75 Questions
What is the duration of acute pharyngitis?
Less than 2 weeks
Which of the following is a viral cause of pharyngitis?
Rhinovirus
What is the primary goal of the general approach to acute pharyngitis?
Rule out serious diagnoses and red flags/alarm symptoms
What is the term for the sensation of mucus running down the back of the throat?
Postnasal drip
What is the term for inflammation of the pharynx?
Pharyngitis
What is the term for a bacterial cause of pharyngitis?
Fusobacterium necrophorum
What is the term for a viral cause of pharyngitis that is also associated with cold sores?
Herpes simplex virus
What is the term for the sensation of mucus running up the back of the throat from the stomach?
Gastroesophageal reflux disease
What is the term for a non-infectious cause of pharyngitis?
Smoking
What percentage of pharyngitis cases are caused by the common cold?
50%
What is the optimal temperature for the growth of rhinoviruses?
32.8°C
What is a complication of the common cold?
All of the above
What is the typical duration of symptoms in a common cold?
7-10 days
What is the most common cause of the common cold?
Rhinovirus
What is a characteristic of the common cold?
Chest exam is normal
What is a type of virus that can cause pharyngitis in children?
All of the above
What is a common symptom associated with primary HIV infection?
Diffuse adenopathy
What is the treatment for the common cold?
Self-limiting
What is the most likely cause of pharyngitis, considering the probabilities?
Viral
What is the name of the score used to determine the probability of streptococcal pharyngitis?
Modified Centor score
What is a possible complication of retropharyngeal abscess?
All of the above
What is a possible cause of mucosal burn injury to the pharynx and larynx?
Recent cocaine smoking
What is a possible underlying condition associated with weight loss, fevers, and night sweats?
Lymphoma, head and neck cancers
What is the primary treatment for a common cold?
Analgesics/antipyretics
Which of the following is a recommended preventive measure for the common cold?
Avoiding sick contacts
What is the typical finding on physical exam in a patient with a common cold?
Posterior oropharynx mildly inflamed and erythematous
What is the recommended humidification method for children with nasal congestion?
Cool-mist humidifier
What is the primary symptom of a patient with a common cold?
Sore throat
What is the role of lozenges in the management of a common cold?
To soothe a sore throat
What is the typical Rinne test finding in conductive hearing loss?
Bone conduction > Air conduction
What is the most likely diagnosis for Alex's condition?
Otitis externa
What is the pathogen most commonly associated with otitis externa?
Pseudomonas species
What is the primary antibiotic used to treat otitis externa?
Amoxicillin
What is the typical duration of antibiotic therapy for children with otitis externa?
10 days
What is the primary benefit of antibiotic therapy in otitis externa?
Decrease in pain by day 2-3
What is the number needed to treat (NNT) to decrease pain by day 2-3 with antibiotic therapy in otitis externa?
20
What is the number needed to harm (NNH) for antibiotic therapy in otitis externa?
14
What percentage of cases of sore throat are caused by Group A beta-hemolytic streptococci?
15-30%
What is the primary goal of prescribing antibiotics in a patient with a common cold?
To prevent secondary bacterial infections
Which of the following viruses has a frequency of less than 1% as a cause of sore throat?
Epstein-Barr virus (EBV)
What is the clinical syndrome associated with Corynebacterium diphtheriae?
Diphtheria
Which of the following is a recommended supportive therapy for children with a common cold?
Cool-mist humidifiers
What is the primary benefit of using saline nasal rinse in a patient with a common cold?
To thin out mucus and make it easier to expel
Which of the following bacteria has a frequency of 10% as a cause of sore throat?
Fusobacterium necrophorum
What is the primary mechanism by which steam inhalation provides relief in a patient with a common cold?
By relaxing the nasal passages and making breathing easier
What is the clinical syndrome associated with Herpes Simplex Virus (HSV) 1 and 2?
Stomatitis, pharyngitis
Which of the following viruses has a frequency of 5% as a cause of sore throat?
Adenovirus
What is the primary role of lozenges in the management of a common cold?
To soothe the throat and provide temporary relief from discomfort
What is the primary way to prevent the spread of a common cold?
By avoiding close contact with people who are sick
What is the clinical syndrome associated with Neisseria gonorrhoeae?
Pharyngitis
What is the significance of the presence of a cloudy, bulging TM with displaced cone of light in the left ear?
It is a sign of otitis media
Which of the following viruses has a frequency of 2% as a cause of sore throat?
Parainfluenza virus
What is the most likely diagnosis for a patient with symptoms of sore throat, dysphagia, and odynophagia?
Acute epiglottitis
What is the potential complication of a retropharyngeal space infection?
Spread to the parapharyngeal or retropharyngeal spaces
What is the significance of the presence of posterior cervical nodes that are enlarged and tender to palpation?
It is a sign of a bacterial infection
What is the primary goal of the initial evaluation of a patient with acute pharyngitis?
To rule out alarm symptoms and signs
What is the significance of a muffled voice in a patient with acute pharyngitis?
It is a sign of peritonsillar abscess
What is the potential complication of a parapharyngeal space infection?
Spread to the mediastinum
What is the significance of the presence of nasal turbinates that are red and swollen?
It is a sign of a viral infection
What is the primary goal of identifying alarm symptoms in acute pharyngitis?
To prompt emergent or urgent management of serious diagnoses
A patient presents with a recent onset sore throat. Which of the following is the most likely cause of pharyngitis?
Viral pharyngitis
What is the primary difference between acute and chronic pharyngitis?
The duration of symptoms
A patient presents with a sore throat and a persistent cough. Which of the following is a possible cause of pharyngitis?
Gastroesophageal reflux disease
What is the purpose of the modified Centor score in acute pharyngitis?
To determine the probability of streptococcal pharyngitis
A patient presents with a sore throat and a history of smoking. Which of the following is a possible cause of pharyngitis?
Neoplasm
What is the primary benefit of antibiotic therapy in acute pharyngitis?
To prevent complications
A patient presents with a sore throat and a history of allergies. Which of the following is a possible cause of pharyngitis?
Allergies
What is the primary difference between conductive and sensorineural hearing loss?
The location of hearing loss in the ear
A patient presents with a sore throat and a history of recent travel. Which of the following is a possible cause of pharyngitis?
Neisseria gonorrhoeae
What is the most likely type of hearing loss that Alex is experiencing?
Conductive hearing loss
What structure separates the outer ear from the middle ear?
Tympanic membrane
Which part of the ear is connected to the nasopharynx by the Eustachian tube?
Middle ear
What is the primary function of the ossicles in the middle ear?
To transmit sound waves from the eardrum to the inner ear
Which type of hearing loss is caused by dysfunction in the auditory pathway between the inner ear and auditory cortex?
Sensorineural hearing loss
What is the term for the hole that connects the middle ear with the inner ear?
Oval window
Study Notes
Week 2: Clinical Medicine
Pharyngitis
- Pharyngitis is the inflammation of the pharynx
- Duration:
- Acute pharyngitis: less than 2 weeks
- Chronic pharyngitis: more than 2 weeks
- General approach to acute pharyngitis:
- Rule out serious diagnoses and red flags/alarm symptoms
- Determine the specific infectious cause (viral or bacterial)
- Identify acute sore throat caused by group A beta-hemolytic streptococcal (GABHS) pharyngitis
Causes of Pharyngitis
- Infectious causes:
- Viral: rhinovirus, coronavirus, adenovirus, parainfluenza virus, influenza A and B, herpes simplex virus (HSV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus (HHV) 6, HIV
- Bacterial: group A beta-hemolytic streptococci (GABHS), Fusobacterium necrophorum, group C beta-hemolytic streptococci, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Mycoplasma pneumoniae, Chlamydophila pneumoniae
- Non-infectious causes:
- Allergies
- Smoking
- Gastroesophageal reflux disease (GERD)
- Acute thyroiditis
- Neoplasm
Alarm Symptoms
- Associated with pharyngitis:
- Fever
- Rash
- Diffuse adenopathy
- Sore throat
- Weight loss
- Night sweats
- Associated with cough:
- Hemoptysis
- Chest pain
- Dyspnea
- Wheezing
- Fever
Modified Centor Score
- Used to determine the probability of streptococcal pharyngitis
- Online calculator available
Viral Pharyngitis
- Most pharyngitis cases are viral in origin
- Associated symptoms:
- Cough
- Nasal congestion
- Conjunctivitis
- Hoarseness
- Diarrhea
- Oropharyngeal lesions (ulcers or vesicles)
- Viral causes of pharyngitis do not require antibiotic therapy unless there is a secondary bacterial infection
Common Cold vs. Influenza
- Common cold:
- Viral infection of the upper respiratory tract
- Peaks in winter months
- Symptoms usually worst 2-3 days then resolve in 7-10 days
- Cough may last 2-3 weeks
- Can be caused by many viruses, including rhinoviruses, coronaviruses, adenoviruses, and parainfluenza viruses
- Influenza:
- Viral infection of the upper and lower respiratory tract
- Peaks in winter months
- Symptoms usually worst 2-3 days then resolve in 7-10 days
- Cough may last 2-3 weeks
- Caused by Influenza A and B viruses
Conductive and Sensorineural Hearing Loss
- Conductive hearing loss:
- Weber test: lateralization to affected ear
- Rinne test: bone conduction > air conduction
- Sensorineural hearing loss:
- Weber test: lateralization to unaffected ear
- Rinne test: air conduction > bone conduction
Otitis Externa
- Inflammation or infection of the external ear canal
- Most commonly a bacterial infection (Pseudomonas species or Staphylococcus aureus)
- Can be a fungal infection
Learning Outcomes
- Differentiate between chronic and acute pharyngitis
- Differentiate between infectious and non-infectious causes of pharyngitis
- Follow a systematic approach to the diagnosis of acute pharyngitis
- Identify alarm symptoms associated with acute pharyngitis and cough
- Apply the modified Centor score to patient cases
- Know the relative frequencies of the causes of acute pharyngitis and how they vary based on patients’ epidemiological characteristics
Pharyngitis
- Pharyngitis refers to inflammation of the pharynx
- Acute pharyngitis: duration less than 2 weeks
- Chronic pharyngitis: duration more than 2 weeks
Causes of Pharyngitis
- Infectious causes:
- Viral: rhinovirus, coronavirus, adenovirus, herpes simplex virus, influenza A and B, parainfluenza virus, Epstein-Barr virus, cytomegalovirus, human herpesvirus (HHV) 6, HIV
- Bacterial: group A beta-hemolytic streptococci, Fusobacterium necrophorum, group C beta-hemolytic streptococci, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Mycoplasma pneumoniae, Chlamydophila pneumoniae
- Non-infectious causes:
- Allergies
- Smoking
- Gastroesophageal reflux disease
- Acute thyroiditis
- Neoplasm
Alarm Symptoms Associated with Acute Pharyngitis
- Sore throat, dysphagia, or odynophagia
- Drooling
- Respiratory distress
- Inability to open mouth fully (trismus)
- Muffled voice
- Stiff neck
- Erythema of neck
- Alarm symptoms associated with cough: productive cough, sneezing, runny nose, ear fullness
Case of Alex Best
- 15-year-old adolescent
- CC: recent onset sore throat
- Associated symptoms: productive cough, sneezing, runny nose, ear fullness, slight fatigue, muscle aches, headache
- Physical exam findings: posterior oropharynx mildly inflamed and erythematous; no exudate present, posterior cervical nodes are enlarged and tender to palpation, nasal turbinates are red and swollen
- Diagnosis: common cold
- Whisper test: unable to repeat words whispered to the left ear
- Hearing loss: conductive or sensorineural?
Types of Hearing Loss
- Conductive Hearing Loss: due to dysfunction in one or more parts of auditory pathway from external ear to middle ear
- Sensorineural Hearing Loss: due to dysfunction in one or more parts of auditory pathway between inner ear and auditory cortex
Assess your knowledge on diagnosing pharyngitis, including differentiating between chronic and acute pharyngitis, identifying alarm symptoms, and applying the modified Centor score. This quiz is based on week 2 of the CMS150 Clinical Medicine course.
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