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36 Cards in this Set
- Front
- Back
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most common cause of acute bacterial pharyngitis?
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group A strep
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percent of acute pharyngitis children with group A strep? adults?
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15 to 30%. 5 to 10%
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when is GAS pharyngitis common?
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winter and early spring
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how may GAS pharyngitis present in children under 3?
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coryza and crusting of the nares, exudative pharyngitis is rare in this age group
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clinical signs that increase likelihood of GAS pharyngitis?
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tonsillopharyngeal exudate and anterior cervival lymphadenitis
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what are indicators of low risk GAS pharyngitis?
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absence of fever (w/o antipyretics), absence of pharyngeal erythema, presence of obvious manifestations of common cold
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gold standard for GAS pharyngitis diagnosis?
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throat culture
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how long does it take a throat culture containing GAS to grow?
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24 to 48 hrs
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what other test is used to Dx GAS pharyngitis and what are the caveats of its results?
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rapid antigen detection test which has results in minutes. good speceficity, thus positive tests are considered diagnostic and no further microbiological study is needed. not as sensitive as the culture thus if it is negative, should culture to confirm.
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how do you distinguish strep carriers with viral pharyngitis and strep throat?
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you cannot, cultures do not help you
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treatments for strep throat?
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10 days of penicillin or amoxil, if allegic give macrolides as a 1st choice then cephalosporins as a second option
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why should the use of macrolides as first line therapy be avoided?
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strep develops resistance to them very quickly
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what is another EXUDATIVE form of bacterial pharyngitis? complications? diagnosis? treatment?
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diptheria from crynebacterium diphtheriae which can induce cardiac toxicity and neurotoxicity, culture the membrane in loeffler's or tellurite mediums, treat with equine hyperimmune diphtheria antitoxin and penicillin or erythromycin.
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what are two bacterial forms of pharyngitis not discussed?
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Arcanobacterium haemolyticum (adolescents, very similar to strep including rash, treat with erythro). gonnorhea which you treat with ceftriaxone or an oral quinolone plus a dose of azrithromycin incase coinfection with chlamydia
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signs and symptoms of EBV (mono) infection?
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15-24 yos, prodorme of fever etc, then triad of severe sore throat that is red, big and might have an exudate, fever and lymphadenopathy splenomegally in 50% and rare hepatomegaly and jaundice. hematology reveals absolute lymphocytosis
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what are the goals of therapy of strep throat?
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prevention of acute rheumatic fever, prevention of suppurative complications, improvement of clinical symptoms and signs, reduction in transmission, minimization of potential adverse effects of inappropriate antimicrobial therapy
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according to the Bisno 2002 article, when is it OK not to do a culture for a confirmation of a negative result of an RADT test?
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when the specefic RADT test being used has comparable sensitivity to culture or when testing adults bc they have low risk of strep throat and even lower risk of rheumatic fever…. I know the doc for my small group said always do a confirmatory culture for negative RADT, but apparently he did not do his homework and read the article, so WHO KNOWS if we should go by him or by the article... I think the article's method is the way to go... someone had to have read it in order to assign it, or at least you would think... bastards need to get their shit straight
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why do some docs use amoxil in children with strep rather than penicillin?
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bc it tastes better, stuff is damn tasty from what I remember…
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if pt is allergic to penicillin, and they have strep, what do you do?
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if the allergy is anaphylactic give them a macrolide, if it is not but still an allergy, try a first generation cephalosporin. Note if giving macrolide, you need to do antimicrobial susceptability testing on the culture bc strep can be resistant
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length of time for antibiotic treatment?
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10 days
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most common causes of acute pharyngitis are…?
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viruses especially respiratory viruses like ADENO, rhino, influenza, parainfluenza, rhino, and respiratory syncytial. EBV (mono) is also a common cause
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age group, region, and seasonality of strep throat?
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5 to 15, temperate climates, in the winter and spring
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strep throat culture sensitivity?
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90 to 95%
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what is good culture technique?
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swab both tonsils and back of the oropharynx, upon removing the swab do not touch any other parts of the oral cavity.
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can you give an antibiotic if you believe the patient has strep but you are waiting for lab evidence?
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yes, but if the lab evidence comes back negative, discontinue antibiotic
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has strep shown any resistance to penicillin?
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nope
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what do you give if the patient is anaphylacticly allergic to penicillin and the strep is resistant to macrolide (rare)?
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clindamycin
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when should post infection culturing be performed?
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in cases with history of rheumatic fever, in cases where pharyngitis develops during rheumatic fever or glomerulonephritis, also test close contacts
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the article in the new england journal blames what for the recent increase of macrolide resistant strep?
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ease of azrithromycin one a day for five days which should not be primary therapy
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age groups that are normally afflicted with pharyngitis caused by adenovirus? Strep? EBV?
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5 and under. 5 to 15. 15 to 24.
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when should serological testing be used for strep?
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never, takes weeks for antibodies
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what do you suspect in a non immunized child with an exudative membrane extending beyond the tonsils?
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diptheria
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what do you consider in a child who was on a recent hinting trip, helping field dress a deer?
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francisella
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what should you consider in a pharyngitis case of a sexually active adolescent?
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gonorrhea or herpes; don't put them thangs in yo mouth if you don't know where they've been!
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what are the suppurative complications of strep throat?
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. Cervical lymphadenitis, peritonsillar abscess, retropharyngeal abscess, otitis media, mastoiditis, and sinusitis
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can acute glomerulonephritis be prevented by antibiotic?
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no, if its gonna happen, it will happen, bc it is due to antibody antigen complexes from strep
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