Otolaryngology Book

http://www.fpnotebook.com/

PharyngitisAka: Sore Throat

Advertisement

  1. Epidemiology
    1. One of four most common episodic clinic visit reasons
  2. Anatomy: Waldeyer's tonsillar ring
    1. Nasopharynx
      1. Adenoids (pharyngeal tonsils) at posterior wall
    2. Oropharynx
      1. Faucial (palatine tonsils) at lateral wall)
    3. Hypopharynx
      1. Lingual tonsil at Tongue base
  3. Causes
    1. See Pharyngitis Causes
  4. Symptoms
    1. Sore throat
    2. Dysphagia (Difficulty swallowing)
    3. Odynophagia (pain with swallowing)
    4. Generalized symptoms
      1. Fever, Chills, Malaise
      2. Headache
      3. Abdominal Pain
      4. Nausea or Vomiting
    5. Symptoms suggestive of viral illness
      1. Coryza
      2. Conjunctivitis
      3. Hoarseness
  5. Signs
    1. Viral
      1. Non-exudative pharyngeal erythema
        1. Exception: Tonsillar exudate in Mononucleosis (EBV)
      2. Vesicular OR ulcerative oral lesions
      3. Conjunctivitis in Adenovirus and Kawasaki Disease
    2. Streptococcus and other bacteria
      1. Enlarged tonsils with or without exudate
      2. Petechiae on Soft Palate (pathognomonic)
      3. Erythema
      4. Tender cervical Lymphadenopathy
      5. Strawberry Tongue (in Scarlet Fever)
    3. Peritonsillar Cellulitis or Peritonsillar Abscess
      1. Unilateral erythema of Soft Palate
      2. Uvula deviated
      3. Dysphagia
      4. Odynophagia
      5. Fever
    4. Diphtheria
      1. Gray membranous exudate covers tonsils and pharynx
      2. Exudate bleeds easily on removal
    5. Kawasaki Disease
      1. Pharyngitis with strawberry Tongue in age <5 years
      2. Non-purulent Conjunctivitis (also in Adenovirus)
      3. Palmar erythema and cracked red lips after 3 days
  6. Diagnosis
    1. See Strep Score
  7. Labs
    1. Leukocytosis on Complete Blood Count (CBC)
      1. WBC greater than 12.5 with bacterial pharyngitis
      2. Lymphocytes more than 10% atypical in EBV
    2. Streptococcal Rapid Antigen Test
    3. Throat Culture
    4. Epstein Bar Virus (Mononucleosis)
      1. Mono-Spot (False negative in young children)
      2. Heterophil Antibody Test (Positive if Titre >= 1:56)
    5. Diphtheria: Fluorescent Antibody
    6. Fungus: Sabouraud dextrose agar Fungal Culture
    7. Gonorrhea Culture
    8. Consider laryngoscopy for severe or refractory symptoms
  8. Management
    1. Sore Throat Symptomatic Treatment
    2. Group A Streptococcal Pharyngitis
      1. Antibiotic Management
    3. Consider other important etiologies if atypical
      1. Kawasaki Disease
      2. Diphtheria
      3. Gonorrhea
      4. Epiglottitis
      5. Bacterial Tracheitis
  9. References
    1. Degowin (1987) Diagnostic Exam p. 149-151
    2. Gwaltney in Mandell (2000) Infectious Dis, p. 656-61
    3. Vincent (2004) Am Fam Physician 69(6):1465

Pharyngitis (C0031350)

Definition (MSH)Inflammation of the throat.
Definition (CSP)inflammation of the throat.
ConceptsDisease or Syndrome (T047)
ICD9462
EnglishInflamed throat, PHARYNGEAL INFLAMMATION, Pharyngitides, Pharyngitis
Spanishfaringitis, faringitis infecciosa, garganta inflamada
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Sore Throat (C0242429)

Definition (NCI)Any kind of inflammatory process of the tonsils, pharynx, or/and larynx characterized by pain in swallowing.
ConceptsSign or Symptom (T184)
ICD9462, 784.1
EnglishPain in the pharynx, Pain in throat, PAIN PHARYNX, PAIN THROAT, Pharyngeal pain, Sore Throat, Sore throat symptom, Sore Throats, SORETHROAT, Throat discomfort, THROAT PAIN, THROAT SORE, Throat soreness
Spanishdolor de garganta, dolor faríngeo, dolor faringeo, síntoma de dolor de garganta, sintoma de dolor de garganta
CreditsDerived from the NIH UMLS (Unified Medical Language System)



Navigation Tree