Otolaryngology Book

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PharyngitisAka: Sore Throat

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  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
MSHD010612
EnglishInflamed throat, PHARYNGEAL INFLAMMATION, Pharyngitides, Pharyngitis
Spanishfaringitis, faringitis infecciosa, garganta inflamada
Parent ConceptsOropharyngeal disorders (C0553694), Nasopharyngeal Diseases (C0027438), PULMONARY DISORDERS: GENERAL (C0549657), AIRWAYS DISEASE (C0699949), Pharyngeal Diseases (C0031345), Respiratory Tract Infections (C0035243), Non-Neoplastic Pharyngeal Disorder (C1335032), Ambiguous concept (C1274012), Inflammation of specific body organs (C1285331), Inflammatory disorder of head (C1285337), Inflammatory disorder of upper respiratory tract (C1290887), Inflammatory disorder of digestive tract (C1290888)
SourcesCOSTAR, CSP, CST, DXP, LCH, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived 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
MSHD010612
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 faringeo, sintoma de dolor de garganta
Parent Concepts[D]Head and neck symptoms NOS (C0476247), Non-Neoplastic Neck Disorder (C1335023), Headache (C0018681), Sore Throat (C0242429), Pharyngeal finding (C0426505), Pain of respiratory structure (C0578045), Pain of digestive structure (C0578052), Pain of head and neck region (C0578055), Duplicate concept (C1274013), Finding reported by subject or history provider (C1689949), Ambiguous concept (C1274012)
SourcesCOSTAR, CSP, CST, DXP, ICD9CM, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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