Pharyngitis Overview

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Questions and Answers

What is a common viral cause of pharyngitis that can also lead to herpangina?

Coxsackie virus (correct)

Mycoplasma pneumonia

Corynebacterium diphtheriae

Neisseria gonorrhoeae

Which of the following symptoms is most commonly associated with bacterial pharyngitis caused by Group A beta-hemolytic streptococcus (GABHS)?

Rhinorrhea

Diarrhea

Gradual onset of sore throat

Tender, swollen cervical nodes (correct)

During which season is the peak incidence of pharyngitis most likely to occur?

Late fall through early spring (correct)

Summer

Late summer

Early fall

What clinical feature is typically seen in viral pharyngitis but not in bacterial pharyngitis?

Ulcerative lesions of the pharynx Signup and view all the answers

Which of the following is NOT considered a differential diagnosis for pharyngitis?

Chronic fatigue syndrome Signup and view all the answers

What action should be taken if a child shows signs of active infection before a Tonsillectomy and Adenoidectomy (T&A)?

Notify the surgeon immediately. Signup and view all the answers

Which of the following is NOT recommended in the preoperative care of a child undergoing T&A?

Allow the child to take aspirin up to surgery day. Signup and view all the answers

What should be monitored frequently in a child after a T&A procedure?

Vital signs and any signs of bleeding. Signup and view all the answers

What type of medication should be avoided for pain management after T&A due to variability in children's metabolism?

Codeine and tramadol. Signup and view all the answers

During the convalescent stage of Pertussis, what symptom is primarily decreased?

Severe coughing. Signup and view all the answers

What is the primary vaccination used to prevent Pertussis in children?

dTap for younger children. Signup and view all the answers

What is a common initial symptom of Pertussis in children?

Flulike illness with rhinorrhea. Signup and view all the answers

What should be done after a child's gag reflex has returned following T&A?

Encourage the child to drink water. Signup and view all the answers

Which prevention strategy is key in reducing the spread of Pertussis?

Practicing droplet precautions. Signup and view all the answers

What behavior should be discouraged to avoid complications after a T&A?

Coughing or clearing the throat. Signup and view all the answers

What should be avoided in the treatment of group A Streptococcus pharyngitis due to high resistance rates?

Tetracyclines Signup and view all the answers

What is a common symptom that indicates a worsening condition, potentially leading to a peritonsillar abscess?

Difficulty swallowing saliva Signup and view all the answers

Which of the following is a recommended action after initiating antibiotic therapy for strep throat?

Change toothbrush and toothpaste Signup and view all the answers

Which condition could develop in children younger than 7 years following a streptococcal infection?

PANDAS Signup and view all the answers

What is the maximum number of infections required in one year to consider tonsillectomy for recurrent infections?

7 episodes Signup and view all the answers

Which method is NOT typically used in performing a tonsillectomy?

Ultrasound ablation Signup and view all the answers

What is a hypersensitivity reaction that can occur following an infection with group A beta-hemolytic streptococci?

Scarlet fever Signup and view all the answers

Which of the following is NOT a complication associated with tonsillectomy?

Chronic cough Signup and view all the answers

What action is important for preventing the transmission of streptococcal infections post-treatment?

Use paper cups and avoid sharing towels Signup and view all the answers

Which option is NOT a cause for direct contact transmission of scarlet fever?

Frequent handwashing Signup and view all the answers

What is a systemic analgesic commonly recommended for alleviating sore throat pain associated with pharyngitis?

Ibuprofen Signup and view all the answers

What color rash is characteristic of scarlet fever resulting from an erythematogenic toxin?

Scarlet Signup and view all the answers

Which of the following medications should not be used for GAS pharyngitis treatment due to frequent failure rates?

Sulfonamides Signup and view all the answers

What is a common sign that may indicate a need for tonsillectomy beyond infections?

Obstructive sleep apnea Signup and view all the answers

Study Notes

Pharyngitis

Inflammation of pharyngeal mucous membranes and underlying structures, often due to infection.
Peak incidence in late fall to early spring.
Viral pharyngitis more common in young children during winter.
Group A β-hemolytic streptococcus (GABHS) most prevalent in 5-15 year olds, also peaking in winter.

Pathogenesis (Viral)

Adenovirus
Influenza A & B
Parainfluenza
Epstein-Barr virus
Coxsackie virus (hand, foot, and mouth disease)
Enterovirus
Herpes simplex virus
Enterovirus and Coxsackie viruses commonly cause herpangina (vesicles and ulcers on anterior pillars).
Coxsackie virus type 16 (hand, foot, and mouth disease) is associated with: tongue and buccal ulcers, papulovesicular rash on hands and feet, coryza, conjunctivitis, cough, diarrhea (spring, summer, and fall).

Pathogenesis (Bacterial)

Group A β-hemolytic streptococcus (GAS)
Group B, C, and G streptococci
Corynebacterium diphtheriae
Chlamydia trachomatis
Neisseria gonorrhoeae
Mycoplasma pneumoniae
Other irritants (foreign body, chemical, referred pain)

Pharyngitis: Differential Diagnoses

Allergic rhinitis
Postnasal drip
Fungal infections
Tonsillar abscess
Retropharyngeal abscess
Epiglottitis

Diagnosis (Viral)

Gradual onset
Cough
Sore throat
Fever
Rhinorrhea
Diarrhea
Pharyngeal erythema
Follicular, ulcerative, or exudative lesions

Diagnosis (Bacterial - GABHS or Streptococcal Pharyngitis)

Rapid onset (incubation 2-4 days)
Sore throat
Fever
Dysphagia
Beefy-red, swollen pharynx; uvula and tonsils
Enlarged, exudative tonsils (tonsillar exudate)
Tender/swollen cervical/tonsillar lymph nodes
Petechiae on soft palate, strawberry tongue
Multiple GI symptoms (vomiting)
Scarlatiniform rash (similar to scarlet fever)

Treatment

Rapid strep test/throat culture.
Antibiotics (e.g., amoxicillin) for bacterial infections.
Increased fluid intake.
Analgesics (acetaminophen, ibuprofen).
Return to school after 24 hours of antibiotic treatment.
Monitor for worsening symptoms (peritonsillar abscess).

Antibiotic Considerations (GABHS)

Penicillin, ampicillin, amoxicillin, cephalosporins, macrolides, clindamycin are options.
Avoid sulfonamides and tetracyclines due to high resistance rates.

Analgesics

Systemic analgesics for moderate to severe pain.
Acetaminophen, ibuprofen effective in reducing pain, fever, and inflammation.

Follow-up

Routine re-culturing not always necessary; test of cure may be recommended for some patients.
Assess for carrier state (common; low transmission risk).

Complications

Acute rheumatic fever
Poststreptococcal glomerulonephritis (children under 7 at higher risk).
Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS).

Education

Transmission via respiratory droplets.
Medication adherence critical.
Return to school/daycare after 24 hours with antibiotics.
Separate personal items (toothbrushes, towels, cups) after starting treatment.

Scarlet Fever

Hypersensitivity reaction to toxin produced by GABHS.
May follow streptococcal pharyngitis or other streptococcal infections.
Known as scarlatina.
Erythemogenic toxin leads to widespread inflammation and vasodilation; characteristic scarlet rash.
Incubation period: 1-7 days, rash usually appears on day 2.

Tonsillectomy/Adenoidectomy (T&A)

Surgical removal of tonsils and adenoids.
Common pediatric procedure.

Indications for T&A

Frequently recurrent/chronic tonsillitis/adenoiditis (≥7 episodes/year, ≥5/yr for 2 years, or ≥3/yr for 3 years).
Obstructive sleep apnea
Peritonsillar abscess/cellulitis (≥1 event).
Recurrent middle ear infections due to tonsil enlargement.
Tonsillar obstruction affecting voice.
Nasal obstruction .

Adenoid Hypertrophy

Allergic (adenoidal) facial appearance (long face syndrome): Allergies may contribute to adenoid swelling, leading to a tired, droopy appearance.

T&A Procedure

Preoperative assessment, informed consent.
Anesthesia/IV access.
Postoperative nausea and vomiting prevention (e.g., dexamethasone).
Surgical removal (scissors, curettes, cautery, or harmonic scalpel).
Bleeding control (e.g., bismuth subgallate, cautery).

T&A Complications

Bleeding
Dehydration
Unresolved airway issues
Infection
Pneumonia
Postoperative airway obstruction
Laryngospasm/bronchospasm
Oral mucosa burns
TMJ issues
Tongue/nerve numbness
Remnants/regrowth
Voice changes
Nasal regurgitation (Rare)

Preoperative Care

Explain the procedure to the child and family.
Assess for active infections.
Ensure informed consent.
NPO status according to meal type before surgery.
Assess for loose teeth.
Use pain scale.

Postoperative Care

Maintain airway patency and suction secretions.
Hydration (after gag reflex returns); avoid straws.
Pain management.
Monitor vital signs, hydration, I&O.
Frequent bleeding checks.
Respiratory monitoring for stridor/obstruction.
Monitor drooling, restlessness, agitation.
Avoid codeine/tramadol post-op.
Highest bleeding risk 7-10 days after surgery emphasized

Pertussis

Infection caused by Bordetella pertussis.
Droplet precautions.
Significant morbidity in children, especially infants.
More prevalent during summer and fall months.
Prevention through dTap or Tdap vaccination (depending on age).

Pertussis Disease Progression

Catarrhal (flu-like): rhinorrhea, malaise, sneezing, dry cough (may be absent in infants), and mild fever.
Paroxysmal (rapid coughing): coughing spasms followed by post-tussive emesis, exhaustion, inspiratory whoop, and thick mucus.
Convalescent (reduced coughing): increased susceptibility to other respiratory infections.

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Description

This quiz explores the inflammation of pharyngeal membranes, focusing on both viral and bacterial pathogenesis. It covers common causative agents, peak incidence times, and specific conditions like herpangina and hand, foot, and mouth disease. Test your knowledge on this prevalent respiratory condition.