Sore Throat

Question 1

pain, irritation, or scratchiness of the throat that often worsens when swallowing

Answer 1

sore throat (symptom of pharyngitis)

Question 2

most common cause of sore throat

sore throat usually occurs with ___

Answer 2

infectious (viral)

common cold

Question 3

non-infectious causes of sore throat

Answer 3

concomitant illness or physiochemical factors

Question 4

pharyngitis vs tonsillitis

Answer 4

pharyngitis: diffuse inflammation of oropharynx
tonsillitis: inflammation of tonsils only

Question 5

pharyngeal structures

Answer 5

tonsils
nasopharynx
epiglottis
base of tongue
uvula/soft palate

Question 6

most common causative agents of sore throat

Answer 6

rhinovirus and adenovirus

Question 7

pathophysiology of viral pharyngitis

Answer 7

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

Question 8

throat pain and irritation are most probably caused by inflammatory mediators like ___

Answer 8

prostaglandins and bradykinins

released as a response to the resulting cellular damage or death OR from host immune response

Question 9

symptoms pointing to viral etiology

Answer 9

coryza, cough, hoarseness, conjunctivitis, diarrhea, malaise/arthralgia

Question 10

PE of viral pharyngitis

Answer 10

• erythema of oropharynx
• discrete ulcerative stomatitis
• no exudates
• viral exanthems
• usually no anterior adenopathies

Question 11

treatment of viral pharyngitis

Answer 11

• self-limiting (gone in 5-7 d)

- supportive and symptomatic

Question 12

most useful symptomatic treatment in viral pharyngitis

Answer 12

nsaids and antipyretics

Question 13

t/f corticosteroids are required treatment in vp

Answer 13

false, role still undefined

Question 14

t/f vitamin c can reduce duration of symptoms in vp

Answer 14

true

Question 15

t/f high doses of vitamin c can affect severity and duration of vp

Answer 15

false

Question 16

t/f routine supplementation of vit c is justified

Answer 16

false

Question 17

effects of zinc at onset of colds

Answer 17

decreases duration but not severity (75 mg within 24 hrs of symptom onset)

Question 18

t/f zinc can be used as a prophylactic treatment in vp

Answer 18

false

Question 19

oral gargles, lozenges, and sprays can give ___

Answer 19

symptom relief

Question 20

t/f oral gargles, lozenges, and sprays can resolve infections faster

Answer 20

false, no solid evidence

Question 21

t/f ice cream, sweets, chocolate, etc are risk factors for sore throat

Answer 21

false

Question 22

t/f sore throat is a common symptoms of covid 19

Answer 22

true

Question 23

most common presenting symptoms of covid

Answer 23

fever, cough, fatigue, dyspnea, headache, sore throat

Question 24

management for covid19

Answer 24

• no treatment
• remdesivir improves recovery time and reduces mortality
• dexamethasone reduces mortality
• best strategy is prevention

Question 25

bacterial pharyngitis is most common in age ___

Answer 25

5-15 years

Question 26

most common pathogenic organism in bacterial pharyngitis

Answer 26

group 1 beta hemolytic strep pyogenes (gabhs or gas)

Question 27

other organisms in bp

Answer 27

``` non group a strep arcanobacterium haemolyticum stis (gonorrhea, syphilis, chlamydia) tb tularemia diptheria ```

Question 28

t/f gabh is pathogenic only in humans

Answer 28

true, <5% of adults are asymptomatic carriers

Question 29

transmission of bp

Answer 29

- most common: aerosolized microdroplets - less common: direct contact - rare: ingestion of contaminated food

Question 30

symptomatology of bp

Answer 30

odynophagia (panful swallowing) fever, headache, nausea, vomiting, abdominal pain unusual: cough, hoarseness, coryza, diarrhea

Question 31

pe for bp

Answer 31

``` tonsillopharyngeal inflammation patchy tp exudates palatal petechiae beefy red swollen uvula anterior cervical adenitis ```

Question 32

challenges in differentiating gabh from viral

Answer 32

- broad overlap in clinical presentations | - low accuracy of clinical diagnosis

Question 33

objectives of diagnosing bacterial pharyngitis

Answer 33

- main: prevent acute rheumatic fever and sequelae (rhd) - prevent suppurative complications - improve clinical s/sx - reduce transmission - prevent inappropriate antimicrobial therapy

Question 34

lab diagnosis for bp

Answer 34

- 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)

Question 35

mcisaac scoring systemp

Answer 35

``` fever tonsillar exudate absent cough anterior cervical lad 3-14 yrs 15-44 yrs 0 >44 yrs -1 ```

Question 36

acp algorithm

Answer 36

0-1 no treatment 2-3 rapid antigen test 4-5 antibiotic

Question 37

nice guidelines

Answer 37

0-2 no treatment | 3-5 antibiotic

Question 38

complications of streptococcal pharyngitis

Answer 38

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 ```

Question 39

doc for strep pharyngitis

Answer 39

penicillin or amoxicillin for 10 days

Question 40

other treatments for strep pharyngitis

Answer 40

- cephalosporin, clindamycin, clarithromycin, azithromycin - nsaids - corticosteroids (undefined)

Question 41

tonsillectomy is done for patients that __

Answer 41

satisfy the paradise criteria

Question 42

paradise criteria for tonsillectomy

Answer 42

- minimum frequency of sore throat episodes - clinical features PLUS presence of more/= 1 quality - treatment - documentation