Sore Throat Flashcards
pain, irritation, or scratchiness of the throat that often worsens when swallowing
sore throat (symptom of pharyngitis)
most common cause of sore throat
sore throat usually occurs with ___
infectious (viral)
common cold
non-infectious causes of sore throat
concomitant illness or physiochemical factors
pharyngitis vs tonsillitis
pharyngitis: diffuse inflammation of oropharynx
tonsillitis: inflammation of tonsils only
pharyngeal structures
tonsils nasopharynx epiglottis base of tongue uvula/soft palate
most common causative agents of sore throat
rhinovirus and adenovirus
pathophysiology of viral pharyngitis
exposure -> virus implants on resp/gi tract -> intracellular access -> replicate -> shedding and infection of other cells -> spread to more distant target organs through mucus later, lymphatics, blood
throat pain and irritation are most probably caused by inflammatory mediators like ___
prostaglandins and bradykinins
released as a response to the resulting cellular damage or death OR from host immune response
symptoms pointing to viral etiology
coryza, cough, hoarseness, conjunctivitis, diarrhea, malaise/arthralgia
PE of viral pharyngitis
- erythema of oropharynx
- discrete ulcerative stomatitis
- no exudates
- viral exanthems
- usually no anterior adenopathies
treatment of viral pharyngitis
- self-limiting (gone in 5-7 d)
- supportive and symptomatic
most useful symptomatic treatment in viral pharyngitis
nsaids and antipyretics
t/f corticosteroids are required treatment in vp
false, role still undefined
t/f vitamin c can reduce duration of symptoms in vp
true
t/f high doses of vitamin c can affect severity and duration of vp
false
t/f routine supplementation of vit c is justified
false
effects of zinc at onset of colds
decreases duration but not severity (75 mg within 24 hrs of symptom onset)
t/f zinc can be used as a prophylactic treatment in vp
false
oral gargles, lozenges, and sprays can give ___
symptom relief
t/f oral gargles, lozenges, and sprays can resolve infections faster
false, no solid evidence
t/f ice cream, sweets, chocolate, etc are risk factors for sore throat
false
t/f sore throat is a common symptoms of covid 19
true
most common presenting symptoms of covid
fever, cough, fatigue, dyspnea, headache, sore throat
management for covid19
- no treatment
- remdesivir improves recovery time and reduces mortality
- dexamethasone reduces mortality
- best strategy is prevention
bacterial pharyngitis is most common in age ___
5-15 years
most common pathogenic organism in bacterial pharyngitis
group 1 beta hemolytic strep pyogenes (gabhs or gas)
other organisms in bp
non group a strep arcanobacterium haemolyticum stis (gonorrhea, syphilis, chlamydia) tb tularemia diptheria
t/f gabh is pathogenic only in humans
true, <5% of adults are asymptomatic carriers
transmission of bp
- most common: aerosolized microdroplets
- less common: direct contact
- rare: ingestion of contaminated food
symptomatology of bp
odynophagia (panful swallowing)
fever, headache, nausea, vomiting, abdominal pain
unusual: cough, hoarseness, coryza, diarrhea
pe for bp
tonsillopharyngeal inflammation patchy tp exudates palatal petechiae beefy red swollen uvula anterior cervical adenitis
challenges in differentiating gabh from viral
- broad overlap in clinical presentations
- low accuracy of clinical diagnosis
objectives of diagnosing bacterial pharyngitis
- main: prevent acute rheumatic fever and sequelae (rhd)
- prevent suppurative complications
- improve clinical s/sx
- reduce transmission
- prevent inappropriate antimicrobial therapy
lab diagnosis for bp
- gold standard: culture of throat swab in sheep agar
- rapid antigen detection test (low false positives)
- aso titers (not helpful, 3-8 wks after infection)
mcisaac scoring systemp
fever tonsillar exudate absent cough anterior cervical lad 3-14 yrs 15-44 yrs 0 >44 yrs -1
acp algorithm
0-1 no treatment
2-3 rapid antigen test
4-5 antibiotic
nice guidelines
0-2 no treatment
3-5 antibiotic
complications of streptococcal pharyngitis
acute rheumatiic fever
- rhd (1-5% of rf)
- antibiotic treatment within 9 days of onset prevents arf
poststreptococcal gn (rare) - incidence is not affected by treatment
doc for strep pharyngitis
penicillin or amoxicillin for 10 days
other treatments for strep pharyngitis
- cephalosporin, clindamycin, clarithromycin, azithromycin
- nsaids
- corticosteroids (undefined)
tonsillectomy is done for patients that __
satisfy the paradise criteria
paradise criteria for tonsillectomy
- minimum frequency of sore throat episodes
- clinical features PLUS presence of more/= 1 quality
- treatment
- documentation
