Strep Pharyngitis or Tonsilitis

Question 1

Definition = infection of tonsils or pharynx with _____

Answer 1

Group A beta hemolytic Strep

GABHS

Question 2

Infection most common in ages

Answer 2

`5-15

Question 3

Transmission

Answer 3

direct contact and droplets

Question 4

Incubation period

Answer 4

2-5 days (short)

Question 5

Diagnosis doesnt necessarily need to include ____

Answer 5

Sore throat

Question 6

Physical exam findings (6)

Answer 6

Exudative tonsilitis
Palatal petechiae (*)
Strawberry tongue
fever
cervical adenopathy
circumoral pallor

Question 7

May be confused with…(3)

Answer 7

viral pharyngitis
coxsackie virus
HSV

Question 8

Routine Tx (4)

Answer 8

Pen V

• -(250mgm for kids, 500mgm for kids over 60 lbs)
• -(Adolescent and adults = 10 days

Benzathing Pen G (IM,single dose)
Erythromycin (10d)
Ceph (10d)

Question 9

Dx is made by…

Answer 9

throat culture

–Rapid test (strep serology or strep antigen)

Question 10

Rapid test based on…

Answer 10

Nitrous acid extraction of Group A CHO antigen from throat bacteria

Question 11

Tx for carrier state (4)

Answer 11

• -Benzathine Pen G
• -Clindamycin, Ceph,or Augmentin (10d)
• -Azith (5d)
• -Penicillin and Rifampin (10d for pen, add rifampin the last 4 days)

Question 12

Carrier state may be as high as ____

Answer 12

10-20%

Question 13

Scarlet fever etiology

Answer 13

Erythrogenic exotoxin in Strep organism

Question 14

Scarlet fever incubation

Answer 14

1-7d, average 3d

Question 15

Scarlet fever rash appearance

Answer 15

First axillae, groin, neck- becomes generalized in 24h.
Begins desquamating after one week
—Face first,then trunk hands and feet

Question 16

Treatment for scarlet fever

Answer 16

Pen for 10d

also symptomatic

Question 17

Rheumatic fever etiology

Answer 17

GABHS pharyngitis, especially M TYPES Extracellular toxin

Question 18

M types of GABHS

Answer 18

1, 3, 5, 6, 18, 19, 24

Question 19

Diagnosis for Rheumatic fever is _____

Answer 19

Jones criteria

• Need 2 major, or one major and two minor
• also need evidence of 1-3 week hx of GAS infection

Question 20

Major Jones

Answer 20

Carditis
Polyarthritis (migratory)
Erythema Marginatum
Chorea
SubQ nodules

Question 21

Minor Jones

Answer 21

Fever
Arthralgia
Elevated ESR or CRP
Prolonged PR interval

Question 22

Additional item needed for Rheumatic fever dx

Answer 22

Evidence of preceding GAS within one to three weeks

Question 23

Rheumatic Tx (a-f)

Answer 23

a. Treat strep
b. Salicylates (90-120 mg/kg per 24h)
c. Corticosteroids (2-3 wks)
d. Bedrest
e. Chorea Tx (diazepam, haloperidol for severe)
f. CHF treatment (bedrest, digitalis, diuresis)

Question 24

Prevention of Rheumatic fever (3, Rhf+/- and Residual +/-)

Answer 24

Bicillin (IM, once per month)
Oral Penicillin daily
Duration
–RhF without carditis = 5 years or until age 21
–RhF with carditis but no residual = 10 years or well into adulthood
–RhF with residual = at least 10 years until age 40

Question 25

GN etiology, serotypes

Answer 25

GABHS throat or skin infection (1-2 wks prior)

Serotypes 1,6,12 (throat) or 49,55,57,59 (skin)

Question 26

GN is ____, usually after ____

Answer 26

rare

after age 3

Question 27

GN diagnosis (5)

Answer 27

Hematuria (RBC casts)
Malaise
Lethargy
Abdominal or flank pain
Fever

Question 28

5 signs of renal fail

Answer 28

Edema (w possible proteinuria)
Oliguria
HTN
CHF
Encephalopathy

Question 29

Other labs for GN

Answer 29

Postive strep culture
Serum C3
Antibodies to streptolysin O

Question 30

Treatment for GN

Answer 30

Treat strep (10d of Pen)
Treat complications

Question 31

Other possible complications (2)

Answer 31

Peritonsilar abscess

TSS (very rare following GABHS pharyngitis or tonsilitis)

Question 32

Petechiae often appear on ____

Answer 32

Soft palate