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74 Cards in this Set
- Front
- Back
why is it important to tx strep |
prevent rheumatic fever
(also suppurative complications, PANDAS- pediatric autoimmune neuropsychiatric disorder, scarlet fever) |
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why might pain refer from the throat to the ears and vise versa
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CN 9 and 10 innervate pharynx, larynx, middle ear and aauditory canal
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what is walderyers Ring
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tonsil ring
Palatine (the ones we talk about) Lingual (on the tongue) Pharyngeal (adenoids) **lymphoid ring of nasopharynx, common site for lymphoma |
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what is the most common cause of pharyngitis
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infectious
Viral 35-50% Strep (adults) 10% Strep (5-15 yo) 15-30% |
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Group A Beta Hemolytic Strep
viral/bacterial/other syndrome? |
bacterial
pharyngitis tonsilitis scarlet fever |
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Rhinovirus
viral/bacterial/other syndrome? |
Viral
common cold |
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Adenovirus
viral/bacterial/other syndrome? |
viral
Acute Upper Respritory ilness Conjunctivitis**** |
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if a pt has a sore throat but tell tale red eyes whats the disease
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adenovirus
**also see acute URI |
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chlamydia
viral/bacterial/other syndrome? |
bacterial (obligate intracellular parasitic properties)
phayrngitis PNEUMONIA** |
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Mycoplasm Pnemonia
viral/bacterial/other syndrome? |
atypical bacteria
Atypical pneumonia bronchitis bullous- TM blister Myringitis pharyngitis |
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if someone have a bronchitis, pharyngitis and a weird ear drum blister (bollous) what is it?
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mycoplasm pneumoniea
**also have atypical pneumonia and myningitis |
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herpes
viral/bacterial/other syndrome? |
viral
gingivitis stomatitis pharyngitis ulcers/sores in front of mouth |
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parainfluenza
influenza viral/bacterial/other syndrome? |
viral viral
common cold, croup (para) myalgias, flu eyndrome |
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EBV
CMV |
viral
infectious mononucleosis splenomegaly rash diffuse lymphadenopathy |
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how can you id...
1. measles, rubella 2. hepatitis 3. Coxsackie |
1. phayrngitis, rash
2. jaundice 3. herangina (large ulcerations on BACK of throat) |
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what gives ulcers in front of mouth, what baout back of throat
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front: herpes
back: coxsackie- the bug( leision is called herpangina) |
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what presents with a grey membrane on tonsil that bleeds when removed
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diptheria
*bacterai |
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what is trench mouth
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sore throat
ulcers foul breath **vincents infection/gingivitis caused by spirochetes or fusibacterium |
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what non infectious reasons can we have pharyngitis
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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 |
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what are the centor criteria for GABHS (group a beta hemolytic strep)
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1. sore throat
2. low fever 3. no cough 4. anterior lymphadenopathy |
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what is the centor for GABHS good for
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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 |
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is there any changes in WBC CBC in GABHS
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leukocytosis
left shift (more PMN) |
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are horasness and cauge suggestive of GABHS
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NO!
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when person has pharyngitis why should we ask about duration and severity
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long/severe can be peritonsillar abcess
**may also have trouble breathing with this |
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why ask about other upper respiratory things with CC pharyngitis
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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 |
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what ask about how the sore throat started
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if started as scratcy we thing viral
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why ask about systemic sx in persons with sore throuat
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1. Strep: Gi upset, anorexia, chills, headache
2. influenza- headache, myalgias (mm pain) fever, dry caugh |
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why ask about exposure to other ppl with sore throat
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supports infectious etiology, cant ID bact v viral
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why ask about past strep with pt CC sore throat
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strep can be recurrent
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why ask if person with sore throat has had rheumativ fever
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change F/U
**needs to be recultured!!!!! |
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why ask about sex for pt with sore throat
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can be gonorrhea, needs a special test
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why ask pt with sore throat about meds?
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maybe they took some old AB they had laying around, this will make a - strep test
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why ask about vaccinations with person with sore throat
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R/O diptheria (grey membrane)
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what do you need to know about epiglotitis?
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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 |
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what are some likely vitals for person with sore throat
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1. fever (more than 100 think strep)
2. tachycardia |
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when might you see a muffled "hot potatoe" voice with sore throat
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peritonsillar abcess (pain rotating head to affected side)
linugual tonsilitis (pain at hyoid) |
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why assess general for sore throat pt
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see if they have weird voice
see if they can still drink |
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what do LN tell you for sore throat
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1. Anterior Cervical- strep
2. Post cervial- mono (also other LN and large spleen) |
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in what diseases are exudates more common on throat
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1. strep
2. Mono 3. GC |
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when might you see vesicles in throat
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herpes (front)
coxsackie (back) |
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one sided tonsilar enlargement suggests what
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peritonsillar abcess
lymphoma |
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if you have sore throat AND conjunctiva what might is be
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adenovirus
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a bullous myringitis suggests what disease
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mycoplasa pnemonea
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scarlet fever presents how
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petechiae on palate and white coating on tongue followed by strawberry tonugue. also a sandpaper rash
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strayberry tongue is seen with what
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scarlet fever
**strawberry tongue is 2 days after initial whit film on tongue and petetciea on palate. sand paper rash |
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atypical pnemonia and sire throat suggests
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mycoplasma
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hepatomegaly/splenomegaly is seen in what
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mono
EBV CBV |
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if you have all 4 centor criteria for strep do you need a culture?
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some say yep some say nope
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what is the gold standard for strep dx
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throat culture
sensitivity 90-95% Specificity >95% **ordered when you have a - rapid strep |
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what is the rapid strep test
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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) |
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does a - rapid strep totally rule out strep/ wht
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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) |
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what do we do with a kid with a - rapid strep but all 4 centron
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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) |
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where do you swab for throat culture
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BOTH tonsils, do it hard
**be sure to do 2 swabs, one for rapid, one for culture **dont swab cheeks or tongue |
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whats a CBC for strep? mono?
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strep: leukocytisis, left shift (to PMN)
mono: r shift, initial leukopenia, atypical lymphs |
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what is a monosopt
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mono test
**sheep cell agglutination rapid AB test. + one week after onset |
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what test for peritonsillar abcess
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CT
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what is the most common cause of epiglottitis
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H influenza
**vaccine against in the HIB |
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how is GABHS transferred? whats incubation period? sx
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repriratory drops
**1-4 days Sx: fever, sore throat, chills, malaise, headache, tummy pain Physical: erythema, exudate, palatal perechiae, cervial anterior lymphadenopathy |
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why treat strep? is f/u culture required
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to prevent rheumatic fever
**not unless you have hx of rheumatic fever |
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what are some complications of strepo
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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 |
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what is scarlet fever
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rash that is 2 to strep.
rash spares the palms and soles, rash feels like sandpaper and you get strawberry tongue. rash then peels |
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what is the tx of choice for GABHS tx
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penicillin
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when can a kid go back to school after tx for strep (with 10 days course of penicillin)
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24 hrs
**sometimes ammoxacilin is given bc it tastes better |
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what drugs shouldnt be used for strep
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sulfa and tetracycline- they dont prevent rheumatic fever
Penicillian is good, there is no resistance FINISH AB!!!! Even if sx resolve before hand |
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what can you do to tx sx before AB kicks in
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no steroids
NSAIDS (no asprin to kids) rest hydrate hard candy |
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when might be strep be a big enough problem to get tonxils removed
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3 cases yearly for 3 years
5 episodes yearly for 2 years 7 episodes for 1 year |
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what causes mono?
transmission? incubation |
EBV
spit 4-8 weeks LONG TIME |
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what are sx of mono
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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 |
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what are labs for mono
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+ monospot
increased ASL ALT aytpical lymphs |
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what are complications of mono
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splenic rupture
hemolytic anemia airway obstruction |
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what is tx for mono
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NSAIDS
rest fluid nutrition steroids PRN to manage airway **return to contact sports 4 weeks, non contact sports 3 weeks |
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what are signs/sx for VIRAL pharyngitis/tinsiliits
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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 |
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what are signs/sx of bacterial pharyngitis/tinsilitis
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1. fever
2. tender ant cervical LN 3. no cough, conjunctivitis, coryza 4. exudate 5. odynophagia 6. scarrlitiniform rash 7. leukocytisis with L shift |
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what drug causes a rash when given to a pt with mono
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ampicillin
amoxacillin |