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41 Cards in this Set
- Front
- Back
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Viral Pharyngitis Symptoms |
-sore throat -malaise/fatigue -coryza -hoarseness -low grade fever -minimal anterior cervical lymphadenopathy -conjunctivitis |
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Viral Pharyngitis Diagnosis |
- (-) rapid antigen test for strep - (-) throat culture -monospot - consider -influenza virus testing -consider -variable WBC count - not needed in most cases |
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Viral Pharyngitis |
- Rhinovirus, coronavirus -Adenovirus -Epstein-Barr virus -Influenza |
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Virtal Pharyngitis Treatment |
-Acetaminophen or ibuprofen for fever and aches -Decongestants -Fluids -Rest -Watch for secondary infection -Consider anti-viral agents for early influenza |
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Mononucleosis (Epstein-Barr virus) |
-Fever, sore throat and malaise -POST cervical lymphadenopathy -Abdominal pain (heptaosplenomegaly) -prolonged course of 3-6 weeks |
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Mononucleosis Rash |
- Maculopapular rash, <15%
If amoxicillin is given then rash is 90% Do NOT give these patients amoxicillin |
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Mono Supportive Measures |
- NSAIDS, Acetaminophen -Warm saline gargles
do NOT give corticosteroids |
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Coxackievirus |
-Herpangina
-Hand-foot-mouth disease |
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Herpes Simplex I and II |
- Pharyngitis, gingivostomatitis, fever, poor oral intake |
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HIV |
- primary infection as a mono-like syndrome
-Immunocompromised state - "thrush" |
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Herpangina |
-Enterovirus
-Acute, self-limited - mostly young children
-Presents as high fever, sore throat and vesicles or ulcers in the throat |
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Hand-Foot-Mouth Disease |
- Coxackieviruses
-macular, petechila or vesicular rash (vesicles or red papules found on hand-foot-mouth)
-Fever, sore throat, and malaise are mild
TX: symptomatic |
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Herpes Simplex Gingivostomatitis |
-Initial symptom is burning -Small vesicles, rupture and form scales -Common on lips, gingiva, tongue, buccal mucosa
-Usually no need to tx -Severe:: Acyclovir may shorten course and reduce pain |
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Acute HIV Syndrome |
-"mono like" illness - fatigue, sore throat, myalgia -Rash in 40-80% of patients -Mucocutaneous ulceration
Symptoms 5-30 days after exposure
Most common manifestation is asymptomatic |
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Bacterial Pharyngitis |
-Group A-beta hemolytic streptococcus -Anaerobes -N. gonorrhea - C. diptheria |
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Strep Throat Features |
- abrupt onset (spring or winter) (sore throat, fever, headaches, abdominal pain)
-pharyngeal/tonsillar erythema
-tender anterior cervical lymph nodes
NO rhinorrhea, cough, hoarseness, diarrhea and conjunctivitis |
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Centor criteria |
Strongly suggests GABHS - Fever >100.4 F - Tender anterior cervical adenopathy - Lack of cough - Pharyngotonsillar exudate
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Bacterial Diagnosis- |
- (+) rapid strep test - (+) throat culture - WBC may or may not be elevated, not very specific |
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Strep Treatment |
- Penicillin (500 mg 2X daily for 10 days) - If allergic ---- Clindamycin |
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When should we avoid penicillin? |
In uncultured pharyngitis |
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When do we refer a patient for pharyngitis? |
-4 episodes in 1 year or 3/yr for 2 years
-recurrrent tonsilitis with complications
-chronic airway obstruction with apnea
-persistent dysphagia |
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Nonsupportive Complications of Strep |
-Acute rheumatic fever
- acute glomerulonephritis |
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Suppurative complications of strep |
- sinusitis - retropharyngeal and peritonsillar abscesses |
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Rheumatic Fever |
- systemic immune response following infection - 2-6 weeks after strep infection -presents with carditis or arthritis |
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Major Manifestations of Rheumatic Fever |
-Carditis -Polyarthritis -Sydenhams chorea -Erythema marginatum -Subcutaneous nodules |
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Minor Manifestations of Rheumatic Fever |
-Fever -Arthralgia -Elevated acute phase reactants -Prolonged PR interval |
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Syndenham's Chorea (Saint Vitus' dance) |
-Acute toxic or infective disorder of the nervous system
-Characterized by involuntary, irregular jerky movements of the muscles of the face, neck and limbs. |
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Acute Glomerulonephritis |
-deposition of AG-AB complexes in kidney - hematuria to renal failure, tea colored urine
-occurs 5-21 days after pharyngitis
-Penicillin is LESS effective at preventing this |
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Peritonsillar Abscess (Quinsy) |
-Bacterial infection (strep, staph, anaerobes)
-Severe sore throat, usually unilateral
-difficulty swallowing, speaking, breathing
-look for deviation of the uvula -Needs URGENT tx/ENT referral |
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Perisonsillar Abscess Treatment |
- Surgical drainage of abscess - Antibiotics (ampcillin - sulbactam) (amoxcillin - clavulanate) -Rehydration -carefully assess and monitor respiratory status
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Scarlet Fever |
-NOT a complication of strep - fine rash, spares palms, soles, face -Pastia lines, strawberry tongue
TX: penicillin |
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Epiglottitis |
- inflammed cellulitis of epiglottis and adjacent structures
- reduces upper airway - could be life threatening
-S/S:: stridor, tachypnea, intercostal retractions and difficulty breathing
-Hib |
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3 D's of Epiglottitis |
- Dysphagia - Drooling - Distress |
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Epiglottitis Treatment |
- Cephalosporins
- monitor and manage airway |
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Diptheria |
- Gm + bacillus - Tough, grayish pharyngeal membrane -Sore throat
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Kawasaki Disease |
- leading cause of acquired heart disease in children
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Kawasaki Disease Diagnostics |
Fever > 5 days plus at least 4 of the following - bilateral, painless conjunctivitis - lips or oral cavity changes - cervical lymphadenopathy - polymorphous rash - extremity changes |
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Complications and Tx of Kawasaki |
- Cardiovascular (myocarditis, pericarditis, valvular heart...)
- Tx: IVIG - intravenous immunoglobulin High dose aspirin |
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Respiratory distress suggests obstruction |
- epiglottitis - retropharyngeal abscess - peritonsillar abscess - massive tonsillar hypertrophy |
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Stridor, drooling |
- epiglottitis
- retropharyngeal abscess
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Red Flag S/S |
- pt with unusually severe s/s - difficulty swallowing secretions - drooling - dysphonia - hot potato voice - neck swelling |
