Summary Throat Problems

Notes For Step 2 CK Stuvia.com Throat Problems Bacterial Pharyngitis - Group A streptococcus is the most common cause of bacterial pharyngitis. Fever, painful cervical lymphadenopathy , and exudative pharyngitis are all compatible with streptococcal pharyngitis. Patients with viral pharyngitis typically have symptoms of conjunctivitis, rhinorrhea or a viral exanthema. Since there can be overlap in the presentations of streptococcal and viral pharyngitis, confirmation with a rapid streptococcal antigen test is recommended. Antimicrobial therapy is warranted in all patients with streptococcal pharyngitis in order to hasten recovery, prev ent transmission, and reduce the incidence of complications, such as rheumatic fever. Since group A streptococcus remains sensitive to penicillin , this is the recommended antibiotic treatment. Macrolide antibiotics such as azithromycin can be used to treat streptococcal pharyngitis in patients who are allergic to penicillin Streptococcal pharyngitis should be treated with antibiotics to hasten recovery, reduce the risk of rheumatic fever , and prevent transmission to close contacts. The rapid test for the streptococcal antigen has a high specificity but a limited sensitivity . Therefore, a positive result does not need confirmation with a throat culture, but a culture should be performed if the rapid test is negative. Antistreptolysin 0 antibodies can be helpful in patients with glomerulonephritis to determine if there has been a recent streptococcal infection. Epiglottitis – These patients present with abrupt onset and rapid progression of symptoms like sore throat & painful swallowing ( usually less than 2 days ). This should immediately raise concern for epiglottitis, which is a potentially life -threatening infection that is characteristically associated with a high -grade fever, a severe sore throat with odynophagia (pain on swallowing) and drooling, and progressive airway obstruction . The harsh shrill or represents stridor , which can occur in some patients with epiglottitis, may be present. Prior to the widespread use of the Haemophilus influenzae type B (Hib) vaccine in child ren, Hib caused the vast majority of cases of epiglottitis, followed by Streptococcus pyogenes . In adults, particularly those from other countries as seen in this case, epiglottitis caused by Hib can still occur because many of these individuals have not been properly vaccinated. As a result, clinicians should have a high index of suspicion of epiglottitis when patients present acutely similar to the patient in this vignette. Acute Epiglottitis = Severe Sore Throat + RAPID ONSET Odynophagia + Stridor/Shrill + Droolling. Peritonsillar Abscess – This presents with fever, sore throat and muffled voice. The sore throat is most likely secondary to tonsillitis. The muffled voice in presence of tonsillitis is called "hot potato voice”. The uvula dev iates to one side is highly suggestive of peritonsillar abscess & is a complication of his tonsillitis. Patients with a peritonsillar abscess typically have prominent