Podcast
Questions and Answers
Which of the following is the most common cause of pharyngitis?
Which of the following is the most common cause of pharyngitis?
- Bacterial infection
- Allergies
- Trauma
- Viral infection (correct)
A patient has been diagnosed with pharyngitis caused by Group A beta-hemolytic streptococci. Which category of infection does this represent?
A patient has been diagnosed with pharyngitis caused by Group A beta-hemolytic streptococci. Which category of infection does this represent?
- Allergic reaction
- Fungal infection
- Viral infection
- Bacterial infection (correct)
Which of the following is least likely to cause pharyngitis directly?
Which of the following is least likely to cause pharyngitis directly?
- Retropharyngeal abscess (correct)
- Rhinovirus
- Candida
- Environmental allergies
What is the primary anatomical location affected by pharyngitis?
What is the primary anatomical location affected by pharyngitis?
In 2010, approximately how many emergency department visits were recorded for pharyngitis?
In 2010, approximately how many emergency department visits were recorded for pharyngitis?
Which age group is most affected by pharyngitis?
Which age group is most affected by pharyngitis?
What is a primary reason that mortality occurs from pharyngitis?
What is a primary reason that mortality occurs from pharyngitis?
In what situation should a household member of a patient with group A streptococci be treated with antibiotics?
In what situation should a household member of a patient with group A streptococci be treated with antibiotics?
What is the recommended course of treatment for a patient diagnosed with viral pharyngitis?
What is the recommended course of treatment for a patient diagnosed with viral pharyngitis?
Why are antibiotics often over used in the treatment of acute pharyngitis?
Why are antibiotics often over used in the treatment of acute pharyngitis?
Which of the following best describes the typical duration of most pharyngitis cases?
Which of the following best describes the typical duration of most pharyngitis cases?
What is a potential complication if bacterial pharyngitis is not fully treated?
What is a potential complication if bacterial pharyngitis is not fully treated?
Which action is most important in preventing the spread of pharyngitis within a household?
Which action is most important in preventing the spread of pharyngitis within a household?
Why is it important to educate patients with pharyngitis against the empirical use of antibiotics?
Why is it important to educate patients with pharyngitis against the empirical use of antibiotics?
Besides medication and hygiene, what is a non-pharmacological recommendation for patients with pharyngitis?
Besides medication and hygiene, what is a non-pharmacological recommendation for patients with pharyngitis?
What recommendation should be made to parents about treating fever in young children with pharyngitis?
What recommendation should be made to parents about treating fever in young children with pharyngitis?
What is the most common cause of pharyngitis globally?
What is the most common cause of pharyngitis globally?
In addition to local invasion, what two symptoms frequently occur in the pharyngeal mucosa due to pharyngitis?
In addition to local invasion, what two symptoms frequently occur in the pharyngeal mucosa due to pharyngitis?
Which of the following is NOT a typical symptom of uncomplicated infectious pharyngitis?
Which of the following is NOT a typical symptom of uncomplicated infectious pharyngitis?
What characteristic is associated with Group A beta-hemolytic streptococcal pharyngitis but not a viral upper respiratory infection?
What characteristic is associated with Group A beta-hemolytic streptococcal pharyngitis but not a viral upper respiratory infection?
Which condition is associated with a morbilliform rash after amoxicillin treatment for suspected strep throat?
Which condition is associated with a morbilliform rash after amoxicillin treatment for suspected strep throat?
A patient is experiencing neck stiffness and pain when extending thier neck. This is consistent with which condition?
A patient is experiencing neck stiffness and pain when extending thier neck. This is consistent with which condition?
What is the purpose of using the Centor Score for a patient complaining of a sore throat?
What is the purpose of using the Centor Score for a patient complaining of a sore throat?
When assessing a patient, what feature is most suggestive of infectious mononucleosis rather than a typical viral infection?
When assessing a patient, what feature is most suggestive of infectious mononucleosis rather than a typical viral infection?
A rapid antigen detection test (RADT) comes back negative for strep, what is the next step?
A rapid antigen detection test (RADT) comes back negative for strep, what is the next step?
What is the ideal standard for diagnosing infectious mononucleosis?
What is the ideal standard for diagnosing infectious mononucleosis?
What is the recommended duration of oral penicillin treatment for Group A beta-hemolytic strep?
What is the recommended duration of oral penicillin treatment for Group A beta-hemolytic strep?
Why are antibiotics generally recommended for Group A beta-hemolytic streptococcal pharyngitis?
Why are antibiotics generally recommended for Group A beta-hemolytic streptococcal pharyngitis?
A patient with a known penicillin allergy has a diagnosis of Group A streptococcal pharyngitis. What treatment is most appropriate if the patient has a history of anaphylaxis?
A patient with a known penicillin allergy has a diagnosis of Group A streptococcal pharyngitis. What treatment is most appropriate if the patient has a history of anaphylaxis?
After starting antibiotic treatment, when is the infection for Group A strep no longer infectious?
After starting antibiotic treatment, when is the infection for Group A strep no longer infectious?
Why should patients diagnosed with infectious mononucleosis avoid contact sports?
Why should patients diagnosed with infectious mononucleosis avoid contact sports?
What does the 'https://' protocol at the beginning of a web address indicate?
What does the 'https://' protocol at the beginning of a web address indicate?
Which of the following is a less common cause of pharyngitis?
Which of the following is a less common cause of pharyngitis?
Which of the following viral pathogens is least likely to cause pharyngitis?
Which of the following viral pathogens is least likely to cause pharyngitis?
Which of these bacterial infections is a common cause of pharyngitis, but less common than Group A Streptococcus?
Which of these bacterial infections is a common cause of pharyngitis, but less common than Group A Streptococcus?
Which of these conditions is NOT mentioned in the text as a potential complication or a disease with similar symptoms to pharyngitis?
Which of these conditions is NOT mentioned in the text as a potential complication or a disease with similar symptoms to pharyngitis?
Which age group had the highest frequency of emergency department visits for pharyngitis in 2010?
Which age group had the highest frequency of emergency department visits for pharyngitis in 2010?
Which of the following statements about the occurrence of pharyngitis is true?
Which of the following statements about the occurrence of pharyngitis is true?
What is the primary focus regarding pharyngitis, as highlighted by the provided information?
What is the primary focus regarding pharyngitis, as highlighted by the provided information?
What is the primary reason for treatment failure in cases of bacterial pharyngitis?
What is the primary reason for treatment failure in cases of bacterial pharyngitis?
Which of the following is a recommended practice for managing viral pharyngitis to address antibiotic resistance?
Which of the following is a recommended practice for managing viral pharyngitis to address antibiotic resistance?
Why are follow-up cultures generally not needed for patients recovering from pharyngitis?
Why are follow-up cultures generally not needed for patients recovering from pharyngitis?
Besides antibiotics, what is an essential recommendation for all patients with pharyngitis?
Besides antibiotics, what is an essential recommendation for all patients with pharyngitis?
In the context of pharyngitis, what is the role of the interprofessional team?
In the context of pharyngitis, what is the role of the interprofessional team?
What is a crucial educational point about antibiotics that should be communicated to all patients with pharyngitis?
What is a crucial educational point about antibiotics that should be communicated to all patients with pharyngitis?
What specific guidance should be given to patients concerning their diet when symptomatic with pharyngitis?
What specific guidance should be given to patients concerning their diet when symptomatic with pharyngitis?
What is the primary reason for recommending a full course of antibiotics for patients diagnosed with group A streptococcus pharyngitis?
What is the primary reason for recommending a full course of antibiotics for patients diagnosed with group A streptococcus pharyngitis?
To help prevent recurrence of pharyngitis, which of the following immunizations should be recommended to at-risk patients?
To help prevent recurrence of pharyngitis, which of the following immunizations should be recommended to at-risk patients?
What is a critical instruction that parents should receive regarding fever management for young children with pharyngitis?
What is a critical instruction that parents should receive regarding fever management for young children with pharyngitis?
In which scenario is a lateral neck X-ray most appropriate for a patient with pharyngitis?
In which scenario is a lateral neck X-ray most appropriate for a patient with pharyngitis?
What is the most important reason to treat a Group A beta-hemolytic streptococcal pharyngitis with antibiotics?
What is the most important reason to treat a Group A beta-hemolytic streptococcal pharyngitis with antibiotics?
A patient presents with pharyngitis, headache, fever, and palpable lymph nodes in the front and back of the neck. Which condition should be suspected, and what additional finding would be most suggestive of this diagnosis?
A patient presents with pharyngitis, headache, fever, and palpable lymph nodes in the front and back of the neck. Which condition should be suspected, and what additional finding would be most suggestive of this diagnosis?
A patient has a negative rapid antigen detection test for Group A strep. What approach is recommended, especially for children?
A patient has a negative rapid antigen detection test for Group A strep. What approach is recommended, especially for children?
Why is it beneficial to avoid contact sports for patients with infectious mononucleosis?
Why is it beneficial to avoid contact sports for patients with infectious mononucleosis?
What is the typical course of uncomplicated infectious pharyngitis?
What is the typical course of uncomplicated infectious pharyngitis?
A patient develops a morbilliform rash after starting amoxicillin for suspected Group A strep throat. Which condition should be highly suspected?
A patient develops a morbilliform rash after starting amoxicillin for suspected Group A strep throat. Which condition should be highly suspected?
What is the main role of white blood cell counts in assessing pharyngitis?
What is the main role of white blood cell counts in assessing pharyngitis?
Which test is most specific for diagnosing Group A beta-hemolytic streptococcal pharyngitis?
Which test is most specific for diagnosing Group A beta-hemolytic streptococcal pharyngitis?
A patient is diagnosed with gonococcal pharyngitis. What additional history is most important to obtain?
A patient is diagnosed with gonococcal pharyngitis. What additional history is most important to obtain?
What clinical finding is most suggestive of a retropharyngeal abscess?
What clinical finding is most suggestive of a retropharyngeal abscess?
What is the recommended length of treatment when using oral penicillin for Group A beta-hemolytic streptococcal pharyngitis?
What is the recommended length of treatment when using oral penicillin for Group A beta-hemolytic streptococcal pharyngitis?
What is the most common cause of pharyngitis in countries where antibiotics are overprescribed, according to the provided material?
What is the most common cause of pharyngitis in countries where antibiotics are overprescribed, according to the provided material?
A patient has a mild penicillin allergy, which antibiotic can be used to treat Group A beta-hemolytic streptococcal pharyngitis?
A patient has a mild penicillin allergy, which antibiotic can be used to treat Group A beta-hemolytic streptococcal pharyngitis?
A patient presents with fever, sore throat, and suspected epiglottitis. Which associated finding would be most indicative of this condition?
A patient presents with fever, sore throat, and suspected epiglottitis. Which associated finding would be most indicative of this condition?
Flashcards
What is pharyngitis?
What is pharyngitis?
Inflammation of the mucous membranes in the oropharynx.
What are the main causes of pharyngitis?
What are the main causes of pharyngitis?
Most commonly caused by viral or bacterial infections. Other less common causes include allergies, trauma, cancer, reflux, and toxins.
What are the common viral pathogens causing pharyngitis?
What are the common viral pathogens causing pharyngitis?
Rhinovirus, influenza, adenovirus, coronavirus, and parainfluenza.
What is the most common bacterial cause of pharyngitis?
What is the most common bacterial cause of pharyngitis?
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Can pharyngitis be a symptom of other illnesses?
Can pharyngitis be a symptom of other illnesses?
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What percentage of pharyngitis cases are viral?
What percentage of pharyngitis cases are viral?
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Who is most likely to get pharyngitis?
Who is most likely to get pharyngitis?
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What is the role of the interprofessional team in managing pharyngitis?
What is the role of the interprofessional team in managing pharyngitis?
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Pharyngitis
Pharyngitis
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Dysphagia
Dysphagia
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Pharyngeal erythema
Pharyngeal erythema
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Group A beta-hemolytic streptococcal pharyngitis
Group A beta-hemolytic streptococcal pharyngitis
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Infectious mononucleosis
Infectious mononucleosis
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Retropharyngeal abscess
Retropharyngeal abscess
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Epiglottitis
Epiglottitis
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Lemierre's syndrome
Lemierre's syndrome
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Centor Score
Centor Score
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Rapid antigen detection test (RADT)
Rapid antigen detection test (RADT)
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Throat culture
Throat culture
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Heterophile antibody or monospot test
Heterophile antibody or monospot test
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Penicillin
Penicillin
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Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
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Non-contagious period after antibiotics
Non-contagious period after antibiotics
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Pharyngitis Recovery Period
Pharyngitis Recovery Period
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Acute Rheumatic Fever
Acute Rheumatic Fever
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Antibiotic Resistance
Antibiotic Resistance
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Antibiotic Overprescribing
Antibiotic Overprescribing
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Viral Pharyngitis
Viral Pharyngitis
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Airway Obstruction
Airway Obstruction
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Symptom Management for Viral Pharyngitis
Symptom Management for Viral Pharyngitis
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Handwashing and Hygiene
Handwashing and Hygiene
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Interprofessional Team Approach
Interprofessional Team Approach
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Pharyngitis Prevention
Pharyngitis Prevention
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What is the Centor Score?
What is the Centor Score?
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How is pharyngitis treated?
How is pharyngitis treated?
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How can you prevent pharyngitis?
How can you prevent pharyngitis?
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What is the main cause of pharyngitis?
What is the main cause of pharyngitis?
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How long does pharyngitis typically last?
How long does pharyngitis typically last?
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When are antibiotics used for pharyngitis?
When are antibiotics used for pharyngitis?
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What is an interprofessional team approach?
What is an interprofessional team approach?
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How can pharyngitis be prevented?
How can pharyngitis be prevented?
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What are the potential complications of pharyngitis?
What are the potential complications of pharyngitis?
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Why is antibiotic overuse a concern for pharyngitis?
Why is antibiotic overuse a concern for pharyngitis?
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How is viral pharyngitis typically managed?
How is viral pharyngitis typically managed?
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What causes pharyngitis?
What causes pharyngitis?
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What are the typical symptoms of pharyngitis?
What are the typical symptoms of pharyngitis?
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How is pharyngitis diagnosed?
How is pharyngitis diagnosed?
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How is bacterial pharyngitis treated?
How is bacterial pharyngitis treated?
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How is the need for antibiotics determined?
How is the need for antibiotics determined?
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Is blood work helpful in diagnosing pharyngitis?
Is blood work helpful in diagnosing pharyngitis?
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How does infectious mononucleosis cause pharyngitis?
How does infectious mononucleosis cause pharyngitis?
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What special precautions are needed for infectious mononucleosis?
What special precautions are needed for infectious mononucleosis?
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Why are clinical decision rules important for pharyngitis?
Why are clinical decision rules important for pharyngitis?
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When are antibiotics necessary for pharyngitis?
When are antibiotics necessary for pharyngitis?
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Why is antibiotic overprescribing a concern?
Why is antibiotic overprescribing a concern?
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What are the risks of infectious mononucleosis?
What are the risks of infectious mononucleosis?
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What are some potential complications of pharyngitis?
What are some potential complications of pharyngitis?
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Study Notes
Pharyngitis: Overview
- Pharyngitis is the inflammation of the oropharynx's mucous membranes.
- Most cases are caused by bacterial or viral infections.
- Less common causes include allergies, trauma, cancer, reflux, and toxins.
- Pharyngitis rates are very high in countries with overprescription of antibiotics.
- Majority of cases resolve spontaneously within 7-10 days.
- 1.814 million ED visits for pharyngitis in 2010, 692,000 under age 15.
- Most cases in children under age 5.
Causes of Pharyngitis
- Viral: 50-80% of cases; common viruses include rhinovirus, influenza, adenovirus, coronavirus, parainfluenza, herpes, Epstein-Barr virus, HIV, and coxsackievirus. Rhinovirus can cause irritation from nasal secretions.
- Bacterial: Less common but more severe; commonly Group A beta-hemolytic streptococci (5-36% of cases), Group B & C streptococci, Chlamydia pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Candida, Neisseria meningitidis, Neisseria gonorrhoeae, Arcanobacterium haemolyticum, Fusobacterium necrophorum, and Corynebacterium diphtheriae.
- Other causes: environmental allergens, chemical exposures.
Symptoms of Pharyngitis
- Generally characterized by a sore throat.
- Common symptoms include fever, tonsillar exudates, painful cervical adenopathy, pharyngeal erythema, and ear pain.
- Viral pharyngitis often accompanies cough, rhinorrhea, conjunctivitis, headache, and rash.
- Group A strep pharyngitis typically lacks respiratory symptoms and involves fever, tonsillar exudates, and cervical adenopathy.
- Infectious mononucleosis (Epstein-Barr virus) can be associated with headaches, fever, tonsillar hypertrophy, lymphocytosis, atypical lymphocytes, myalgia, and fatigue, persistent lymphadenopathy & fatigue (up to 3 weeks), potential hepatomegaly or splenomegaly.
- Morbilliform rash following amoxicillin suggests infectious mononucleosis.
- Peritonsillar abscess: neck stiffness, pain with neck extension.
- Retropharyngeal abscess: similar to peritonsillar abscess.
- Epiglottitis: stridor (a whistling sound during breathing).
- Lemierre's syndrome (internal jugular vein thrombophlebitis): caused by Fusobacterium necrophorum.
Diagnosis of Pharyngitis
- Physical exam and history are crucial.
- Avoid empirical antibiotic use.
- White blood cell counts are not reliable for differentiating viral vs. bacterial pharyngitis. Lymphocytosis (>50%) or increased atypical lymphocytes (greater than 10%) may suggest mononucleosis.
- Rapid antigen detection tests (RADTs) are highly specific for Group A strep but have variable sensitivity (70-90%).
- Throat cultures are considered the gold standard but have variable sensitivity, influenced by factors such as bacterial burden, collection site, culture medium, and atmosphere.
- Heterophile antibody (monospot) tests are used for infectious mononucleosis (70-92% sensitive, 96-100% specific).
- Epstein-Barr virus (EBV) serology is the best confirmation of infectious mononucleosis, particularly for children under 12.
- Specific cultures (Thayer-Martin, potassium hydroxide, Sabouraud) may be used for bacteria and Candida.
- X-rays (lateral neck, chest) are only warranted if airway compromise is suspected or a peritonsillar abscess is suspected. CT scans may aid in diagnosing peritonsillar abscess.
- Centor Score used for diagnosis, particularly in adults.
Treatment of Pharyngitis
- Treatment is primarily symptomatic.
- Antibiotics are typically used only for confirmed Group A strep infections, especially in children - based on positive RADT or culture.
- Oral penicillin V, amoxicillin, cephalosporins, macrolides, or clindamycin may be used.
- Intramuscular penicillin is an alternative.
- Avoid antibiotics in viral cases to prevent antibiotic resistance.
- Symptomatic relief: gargles, acetaminophen, NSAIDs. Avoid aspirin in children or those prone to allergy.
- Dexamethasone may reduce symptoms, but evidence is limited.
- Patients with infectious mononucleosis should avoid contact sports for 6-8 weeks due to splenic rupture risk.
- 10-day course of penicillin recommended to eradicate bacterial carriage and prevent rheumatic fever, optimal for eradication of bacterial carriage and prevention of rheumatic fever.
- Household contacts with strep should receive treatment if symptomatic, but asymptomatic individuals do not need treatment.
- Antibiotics shorten symptoms by 16-24 hours and help prevent rheumatic fever (1 in 400 untreated strep cases).
Prognosis and Complications
- Most cases are self-limiting (5-7 days for uncomplicated infection).
- Complications are rare, but occur in less than 1% of infections.
- Potential complications include otitis media, pneumonia, nephritis, and meningitis.
- Mortality from untreated or severe pharyngitis is rare, but can occur from airway obstruction.
- Treatment failures commonly due to antibiotic resistance, poor compliance, and untreated close contacts.
- Acute rheumatic fever is a significant cause of death in younger people in developing countries. Over 20 million individuals affected by streptococcal pharyngitis globally and develop acute rheumatic fever.
Prevention
- Hand hygiene is crucial for preventing spread.
- Immunizations against relevant pathogens (flu, diphtheria) can help reduce recurrence.
- Patient and parent education are important for proper antibiotic use and self-care measures. Educate patients to avoid empiric antibiotics and that their course is often viral. Also, educate patients on the importance of handwashing, rest, and hydration.
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Description
This quiz covers key aspects of pharyngitis, an inflammation of the oropharynx's mucous membranes. Learn about the various causes, symptoms, and the most common pathogens involved in this condition. Test your understanding of how viral and bacterial infections contribute to pharyngitis.
