PANCE Blueprint EENT (9%)

Acute pharyngitis (ReelDx)

VIDEO-CASE-PRESENTATION-REEL-DX

Strep Pharyngitis

Patient will present with → triad of headache, sore throat and fever suggests strep throat

I. Bacterial pharyngitis:

  • Streptococcal pharyngitis - positive rapid antigen test
  • Consider gonorrhea pharyngitis in patients with recent sexual encounters, or with non-resolving pharyngitis.

II. Viral Pharyngitis (watch video)

  • Less likely exudative: CMV, EBV (mononucleosis), adenovirus, influenza, herpes simplex
  • Infectious mononucleosis - caused by EBV, characterized by malaise, fever, severe sore throat, splenomegaly
    • Rash with penicillins
    • Diagnosed by atypical lymphocytes, heterophile agglutination test (monospot)
    • Splenic rupture possible with trauma
    • symptomatic treatment, steroids if respiratory distress,

III. Fungal Pharyngitis

  • Common in patients using inhaled steroids – counsel patients to rinse mouth after use of inhaled steroids.

Throat culture is the gold standard for diagnosis

Penicillin first line, macrolides (Azithromycin) second line for pen allergic patients.

No media at this time

Question 1
A 19 year-old college student complains of a sore throat for over a week, with fever and general malaise. On exam T-38°C P-70/minute R-20/minute BP-110/76 mmHg. The patient is alert and oriented x 3. The skin is warm, dry, and without rash. The TMs have a normal light reflex and the canals are clear. The oropharynx is inflamed, with bilaterally enlarged tonsils, and a small amount of exudate. The neck is supple, with anterior cervical adenopathy. The lungs are clear. The heart has a regular rhythm without murmurs. The abdomen is soft, nontender and a spleen tip is palpable. The labs reveal a negative rapid strep screen and positive Monospot. The WBC count is 9,000/microliter with a differential of 40% atypical lymphocytes, 35% lymphocytes, 5% monocytes, 10% eosinophils, and 10% neutrophils. Which of the following is the most appropriate treatment?
A
Penicillin
Hint:
Antibiotics are not indicated in the treatment infectious mononucleosis, or Epstein-Barr virus infections.
B
Erythromycin
Hint:
See A for explanation.
C
Acetaminophen
D
Acyclovir
Hint:
Acyclovir is not approved for use in treatment of EBV, although it is active against the EBV in vitro and in vivo. It may be used in certain patients with AIDS, but has not been shown to affect the outcome of EBV in these patients.
Question 1 Explanation: 
Aspirin or acetaminophen may be used to treat fever and pain associated with infectious mononucleosis, or EBV infection.
Question 2
Small grayish vesicles and punched-out ulcers in the posterior pharynx in a child with pharyngitis is representative of which organism?
A
Epstein-Barr virus
Hint:
Epstein-Barr virus presents with enlarged tonsils with exudates and petechiae of the palate.Epstein-Barr virus presents with enlarged tonsils with exudates and petechiae of the palate.
B
Group C Streptococcus
Hint:
Group C Streptococcus presents with a red pharynx and enlarged tonsils with a yellow, blood tinged exudates
C
Coxsackievirus
D
Gonorrhea
Hint:
Neisseria gonorrhea of the pharynx may be asymptomatic
Question 2 Explanation: 
Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx.
There are 2 questions to complete.
List
Return
Shaded items are complete.
12
Return
Please login to get access to the quiz
Mouth and Throat Disorders (PEARLS) (Prev Lesson)
(Next Lesson) Aphthous ulcers (ReelDx)
Back to PANCE Blueprint EENT (9%)

NCCPA™ Content Blueprint