Updated: 8/26/2020

Pharyngitis

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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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(M2.PD.15.4678) 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, cough, and fatigue. The patient denies any 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? Tested Concept

QID: 107246
1

Prescribe 10-day course of penicillin

7%

(2/27)

2

Recommend acetaminophen for symptomatic relief

4%

(1/27)

3

Prescribe acyclovir

0%

(0/27)

4

Perform throat culture

30%

(8/27)

5

Perform rapid antigen detection test

56%

(15/27)

M 7 E

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