Icm Fall Paryngitis

Front 1

why is it important to tx strep

Back 1

prevent rheumatic fever

(also suppurative complications, PANDAS- pediatric autoimmune neuropsychiatric disorder, scarlet fever)

Front 2

why might pain refer from the throat to the ears and vise versa

Back 2

CN 9 and 10 innervate pharynx, larynx, middle ear and aauditory canal

Front 3

what is walderyers Ring

Back 3

tonsil ring

Palatine (the ones we talk about)
Lingual (on the tongue)
Pharyngeal (adenoids)

**lymphoid ring of nasopharynx, common site for lymphoma

Front 4

what is the most common cause of pharyngitis

Back 4

infectious
Viral 35-50%
Strep (adults) 10%

Strep (5-15 yo) 15-30%

Front 5

Group A Beta Hemolytic Strep

viral/bacterial/other
syndrome?

Back 5

bacterial

pharyngitis
tonsilitis
scarlet fever

Front 6

Rhinovirus

viral/bacterial/other
syndrome?

Back 6

Viral

common cold

Front 7

Adenovirus

viral/bacterial/other
syndrome?

Back 7

viral

Acute Upper Respritory ilness
Conjunctivitis****

Front 8

if a pt has a sore throat but tell tale red eyes whats the disease

Back 8

adenovirus

**also see acute URI

Front 9

chlamydia

viral/bacterial/other
syndrome?

Back 9

bacterial (obligate intracellular parasitic properties)

phayrngitis
PNEUMONIA**

Front 10

Mycoplasm Pnemonia

viral/bacterial/other
syndrome?

Back 10

atypical bacteria

Atypical pneumonia
bronchitis
bullous- TM blister
Myringitis
pharyngitis

Front 11

if someone have a bronchitis, pharyngitis and a weird ear drum blister (bollous) what is it?

Back 11

mycoplasm pneumoniea

**also have atypical pneumonia and myningitis

Front 12

herpes

viral/bacterial/other
syndrome?

Back 12

viral

gingivitis
stomatitis
pharyngitis
ulcers/sores in front of mouth

Front 13

parainfluenza
influenza

viral/bacterial/other
syndrome?

Back 13

viral viral

common cold, croup (para)
myalgias, flu eyndrome

Front 14

EBV
CMV

Back 14

viral

infectious mononucleosis
splenomegaly
rash
diffuse lymphadenopathy

Front 15

how can you id...

1. measles, rubella
2. hepatitis
3. Coxsackie

Back 15

1. phayrngitis, rash

2. jaundice

3. herangina (large ulcerations on BACK of throat)

Front 16

what gives ulcers in front of mouth, what baout back of throat

Back 16

front: herpes

back: coxsackie- the bug( leision is called herpangina)

Front 17

what presents with a grey membrane on tonsil that bleeds when removed

Back 17

diptheria

*bacterai

Front 18

what is trench mouth

Back 18

sore throat
ulcers
foul breath

**vincents infection/gingivitis

caused by spirochetes or fusibacterium

Front 19

what non infectious reasons can we have pharyngitis

Back 19

1. hot liquids
2. trauma
3. dryness
4. allergies/post nasal drip
5. reflux
6. subacute thyroiditis
7. leukemia/lymphoma
8. kawasaski disease
9. steven johnson- serious reaction to drug, peel skin
10. Bechets syndrome
11. bulemia

Front 20

what are the centor criteria for GABHS (group a beta hemolytic strep)

Back 20

1. sore throat
2. low fever
3. no cough
4. anterior lymphadenopathy

Front 21

what is the centor for GABHS good for

Back 21

better NPV (better chance if you dont have these thinngs you dont have disease)

PPV- if you have these things you still may not have strep. poor ppv

Front 22

is there any changes in WBC CBC in GABHS

Back 22

leukocytosis

left shift (more PMN)

Front 23

are horasness and cauge suggestive of GABHS

Back 23

NO!

Front 24

when person has pharyngitis why should we ask about duration and severity

Back 24

long/severe can be peritonsillar abcess

**may also have trouble breathing with this

Front 25

why ask about other upper respiratory things with CC pharyngitis

Back 25

Viral: will have rhinorrea, croup cough, haryngitis

Strep: localized to throat, no systemic infection

Respiratory difficulty suggest obstruction: epiglotitis, retropharyngeal/peritonsillar abcess, or massive palantine tonsils as seen in mono

Front 26

what ask about how the sore throat started

Back 26

if started as scratcy we thing viral

Front 27

why ask about systemic sx in persons with sore throuat

Back 27

1. Strep: Gi upset, anorexia, chills, headache

2. influenza- headache, myalgias (mm pain) fever, dry caugh

Front 28

why ask about exposure to other ppl with sore throat

Back 28

supports infectious etiology, cant ID bact v viral

Front 29

why ask about past strep with pt CC sore throat

Back 29

strep can be recurrent

Front 30

why ask if person with sore throat has had rheumativ fever

Back 30

change F/U

**needs to be recultured!!!!!

Front 31

why ask about sex for pt with sore throat

Back 31

can be gonorrhea, needs a special test

Front 32

why ask pt with sore throat about meds?

Back 32

maybe they took some old AB they had laying around, this will make a - strep test

Front 33

why ask about vaccinations with person with sore throat

Back 33

R/O diptheria (grey membrane)

Front 34

what do you need to know about epiglotitis?

Back 34

DO NOT PUT THINGS IN THEIR MOUTH!!!! call anesthesia bc they can stop breathing

**kiddo with DROOLING, sore throat, fever, respiratory difficulty, stridor

**will have thumbprint sign on X ray

Front 35

what are some likely vitals for person with sore throat

Back 35

1. fever (more than 100 think strep)
2. tachycardia

Front 36

when might you see a muffled "hot potatoe" voice with sore throat

Back 36

peritonsillar abcess (pain rotating head to affected side)

linugual tonsilitis (pain at hyoid)

Front 37

why assess general for sore throat pt

Back 37

see if they have weird voice
see if they can still drink

Front 38

what do LN tell you for sore throat

Back 38

1. Anterior Cervical- strep
2. Post cervial- mono (also other LN and large spleen)

Front 39

in what diseases are exudates more common on throat

Back 39

1. strep
2. Mono
3. GC

Front 40

when might you see vesicles in throat

Back 40

herpes (front)
coxsackie (back)

Front 41

one sided tonsilar enlargement suggests what

Back 41

peritonsillar abcess
lymphoma

Front 42

if you have sore throat AND conjunctiva what might is be

Back 42

adenovirus

Front 43

a bullous myringitis suggests what disease

Back 43

mycoplasa pnemonea

Front 44

scarlet fever presents how

Back 44

petechiae on palate and white coating on tongue followed by strawberry tonugue. also a sandpaper rash

Front 45

strayberry tongue is seen with what

Back 45

scarlet fever

**strawberry tongue is 2 days after initial whit film on tongue and petetciea on palate. sand paper rash

Front 46

atypical pnemonia and sire throat suggests

Back 46

mycoplasma

Front 47

hepatomegaly/splenomegaly is seen in what

Back 47

mono
EBV
CBV

Front 48

if you have all 4 centor criteria for strep do you need a culture?

Back 48

some say yep some say nope

Front 49

what is the gold standard for strep dx

Back 49

throat culture

sensitivity 90-95%
Specificity >95%

**ordered when you have a - rapid strep

Front 50

what is the rapid strep test

Back 50

ELIZA- detects AB to strep

**high specificity, low false positives (if you have strep you get a +, but you might get a - even if you have it)

Front 51

does a - rapid strep totally rule out strep/ wht

Back 51

nope

The test isnt very specific so a - result can be a false -. BUT its pretty darn sensitive so if you get a + test its sure you have strep

**confirm a - rapid strep with a culture in kids (adults not as big of a deal bc decreased incidence of rheumatic fever)

Front 52

what do we do with a kid with a - rapid strep but all 4 centron

Back 52

we can treat it

**we should def get a throat culture to rule out strep for sure bc of rheumatic fever (even in AB given 9 days after onset we prevent rheumatic fever)

Front 53

where do you swab for throat culture

Back 53

BOTH tonsils, do it hard

**be sure to do 2 swabs, one for rapid, one for culture

**dont swab cheeks or tongue

Front 54

whats a CBC for strep? mono?

Back 54

strep: leukocytisis, left shift (to PMN)

mono: r shift, initial leukopenia, atypical lymphs

Front 55

what is a monosopt

Back 55

mono test

**sheep cell agglutination rapid AB test. + one week after onset

Front 56

what test for peritonsillar abcess

Back 56

CT

Front 57

what is the most common cause of epiglottitis

Back 57

H influenza

**vaccine against in the HIB

Front 58

how is GABHS transferred? whats incubation period? sx

Back 58

repriratory drops

**1-4 days

Sx: fever, sore throat, chills, malaise, headache, tummy pain

Physical: erythema, exudate, palatal perechiae, cervial anterior lymphadenopathy

Front 59

why treat strep? is f/u culture required

Back 59

to prevent rheumatic fever

**not unless you have hx of rheumatic fever

Front 60

what are some complications of strepo

Back 60

not common bc of AB

1. Rheumatic fever: 1-4 wks after strep infection, prevented with AB

2. poststreptococcal glomerulonephritis: not prevented with AB, begins 1-3 wks after strep infection

3. suppurative complications: cervical lymphadenitis, poritonsillar/retropharyngeal abcess, sunusitis, otitus media, mastoiditis, meningitis, bacteremia, endocarditis. prevented with AB

4. PANDAS- pediatric autoimmune neuropsychiatric disorder

Front 61

what is scarlet fever

Back 61

rash that is 2 to strep.

rash spares the palms and soles, rash feels like sandpaper and you get strawberry tongue. rash then peels

Front 62

what is the tx of choice for GABHS tx

Back 62

penicillin

Front 63

when can a kid go back to school after tx for strep (with 10 days course of penicillin)

Back 63

24 hrs

**sometimes ammoxacilin is given bc it tastes better

Front 64

what drugs shouldnt be used for strep

Back 64

sulfa and tetracycline- they dont prevent rheumatic fever

Penicillian is good, there is no resistance

FINISH AB!!!! Even if sx resolve before hand

Front 65

what can you do to tx sx before AB kicks in

Back 65

no steroids
NSAIDS (no asprin to kids)
rest
hydrate
hard candy

Front 66

when might be strep be a big enough problem to get tonxils removed

Back 66

3 cases yearly for 3 years
5 episodes yearly for 2 years
7 episodes for 1 year

Front 67

what causes mono?
transmission?
incubation

Back 67

EBV
spit
4-8 weeks LONG TIME

Front 68

what are sx of mono

Back 68

1. fever
2. malaise
3. sore troat
4. post lymphadenopathy
5. splenomegaly
6. hepatitis,
7. atypical lymphocytes (R shift)
8. positive monospot
9. rash
10. 1/3 of mono also have strep

Front 69

what are labs for mono

Back 69

+ monospot
increased ASL ALT
aytpical lymphs

Front 70

what are complications of mono

Back 70

splenic rupture
hemolytic anemia
airway obstruction

Front 71

what is tx for mono

Back 71

NSAIDS
rest
fluid
nutrition
steroids PRN to manage airway

**return to contact sports 4 weeks, non contact sports 3 weeks

Front 72

what are signs/sx for VIRAL pharyngitis/tinsiliits

Back 72

1. no fever
2. conjunctivitis, coryza, cough, diarrhea
3. preceded by scratchy feeling
4. ulcrations/vesicles in HSV, Coxsackie, varicella
5. hepatosplenomegaly
6. diffuse lymphadenopathy
7. leukopenia in mono with atypical lymphs

Front 73

what are signs/sx of bacterial pharyngitis/tinsilitis

Back 73

1. fever
2. tender ant cervical LN
3. no cough, conjunctivitis, coryza
4. exudate
5. odynophagia
6. scarrlitiniform rash
7. leukocytisis with L shift

Front 74

what drug causes a rash when given to a pt with mono

Back 74

ampicillin
amoxacillin