Pharyngitis

Question 1

Etiology of Pharyngitis


Answer 1

1. Most common cause is viral infections like Rhinovirus, Coronavirus, Adenovirus
2. Some bacterial causes include Group A β-haemolytic Streptococcus (GABHS) or Streptococcus pyogenes
3. other causes- allergy, trauma, toxins and neoplasm

Question 2

Clinical presentation of Pharyngitis


Answer 2

1. Sore throat
2. Dysphagia
3. Fever
4. Headache, Nausea/Vomiting, Abdominal pain
5. Erythema in tonsils and pharynx with or without exudate
6. Enlarged lymph nodes
7. Petechia especially in the soft palate
8. Scarlatiniform rash on the body
9. Exudate
10. Petechia
11. Inflammation of the pharyngeal mucosa

Question 3

Types of Pharyngitis


Answer 3

Acute pharyngitis
Chronic pharyngitis

Question 4

Other pathogens causing Pharyngitis


Answer 4

• H. influenza
• Staph aureus
• Corynebacterium diphtheria
• Neisseria spp (Gonococcal)

Question 5

Other causes of Pharyngitis


Answer 5

• Allergy
• Trauma
• Toxins
• Neoplasm

Question 6

Pharyngitis (Sore throat) is ——-

Answer 6

an acute inflammation or irritation of the pharyngeal mucosa following infection of the nasopharynx or oropharynx

Question 7

Risk factors for Pharyngitis


Answer 7

• Exposure to cigarette smoking
• Frequent common cold and flu
• GERD

Question 8

Pathophysiology of Pharyngitis


Answer 8

• Bacterial and viral infections lead to invasion of the mucosa
• local inflammatory response
• increased capillary permeability
• Leading to swelling, erythema, exudate, fever, and production of extracellular toxins and proteases in Streptococcal infections

Question 9

Diagnosis of GABHS infection

Answer 9

Group A beta-hemolytic streptococcal rapid antigen detection test is the preferred method for diagnosing GABHS infection in the emergency department

Question 10

Centor criteria for GABHS pharyngitis


Answer 10

Fever (1 point)
Anterior cervical lymphadenopathy (1 point)
Tonsillar exudate (1 point)
Absence of cough (1 point)

• > predictive for GABHS pharyngitis in children

Question 11

Differential diagnosis


Answer 11

• Allergic rhinitis with postnasal drip
• Airway obstruction
• Neoplasms - head and neck
• Gastroesophageal reflux disease (GERD)
• Peritonsillar cellulitis
• Candidiasis
• Diphtheria
• Croup (Laryngotracheobronchitis)
• Gonorrhea
• Epiglottitis
• Herpes Simplex Virus (HSV)
• Infectious Mononucleosis (IM)
• Pneumonia, Mycoplasma
• Retropharyngeal abscess
• Scarlet Fever

Question 12

——— is less expensive than the rapid antigen detection test but not the best test to use in the emergency department due to difficulty with follow-up

Answer 12

Throat culture

Question 13

Physical examination


Answer 13

1. Assessment of airway patency
2. Temperature
3. Hydration status
4. HEENT
5. Lymphadenopathy
6. Cardiovascular evaluation
7. Pulmonary assessment
8. Abdominal examination
9. Skin examination

Question 14

———- is the preferred method for diagnosing GABHS infection in the emergency department

Answer 14

GABHS rapid antigen detection test

Question 15

Factors to rule in or rule out diagnosis of GABHS pharyngitis


Answer 15

1. Sore throat
2. Fever
3. Most common in children aged 4-7 years (but other ages may also be affected)
4. Associated w/ sudden onset of symptoms

Question 16

Complications of pharyngitis


Answer 16

• Acute rheumatic fever
• Acute glomerulonephritis
• Mastoiditis
• Peritonsillar abscess
• Otitis media
• Rhinosinusitis
• Necrotizing fasciitis

Question 17

Treatment of Pharyngitis


Answer 17

1. Antimicrobial treatment
   2 . Analgesic and antipyretic

Question 18

Analgesic and antipyretic treatment for Pharyngitis includes pain and fever management with ———-

Answer 18

Paracetamol or Ibuprofen

Question 19

If allergic to penicillins, alternatives include ——–

Answer 19

cephalosporins, Macrolides, or Clindamycin

Question 20

What is the first-choice treatment for Pharyngitis

Answer 20

Penicillin V

Question 21

Follow and monitoring parameters


Answer 21

1. Alleviation of signs and symptoms after 3 days and at the end of the course of antibiotics
2. Culture if history or evidence of rheumatic fever or if symptoms are consistent with a relapse
3. Patients advised to avoid contact sports
4. Viral pharyngitis generally requires no specific follow-up unless immunosuppression is suspected or symptoms worsen

Question 22

Antimicrobial treatment for Pharyngitis should be based on ?

Answer 22

laboratory confirmation of GABHS pharyngitis

Question 23

Advantage of the GABHS rapid antigen test ?

Answer 23

The GABHS rapid antigen detection test decreases the use of unnecessary antibiotics in pediatric patients when used properly

Question 24

The goal of treatment for Pharyngitis

Answer 24

• to improve clinical signs and symptoms
• minimize adverse drug reactions
• prevent transmission to close contacts
• prevent complications

complications – including rheumatic
fever, peritonsillar abscess, cervical
lymphadenitis or mastoiditis

Question 25

Criteria for Steroids use

Answer 25

Steroids may improve clinical symptoms and shorten the clinical course in patients with; * severe or exudative pharyngitis * airway obstruction * significant swelling * odynophagia

Question 26

Duration of antibiotic therapy?

Answer 26

Antibiotics may be given up to 7-10 days after onset of symptoms to prevent acute rheumatic fever

Question 27

Pharmacological management of Pharyngitis

Answer 27

* Penicillin V = first choice treatment – 250mg PO q8h (children) X 10 days – 250mg PO q6h or 500mg PO q12h (adults) * Benzathine penicillin i.m. stat * or amoxicillin (50 mg/kg/d in 2-3 doses orally) X 10 days