatine petichiae pharyngeal exudate vomitting and tender cervical adenopathy associated with GABHS pharyngitis
Best negative LRS for diagnosing strep
absence of enlarged tonsils
absence of tender cervical adenopathy
absence of exudate
decrease the chance of strep
What is GABHS pharyngitis?
Group A Beta hemolytic strepococal pharyngitis
strep throat
FeverPAIN scale
fever, purulence, attend rapidly, inflammed tonsils, no cough or coryza
used for streptococcus
WHO strep approch
treat all children with pharyngeal exudate and enlarged tender cervical lymph nodes
not recommended
specific but not sensitive
High moderate and low risk patients with potential strep throat Tx
Empiric - Abx for high risk
symptomatic therapy and follow up for low risk
delayed prescription and rapid antigen testing for moderate risk
T or False
the absence of exudate is enough to effectively rule out streptococcal pharyngitis as the bacteria congregate on the tonsils. Thus, the lack of exudate indicated no bacteral infection.
False :
no individual element of history taking or physical exams are accurate enough alone to rule in or out strep
However : Creamy exudate from tonsillar pillars b/c pf pustular nature of the infection
Why do we care about knowing if it’s strep or not?
complications from strep may arise such as scarlet and rheumatic fever
Which lymph nodes drain the pharynx?
relevance
Anterior cervical nodes – which may become tender and enlarged during infection. (strep)
Is GABHS a commensal bacteria?
No, not apart of the normal throat flora
DDxs of strep
pharyngitis tonsilitis viral infections absecesses epiglotitis Epstein Bar Virus
Strep presentation in adults vs children
Strep in adults is rapid onset
Symptoms less focal and more gradual in children
Both:
Severe throat pain and difficulty swallowing
Fever 39-40.5
Also typically present with malaise, mild stiff neck, GI symptoms
PE for strep?
what will we see? (5)
Examination of throat – erythema, edema of pharynx and uvula
Diffuse erythema and hypertrophy of the lymphoid tissue
Post pharynx pillars covered with grey white exudate, and it is beefy bright red, colour ending abrumptly at soft palate
Petichae on soft palate
Tonsils swollen with exudate
Breath is characteristically foul
Which condition is a complication of GABHS?
how does it present? 4
Scarlet Fever
erythematous papules trunk spreading sparing the palsm and soles
Blanches,
strawberry tongue
Pharyngeal ulcers also suggest group a b hemplytic strep
At what age does Step peak?
5-10 years
Centor’s 4 item clinical prediction rule
explain
tonsillar exudate, swollen tender anterior cervical nodes, absence of cough, and history of fever. 1 point assigned for each of the patients signs and symptoms
Subtract ones if older than 45
used for the diagnosis of strep
Score 3-4 increases strep prob
0-1 very low risk
Most common and freuqnet sore throat cause
other common (5)
viral infection of the pharynx (pharyngitis)
common cold influenza mononucleiosis environmental exposure strep
Which structures are vital in emergency throat issues?
epliglottis : if inflammed can close off airway - emergent
Common Strep thoriat ‘no’ signs
No nasal symptoms
no cough
maybe some anterior cervical lymph node swelling
Localized vs. diffuse thorat pain
localized : more suggestive of a bacteria
diffuse - more viral
How long do bengin sore throats take to heal?
within 5 days to resolve
Worse on waking sore thorat
post nasal drip, mouth breathing, sleep apnea
worse after meals sore throat
GERD maybe
Red flags for sore throat (5)
due to? (3)
Airway distress (stridor, tachypnea, tripod posture, drooling, cyanosis)
due to obstruction (abscess, edema, neoplasm)
