week 1 Flashcards
sore throat aka pharyngitis
acute vs chronic
acute= <2 weeks
chronic= > 2 weeks
infectious causes of pharyngitis
what is most common?
viral or bacterial (or fungal)
**viral is most common (via common cold)
–> also non infectious causes
most common cause of viral pharyngitis
- common cold
AKA –> rhinoviruses and corona viruses - infleunza
- mononucleosis (EBV)
also HSV, Epstein bar, HIV, influenza, adenovirus etc
most common cause of bacterial pharyngitis
group A beta-hemolytic streptococci
also pneumonia, gonorrhoea etc
causes of non infectious pharyngitis
usually chronic and no signs of infection (i.e fever) and doesnt respond well to treatment
i.e. post nasal drip, GERD, thyroiditis, neoplasm, allergies, smoking
serious alarm symptoms when have sore throat
drooling, stiff neck, muffled voice, weight loss, night sweats, fever
red flag conditions for sore throat
acute epiglottitis
peritonsillar abscess
retropharyngeal abscess
acute epiglottitis
what bacteria causes it?
what is a diagnostic test?
inflamed epiglottis
bacterial infection of haemophilia influenza
positive thumb sign on lateral radiograph of neck
need antibiotics and airway management
–> seen most in kids
what is the clinical presentation of acute epiglottis? hint: 4 Ds
acute onset fever, severe sore throat, toxic appearance
4 Ds
Dysphasia (difficulty swallowing)
Drooling
Dysphonia (muffled, hoarse, abnormal voice)
Distress (inspiratory stridor, tripod position, severe dyspnea, irritability, restlessness)
**dont use tongue depressor; can make airway obstruction worse
peritosillar abscess (quinsy) features
infection in head and neck in young adults
starts as acute tonsillitis –> cellulitis –> abcess
many organisms: group A strep, staph aureus, H influenza ….
imaging not necessary, can just look
drain pus and if bacterial treat w antibiotics
peritonsillar abscess clinical features
unilateral sore throat
-dysphagia
-odynophaia
-dyspphonia
-rancid breath
-otalgia
-trismus (lock jaw)
**uvular deviation to contralateral side
retropharyngeal abscess
in kids 3-5
-prevertebral soft tissue thickening
-Retropharyngeal edema due to cellulitis and suppurative adenitis of lymph nodes in retropharyngeal space
* Preceded by upper respiratory infection, pharyngitis, otitis media, wound infection following penetrating injury to posterior pharynx
treat as impending airway emergency
retropharyngeal abscess symptoms
dysphagia, drooling, dysphonia, stiff neck, stridor, buldging on posterior wall of oropharynx
what to take antibiotics for?
bacterial infection
Viral causes of pharyngitis do not require antibiotic therapy unless there is a secondary bacterial infection
streptococcal pharyngitis
cause
age group
presentation
from group A beta hemolytic spreptococci (GABHS)
kids 5-15yrs(30%)
fever, sore throat, headache, vomit, dysphasia, cough, rhinorrhea, edema, erythema of tonsils and pharynx, enlarged lymphs, palatine petechiae (red spots on roof of mouth), tonsillar or pharyngeal exudates
**scarlet fever; rash and strawberry tongue
non suppurative (no pus) complications of streptococcal pharyngitis
-acute rheumatic fever
–>cross reactive antibodies from GABHS causes fever, arthralgia, erythema marginatum, subcutaneous nodules, caridits, ESR and CRP increase, chorea,
-poststreptococcal glomerulonephritis
–> deposit immune complexes and autoantibodies
-pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal (PANDAS) infection
–> abrupt onset of OCD and tics after GABHS from antibodies cross reacting with basal ganglia
suppurative (pus) complications of streptococcal pharyngitis
- Peritonsillar abscess
- Retropharyngeal abscess
- Otitis media
- Sinusitis
- Mastoiditis
- Cervical lymphadenitis
- Meningitis
- Bacteremia
if LR is close to 1
not useful
what is something that increases chance of having strep throat (LR+)
tonsillar exudates
clinical score for diagnosing strep throat
add a point for each: < 15 yrs, fever, cervical adenopathy, tonsillar exudate, no cough
( remove 1 point if > 45 years)
if have 4> points then do antibiotic therapy
modified centor score
4 features for probability of strep
- absence of cough (presence of cough suggest more viral illness)
- presence of fever
- tonsillar exudates,
- anterior cervical lymphadenopathy
–> more common in kids <15, less in adults >45 and infants <3
M-CENTOR pneumonic for modfiied centor score
Must be older than 2 years old
Cough- no cough (+1)
Exudates or swelling -tonsillar exudates/ swelling (+1)
Nodes- anterior cervical adenopathy (+1)
Temperature- Hx of fever >38 (+1)
Only young - <15 (+1)
Rarely elder >45 (-1)
> 4 = antibiotics
if less confirm with rapid strep test or throat culture (gold standard)
what is the disadvantage of rapid point of care testing (new nucleic acid tests) for detecting strep
Rapid point-of-care testing cannot distinguish between carriers of GABHS and active infection, nor does it indicate antibiotic susceptibility or strain virulence
benefits of antibiotics for GABHS pharyngitis (strep)
prevent acute rheumatic fever,
decrease transmission, shorten illness, reduce symptoms and complications
how long does strep usually lasts
Most cases are self-limiting in 7-10 days even without antibiotics
consider delayed prescription or if likely to have complications
antibiotic choice: penicillin
supports: analgesics (NSAIDs, lozenges, gargles
infectious mononucleosis
cause
presentation
age
Epstein barr virus
ages 5-25
fever, sore throat, fatigue, tonsillar exudates, palatine petechiae,
lympadenotpathy (posterior cervical lymph nodes)
*splenomegaly (50% of cases)
*atypical lymphocytosis (WBC) increase likelihood
posterior cervical lymph nodes
vs anterior cervical lymph nodes
posterior- mono
anterior - strep
what is the test for mono (EBV) and what does it detect
monospot test
- Rapid screening test that detects heterophil antibody agglutination
