Strep Throat

Question 1

What are the most common causes of soar throat?

Answer 1

Viruses
• Adeno
• Parainfluenza
• EBV
• Rhino
• Herpes

Question 2

Why do we worry so much about group A b-hemolytic strep?

Answer 2

It can lead to rheumatic fever

Question 3

What is the 50/50 rule of soar throats?

Answer 3

Only 50% of people with exudates will have strep throat and only 50% with strep throat will have exudates

Question 4

Incubation period for strep throat?

Answer 4

2-5 days

Question 5

Physical exam findings for strep throat?

Answer 5

1. Exudative tonsillitis
2. Petechiae on palate
3. Strawberry tongue
4. Fever
5. Cervical adenopathy
6. Circumoral pallor-cheeks flushed but area around the mouth is pale

Question 6

What is the science behind a rapid strep test?

Answer 6

Based on nitrous acid extraction of Group A carbohydrate antigen from bacteria obtained from the throat

Question 7

How do you treat strep throat in PTs allergic to PCN?

Answer 7

Erythromycin or cephalosporins x 10 days

Question 8

What PO PCN can you give for strep throat?

Answer 8

PCN V x 10 days

Question 9

What parenteral PCN can you give for strep throat?

Answer 9

PCN G x single dose

Question 10

What are three ways you can treat strep carrier state (10-20% of patients)

Answer 10

1. Benzathine PCN G
2. Clindamycin, cephalosporins, augmentin x 10 days
3. Azithromycin x 5 days
4. PCN x 10 days and Rifampin x last 4 days

Question 11

What causes scarlet fever from strep pyogenes? This is just strep pharyngitis with a rash.

Answer 11

It releases an erythrogenic exotoxin (Incubation period 1-7 days)

Question 12

What additional symptoms will you see with Scarlet Fever?

Answer 12

Vomiting, HA, abdominal pain, rash

Question 13

Where does the rash start in Scarlet Fever?

Answer 13

First in axilla, groin, and neck and spread within 24 hours

Question 14

What criteria is used to diagnose rheumatic fever?

Answer 14

Jones criteria

Question 15

What are the minor Jones criteria?

Answer 15

Minor (needs 1 for Dx)
• Fever
• Arthralgia
• Elevated ESR, CRP
• Prolonged PR interval
Plus evidence of Group A strep infection 1-3 weeks prior to onset of symptoms

Question 16

How do you treat rheumatic fever?

Answer 16

1. Treat strep
2. Salicylates
3. Corticosteroids
4. Bed rest
5. Treat chorea (diazepam, haloperidol)
6. Treat CHF (digitalis, diuretics)

Question 17

How do you prevent recurrent rheumatic fever?

Answer 17

1. Bicillin shot monthly
2. PO PCN daily
   * *Without carditis-5 years or until 21
   * *with carditis but no residual-10 years or until 21
   * *with carditis and residual-at least 10 years and to age 40

Question 18

What will a UA show in a PT with Group A strep glomerulonephritis?

Answer 18

Hematuria-RBC casts

Question 19

What are some clinical findings of renal failure?

Answer 19

1. Edema and maybe proteinuria
2. Oliguria
3. HTN
4. CHF
5. Encephalopathy

Question 20

What will blood work show in a PT with group A glomerulonephritis?

Answer 20

1. • strep culture
2. ↓ serum C3
3. Antistreptolysin O +

Question 21

What is treatment for Group A glomerulonephritis?

Answer 21

1. Treat strep

2. Treat additional symptoms

Question 22

Beyond rheumatic fever and glomerulonephritis, what are two other very rare sequelae of strep infection?

Answer 22

1. Peritonsillar abscess

2. Toxic shock syndrome

Question 23

Why do you give ASA for rheumatic fever?

Answer 23

It helps reduce inflammation and joints and possibly the heart. You run the risk of Reye’s syndrome but this is exceedingly rare.