Clinical Medicine: Pharyngitis Diagnosis

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Questions and Answers

What is the duration of acute pharyngitis?

Exactly 2 weeks

Less than 2 weeks (correct)

More than 2 weeks

Unknown

What is the primary goal of the general approach to acute pharyngitis?

To identify acute sore throat caused by GABHS

To rule out serious diagnoses and red flags/alarm symptoms (correct)

To determine the specific infectious cause

To prescribe antibiotic treatment

What is a possible non-infectious cause of pharyngitis?

Gastroesophageal reflux disease (correct)

Group A beta-hemolytic streptococcal (GABHS)

Rhinovirus

Influenza A

Which of the following viruses is a cause of pharyngitis?

Herpes simplex virus (HSV) Signup and view all the answers

What is the name of the bacterial cause of pharyngitis that may require antibiotic treatment?

Group A beta-hemolytic streptococcal (GABHS) Signup and view all the answers

What is the point value assigned to 'Fever plus cough' in the influenza clinical decision rule?

2 points Signup and view all the answers

What is the risk of influenza associated with a total score of 3 points?

30% Signup and view all the answers

What symptom is assigned 1 point in the influenza clinical decision rule?

Duration < 48 hours Signup and view all the answers

What is the total score for Alex Best based on the provided information?

3 points Signup and view all the answers

According to the clinical decision rule, what is the risk of influenza associated with a total score of 0 to 2 points?

8% Signup and view all the answers

What is the primary concern in a patient with a recent history of foreign body impaction or oropharyngeal procedure?

Airway obstruction Signup and view all the answers

What is the most common cause of acute pharyngitis?

Viral Signup and view all the answers

What score is used to determine the probability of streptococcal pharyngitis?

Modified Centor score Signup and view all the answers

What is a potential complication of retropharyngeal abscess?

All of the above Signup and view all the answers

What type of hearing loss would occur if the dysfunction is in the cochlea?

Sensorineural Hearing Loss Signup and view all the answers

What is a potential diagnosis in a patient with weight loss, fever, and night sweats?

Lymphoma Signup and view all the answers

What separates the outer ear from the middle ear?

Tympanic membrane Signup and view all the answers

What is the function of the Eustachian tube?

To connect the middle ear with the nasopharynx Signup and view all the answers

What is the part of the ear that comprises the auricle and the ear canal?

Outer ear Signup and view all the answers

What type of hearing loss would occur if the dysfunction is in the ossicles?

Conductive Hearing Loss Signup and view all the answers

What is the Weber test finding in a patient with sensorineural hearing loss?

Lateralization to the unaffected ear Signup and view all the answers

What is the most common type of infection in otitis externa?

Bacterial infection Signup and view all the answers

What is the benefit of antibiotic therapy in acute otitis media?

Decreased pain by day 2 to 3 Signup and view all the answers

What is the antibiotic therapy of choice for acute otitis media in children?

Amoxicillin Signup and view all the answers

What is the primary symptom of otitis externa?

Ear fullness Signup and view all the answers

Study Notes

Pharyngitis

Pharyngitis is the inflammation of the pharynx
Acute pharyngitis lasts less than 2 weeks, while chronic pharyngitis lasts more than 2 weeks
Causes of pharyngitis include:
- Viral: Rhinovirus, Coronavirus, Adenovirus, Herpes simplex virus (HSV), Influenza A and B, Parainfluenza virus, Epstein-Barr virus, Cytomegalovirus, Human herpesvirus (HHV) 6
- Bacterial: Group A beta-hemolytic streptococci (GABHS), Fusobacterium necrophorum, Group C beta-hemolytic streptococci, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Mycoplasma pneumoniae, Chlamydophila pneumoniae
- Non-infectious: Allergies, Smoking, Gastroesophageal reflux disease, Acute thyroiditis, Neoplasm

General Approach to Acute Pharyngitis

Rule out serious diagnoses and red flags/alarm symptoms that prompt emergent/urgent management
Most cases of acute pharyngitis are due to infectious causes
Determine the specific infectious cause (i.e., viral or bacterial)
Identify acute sore throat caused by GABHS pharyngitis, which may require antibiotic treatment

Alarm Symptoms

Associated with pharyngitis: fever, rash, diffuse adenopathy, sore throat
Associated with cough: persistent cough, upper airway cough syndrome, gastroesophageal reflux disease

Modified Centor Score (McIsaac)

A clinical decision rule to determine the probability of streptococcal pharyngitis
An online calculator is available to apply the score to a patient case

Influenza Clinical Decision Rule

A clinical decision rule to determine the probability of influenza
Score:
- Fever plus cough: 2 points
- Myalgias: 2 points
- Duration < 48 hours: 1 point
- Chills or sweats: 1 point
Risk of influenza based on total points:
- 0 to 2 points: 8%
- 3 points: 30%
- 4 to 6 points: 59%

Hearing Loss

Types of hearing loss:
- Conductive hearing loss: due to dysfunction in the auditory pathway from the external ear to the middle ear
- Sensorineural hearing loss: due to dysfunction in the auditory pathway between the inner ear and auditory cortex
Whisper test: a screening test for hearing loss
Weber and Rinne test findings:
- Conductive hearing loss: lateralization to affected ear, bone conduction > air conduction
- Sensorineural hearing loss: lateralization to unaffected ear, air conduction > bone conduction

Otitis Externa (Swimmer's Ear)

Inflammation or infection of the external ear canal
Most commonly a bacterial infection (Pseudomonas species or Staphylococcus aureus) or fungal infection
Treatment: antibiotics (e.g., Amoxicillin) for 10 days in children

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Description

Test your knowledge on differentiating between chronic and acute pharyngitis, identifying alarm symptoms, and applying the modified Centor score to patient cases. This quiz covers the key concepts of acute pharyngitis diagnosis in clinical medicine.