Untitled Quiz

Red Flags and Serious Diagnoses

• Red flags are signs and symptoms that indicate possible serious underlying pathology
• Red flags prompt further investigation and/or referral

Symptoms and Serious Diagnoses

• Sore throat, dysphagia, or odynophagia with respiratory distress, inability to open mouth fully, or stiff neck may indicate serious diagnoses such as acute epiglottitis, peritonsillar abscess, or retropharyngeal space infection
• Erythema of neck, muffled voice, or fever, rash, diffuse adenopathy, and sore throat may indicate primary HIV infection
• Weight loss, fevers, night sweats, and sore throat may indicate lymphoma or head and neck cancers
• Recent cocaine smoking may indicate mucosal burn injury to pharynx and larynx
• Recent foreign body impaction or oropharyngeal procedure may indicate retropharyngeal abscess

Acute Epiglottitis

• Rare but potentially fatal condition
• Inflammation of epiglottis and adjacent tissues
• Bacterial infection primarily caused by Haemophilus influenzae
• Most commonly seen in children aged 2-6, but incidence decreased with HiB vaccination
• Positive thumb sign on lateral radiograph of the neck is diagnostic
• Medical emergency requiring airway management and antibiotic therapy

Acute Epiglottitis Clinical Presentation

• Acute onset fever, severe sore throat, and toxic appearance
• The 4 Ds: dysphagia, drooling, dysphonia, and distress

Peritonsillar Abscess

• Also known as quinsy
• Most common deep infection of head and neck
• Most common in young adults, with increased risk in immunocompromised and diabetics
• Polymicrobial infection, with common organisms including Group A streptococci, Staphylococcus aureus, and Haemophilus influenzae
• Diagnosis can be made clinically without lab work or imaging in patients with typical presentation

Peritonsillar Abscess Clinical Presentation

• Severe unilateral sore throat
• Dysphagia and odynophagia, leading to pooling of saliva or drooling
• Fever and malaise
• Dysphonia: muffled "hot potato" voice
• Rancid or fetor breath
• Otalgia
• Trismus and oropharyngeal exam: erythematous enlarged tonsil and bulging soft palate on affected side

Complications

• Non-suppurative complications:
  • Acute rheumatic fever (ARF)
  • Poststreptococcal glomerulonephritis
  • Pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal (PANDAS) infection
• Suppurative complications:
  • Peritonsillar abscess
  • Retropharyngeal abscess
  • Otitis media
  • Sinusitis
  • Mastoiditis
  • Cervical lymphadenitis
  • Meningitis
  • Bacteremia

Diagnosing Strep Throat

• Best history questions to ask:
  • Reported fever
  • Absence of cough
  • Absence of runny nose
  • Presence of myalgias
  • Presence of headache
  • Presence of nausea
  • Duration of symptoms < 3 days
  • Streptococcal exposure in previous 2 weeks
• Best physical exams to perform:
  • Any exudates
  • Reported fever
  • Measured temperature >37.8°C
  • Anterior cervical nodes swollen/enlarged
  • Pharyngeal exudates
  • Tonsillar swelling/enlargement
  • Tonsillar or pharyngeal exudates
  • Anterior cervical nodes tender
  • Tonsillar exudates