Updated: 12/11/2018

Pharyngitis

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Questions
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Evidence
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Snapshot
  • A 12-year-old girl presents to her pediatrician for a sore throat. Her symptoms began approximately 1 week ago after she attended a sleepover. Since then she experienced a sore throat and noted a temperature of 101°F (38.3°C). She denies a cough but has noticed increasing fatigue and difficulty swallowing due to pain. On physical exam, she has anterior cervical lymphadenopathy and patchy tonsillar exudates and swelling. A rapid antigen detection test is positive for group A streptococcus infection, which prompted treatment with penicillin V.
Introduction
  • Definition
    • inflammation of the pharynx
      • also known as having a "sore throat"
  • Etiology
    • infectious causes
      • bacterial
        • group A streptococcus
        • Corynebacterium diphtheriae
      • viral
        • adenovirus
        • rhinovirus
        • influenza
        • Ebstein-Barr virus
        • coxsackievirus
    • noninfectious causes
      • gastroesophageal reflux disease
Differential
 
Pharyngitis
Etiology Presentation Workup Treatment Comments
Group A streptococcus
  • Symptoms
    • a sore throat
    • fever
  • Physical exam
    • fever
    • patchy tonsillar exudates
    • anterior cervical lymphadenopathy
    • palatal petechiae
    • scarlatiniform rash
    • strawberry tongue
  • Rapid antigen detection test (RADT)  
  • Throat score
    • obtained if RADT is negative
  • Penicillin V
  • Benzathine penicillin
  • In patients with a penicillin allergy
    • cephalosporins
    • clindamycin
  • The most common bacterial cause of acute pharyngitis
  • If untreated can result in rheumatic heart disease 
Corynebacterium diphtheriae
  • Symptoms
    • sore throat
    • cervical lymphadenopathy
  • Physical exam
    • low-grade fever
    • gray membranes
      • bleeds when dislodged
  • This is a clinical diagnosis
  • Confirmed with throat culture
  • Antitoxin
  • Erythromycin
  • Toxoid vaccine prevents diphtheria
Ebstein-Barr virus
  • Symptoms
    • fatigue
    • tender symmetric posterior cervical lymphadenopathy
  • Physical exam
    • fever
    • patchy pharyngeal exudates
    • palatal petechiae
    • splenomegaly
    • atypical lymphocytosis
  • Heterophile antibody testing
  • Supportive care such as
    • acetaminophen
    • NSAIDs
    • fluids
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Adenovirus
  • Symptoms
    • sore throat
    • laryngotracheitis
    • bronchitis
    • malaise
    • headache
    • myalgia
  • Physical exam
    • conjunctivitis
    • fever
  • This is a clinical diagnosis
  • Supportive care such as
    • acetaminophen
    • NSAIDs
    • fluids
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References

 

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Questions (3)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
Calculator

(M2.PD.4678) A 7-year-old boy is brought to his pediatrician for evaluation of a sore throat. The sore throat began 4 days ago and has progressively worsened. Associated symptoms include subjective fever, pain with swallowing, and fatigue. The patient denies any cough or rhinorrhea. Vital signs are as follows: T 38.6 C, HR 88, BP 115/67, RR 14, and SpO2 99%. Physical examination is significant for purulent tonsillar exudate; no cervical lymphadenopathy is noted. Which of the following is the best next step in the management of this patient? Review Topic

QID: 107246
1

Prescribe 10-day course of penicillin

11%

(2/19)

2

Recommend acetaminophen for symptomatic relief

0%

(0/19)

3

Prescribe acyclovir

0%

(0/19)

4

Perform throat culture

16%

(3/19)

5

Perform rapid antigen detection test

68%

(13/19)

M2

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