25 Questions
What is the duration of acute pharyngitis?
Less than 2 weeks
What is the primary goal of the general approach to acute pharyngitis?
To rule out serious diagnoses and red flags/alarm symptoms
What is a possible non-infectious cause of pharyngitis?
Gastroesophageal reflux disease
Which of the following viruses is a cause of pharyngitis?
Herpes simplex virus (HSV)
What is the name of the bacterial cause of pharyngitis that may require antibiotic treatment?
Group A beta-hemolytic streptococcal (GABHS)
What is the point value assigned to 'Fever plus cough' in the influenza clinical decision rule?
2 points
What is the risk of influenza associated with a total score of 3 points?
30%
What symptom is assigned 1 point in the influenza clinical decision rule?
Duration < 48 hours
What is the total score for Alex Best based on the provided information?
3 points
According to the clinical decision rule, what is the risk of influenza associated with a total score of 0 to 2 points?
8%
What is the primary concern in a patient with a recent history of foreign body impaction or oropharyngeal procedure?
Airway obstruction
What is the most common cause of acute pharyngitis?
Viral
What score is used to determine the probability of streptococcal pharyngitis?
Modified Centor score
What is a potential complication of retropharyngeal abscess?
All of the above
What type of hearing loss would occur if the dysfunction is in the cochlea?
Sensorineural Hearing Loss
What is a potential diagnosis in a patient with weight loss, fever, and night sweats?
Lymphoma
What separates the outer ear from the middle ear?
Tympanic membrane
What is the function of the Eustachian tube?
To connect the middle ear with the nasopharynx
What is the part of the ear that comprises the auricle and the ear canal?
Outer ear
What type of hearing loss would occur if the dysfunction is in the ossicles?
Conductive Hearing Loss
What is the Weber test finding in a patient with sensorineural hearing loss?
Lateralization to the unaffected ear
What is the most common type of infection in otitis externa?
Bacterial infection
What is the benefit of antibiotic therapy in acute otitis media?
Decreased pain by day 2 to 3
What is the antibiotic therapy of choice for acute otitis media in children?
Amoxicillin
What is the primary symptom of otitis externa?
Ear fullness
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
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.
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