Throat Infection

Question 1

whats the gold standard for diagnosing GAS

Answer 1

throat culture

Question 2

red flags for throat infection

Answer 2

difficulty swallowing, drooling, “hot potato” muffled voice, stridor, obstructive sensation. Must consider epiglottitis, peri-tonsillar abscess or retropharyngeal abscess until proven otherwise

Question 3

never examine the throat when

Answer 3

when there is Stridor
can cause epiglottis spasm and obstruction of the airway

Question 4

what is Acute Rheumatic Fever

Answer 4

Type II autoimmune hypersensitivity
In a small number of individuals with GAS pharyngitis, the M proteins in the bacterial capsule mimic normal heart antigens (antigenic mimicry) and induce antibodies that also react with proteins in the heart valve, damaging the valve

Question 5

what are the two types of complications of GAS

Answer 5

Nonsuppurative (immune-mediated conditions)
Suppurative (extension of infection beyond the oropharynx)

Question 6

Nonsuppurative (immune-mediated conditions) complications of GAS

Answer 6

Poststreptococcal Glomerulonephritis (abx may help prevent this)
Poststreptococcal Reactive arthritis
Pediatric autoimmune neuro psychiatric disorders (PANDAS)

Question 7

acute monoclueosis is caused by ___

Answer 7

EBV

Question 8

the classic triad of acute mononucleosis

Answer 8

fever, exudative pharyngitis, adenopathy

Question 9

potential complications of acute mononucleosis

Answer 9

airway obstruction,
splenic rupture,
hepatitis,
hemolytic anemia,
encephalitis

Question 10

Diagnostic test for acute mononucleosis

Answer 10

Heterophile Antibody (Monospot) test: may be false negative in first 7 days of symptoms + under age 5, can repeat prn in 1 week)
‣CBC: atypical lymphocytes (up to 30% of WBC’s)
‣EBV IgM/IgG

Question 11

It’s important to advise patients with mononucleosis to avoid ____ due to ____

Answer 11

efrain from strenuous exercise, heavy lifting & contact sports for 3-4 weeks, or until spleen has returned to normal size due to ↑ risk of splenic rupture

Question 12

what diagnostic test for gonococcal pharyngitis?

Answer 12

hroat swab for culture or nucleic acid amplification test (NAAT) ***NAAT most sensitive

Question 13

treatment for gonococcal pharyngitis?

Answer 13

Treatment: ceftriaxone IM + azithromycin PO single dose

Question 14

What can cause rash in acute mononucleosis?

Answer 14

Penicillins (notably amoxicillin or ampicillin) and other antibiotics may trigger a rash due to abnormal immune response. **Not a true allergy

Question 15

What medication should be avoided in children due to ?

Answer 15

ASA due to risk of Reye syndrome

Question 16

What condition would you be suspicious of in this presentation and unilateral neck swelling?

Answer 16

Lemierre’s syndrome

Question 17

treatment for viral pharyngitis

Answer 17

no abx

Question 18

1st line of treatment for GAS

Answer 18

penicillin, amoxicillin

Question 19

2nd line of treatment for GAS

Answer 19

Cephalexin Cefadroxil Cefuroxime Cefprozil

Question 20

3rd line of treatment for GAS

Answer 20

Azithromycin Clarithromycin

Question 21

3 stages of pertussis

Answer 21

Catarrhal stage:1 to 2 weeks of gradually worsening cough
Paroxysmal stage: This stage can last from 2 to 8 weeks.
Convalescent stage: gradual recovery over weeks to months.

Question 22

treatment for pertussis
1st, 2nd, duration

Answer 22

1st line- Macrolides: erythromycin (adults), clarithromycin, azithromycin
2nd line- Trimethoprim- sulfamethoxazole
Duration: 5-7 days, depending on agent

Question 23

sore throat score criteria

Answer 23

temp >38 (1)
no cough (1)
swollen, tender anterior cervical nodes (1)
tonsillar swelling or exudate (1)
age 3-14 (1)
age 15-44 (0)
age >= 45 (-1)

Question 24

sore throat score

Answer 24

0 or less no culture or antibiotic required
2 culture or rapid antigen test
3 treat only if test is positive for strep A
4 or more: start abx; if culture is negative then stop abx