URTIs (Pharynx and Larynx)

Question 1

Sore throat is also known as what?

Answer 1

Acute pharyngotonsillitis

Question 2

Define acute pharyngotonsillitis

Answer 2

a painful red throat and/or enlarged inflammed tonsils. white pus exudates, either spots or patches, may be present. Tender anterior cervical lymphadenopathy may be present

Question 3

List clinical features that might suggest streptococcal infection

Answer 3

palatal petechiae, inflammed tongue mucosal papillae
a scarlitiniform rash

Question 4

Group A beta haemolytic streptococcus causes?

Answer 4

20% of pharyngitis/tonsillitis and may result in rheumatic fever(which can cause serious heart disease) as well as local supurative complications

Question 5

List general measures of acute pharyngotonsillitis

Answer 5

Homemade salt mouthwash, gargle for 1 minute twice daily:
* 2.5 mL (½ medicine measure) of table salt in 200 mL lukewarm water.
* Do not give to children unable to gargle.
* Advise adequate hydration.
* Avoid irritants e.g. vaporubs inserted into nostrils.
* For children < 6 years of age: Soothe the throat with breastmilk. If
not exclusively breastfed, give warm water or weak tea: add sugar or
honey and lemon if available.

Question 6

how to differentiates the bacterial and viral acute pharyngotonsillitis

Answer 6

Bacterial: acute onset, Temperature >38 degree celcius, tender anterior cervical lymph nodes, age 3-15 years, previous rheumatic fever or rheumatic heart disease
Pus or white patches on tonsils
PCT>0,25 ng/ml

Viral: Rhinorrhoea, cough, diarhoea, conjuctivitis, age>45 yeats, PCT,0.25 ng/ml

Question 7

Are antibiotics use for sore throat?

Answer 7

No

Question 8

Antibiotics to eradicate streprococci should be given to patient presenting with?

Answer 8

Sore throat who are at risk for rheumatic fevr (3-21 years of age) if they have:
enlarged tonsils
Plus at least one of the following criteria:
Exudate on their tonsils
No cough
No runny nose

Question 9

Drug treatment for acute pharyngotonsillitis
List them?

Answer 9

Benzathine benzyl penicillin, IM, single dose
OR
Amoxicillin, PO, 1000 mg 12 hourly for 10 days
OR
Phenoxymethypenicillin, PO, 500 mg 12 hourly for 10 days
Severe penicillin allergy
Macrolide: azithromycin 500 mg daily for 3 days

Question 10

Name one drug-disease interaction

Answer 10

Penicillins+viral sore throat

Question 11

which drug-disease interaction causes skin rash in children

Answer 11

Amoxicillin and ampicillin and Epstein-Bar virus
It is though to induce the reactivation of EBV, leading to a skin eruption

Question 12

explain when the patient should be referred in acute pharyngotonsillitis

Answer 12

Any suppurative complications, e.g. retropharyngeal or peritonsillar
abscess.
* Tonsillitis accompanied by difficulty in opening the mouth (trismus).
* Recurrent tonsillitis (≥ 6 documented episodes/year) for possible
tonsillectomy.
* Suspected acute rheumatic fever.
* Suspected acute glomerulonephritis.
* Heart murmurs not previously diagnosed

Question 13

what is acute rheumatic fever

Answer 13

a condition in which a body develops antibodies against its own tissues followinga streptococcal throat infection. effective treatment of streptococcal pharyngitis can markdly reduce the occurence of the disease.

Question 14

Acute rheumatic fever occurs commonly in adults
TRUE OR FALSE

Answer 14

FALSE
Commonly occurs in children, 3–15 years of age.

Question 15

List clinical signs and symptoms of acute rheumatic fever

Answer 15

arthralgia or arthritis that may shift from one joint to another
* carditis including cardiac failure
* heart murmurs
* subcutaneous nodules
* erythema marginatum
* chorea (involuntary movements of limbs or face)
* other complaints indicating a systemic illness e.g. fever

Question 16

Rheumatic fever medicine treatment for eradication of streptococci in throat

Answer 16

Phenoxymethylpenicillin / amoxicillin, po, for 10 days / benzathine
benzylpenicillin, im, stat (severe pen allergy) azithromycin

Question 17

Rheumatic fever medicine treatment for prophylaxis for rheumatic fever

Answer 17

All patients with confirmed rheumatic fever and no persistent
rheumatic valvular disease
* Treat for 10 years or until the age of 21 years, whichever is longer

Question 18

what are rheumatic heart disease

Answer 18

These are chronic sequelae of rheumatic fever consisting of valvular
damage, usually involving left heart valves, with progression and
complications.

Question 19

Acute stage of rheumatic fever characterized

Answer 19

best rest and supportive care

Question 20

All patients with confirmed rheumatic fever and persistent rheumatic valvular disease should be treated lifelong with what medication?

Answer 20

Treat lifelong.
* Benzathine benzylpenicillin (depot formulation), IM, every 3–4 weeks
(preferred treatment).
* OR
* Phenoxymethylpenicillin, oral, 12 hourly.
* Severe penicillin allergy: Macrolide, e.g.: Azithromycin, oral, daily.