[10.35] Sore Throat V2.2.pdf

Pain, irritation, or scratchiness of the throat that often worsens when swallowing

What is the definition of a sore throat?

Pharyngitis

With what clinical term is sore throat often used interchangeably?

15 million

How many visits to primary care physicians per year are for sore throat in the United States?

1 to 2 percent

What percentage of all outpatient and emergency room visits in the US are due to sore throat?

8th

Where does sore throat rank as a cause for seeking medical advice in Germany?

A minor ailment

Clinically, how is a sore throat generally considered?

Considerable suffering

Despite being considered a minor ailment, what is sore throat associated with clinically?

Significant economic burden

From a public health point of view, what does the large number of healthcare consults for sore throat result in?

Mostly viral

What is the nature of most infectious sore throat cases?

Nasal congestion, nasal discharge, cough, fatigue, and hoarseness

What five symptoms are commonly associated with viral sore throat?

Physicochemical factors, environmental factors, and concomitant illnesses

What are the three categories of non infectious causes of sore throat?

Cancer and laryngopharyngeal reflux

Name two concomitant illnesses that cause sore throat.

Trauma, foreign body, glossopharyngeal neuralgia, and drugs

Name four physicochemical factors that can cause sore throat.

Smoking, snoring, and shouting

Name three behavioral environmental factors for sore throat.

Cold temperature, low humidity, and industrial irritants

Name three environmental conditions that can cause sore throat.

Palatine tonsils, soft palate, uvula, and oropharynx

What four structures are relevant in the anatomy of a sore throat?

Nasopharynx, epiglottis, and base of the tongue

Name three other pharyngeal structures that may be inflamed in a sore throat.

Viral pharyngitis

What is the most common cause of sore throat?

85 to 95 percent

What percentage of sore throat cases in adults are caused by viruses?

70 to 80 percent

What percentage of sore throat cases in children are caused by viruses?

The common cold

Viral pharyngitis usually occurs as part of what common condition?

Rhinovirus and Adenovirus

What are the two most common causative agents of viral pharyngitis?

40 to 50 percent

Rhinovirus and Adenovirus together account for what percentage of all infectious sore throats?

Human coronavirus and parainfluenza virus

Name two other viral agents mentioned as causes of pharyngitis.

Military recruits and boarding schools

Adenovirus pharyngoconjunctival fever is common in which two specific populations?

Gingivostomatitis

What associated disorder is caused by Herpes simplex virus types 1 and 2?

Parainfluenza and Respiratory syncytial virus

Which two viruses cause croup and are common in children?

Herpangina and hand foot and mouth disease

What two disorders are associated with Coxsackievirus A?

High fever, vomiting, diarrhea, and abdominal pain

What are the four common symptoms of herpangina?

Infectious mononucleosis

What disorder is associated with the Epstein Barr virus?

Adolescents during winter

In what population and season is Epstein Barr virus pharyngitis common?

Cytomegalovirus or CMV

Which virus causes CMV mononucleosis?

Primary HIV infection

Human immunodeficiency virus causes pharyngitis during which phase?

Respiratory and gastrointestinal tracts

What are the portals of entry where viruses implant after exposure?

Utilize the host cells machinery to replicate

How do most viruses behave once they gain intracellular access?

Virus shedding

What is the term for the release of viral progeny extracellularly to infect adjacent cells?

Mucus layer, lymphatics, and blood

Through what three pathways do viruses spread to target distal organs?

Inflammation

How do viruses primarily produce disease once established?

Prostaglandins and Bradykinins

Which two inflammatory mediators likely cause throat pain and irritation?

Cell damage, toxic products of damaged cells, and the host immune response

Name three factors that trigger the release of inflammatory mediators.

Post nasal drip

Irritation from what other clinical occurrence can cause throat pain?

Determining whether the infection is viral or bacterial

What is the common challenge for clinicians when seeing a sore throat?

Coryza, cough, hoarseness, conjunctivitis, and diarrhea

What five symptoms point specifically to a viral etiology?

None

Which of the viral symptoms is considered pathognomonic?

Erythema of the oropharyngeal area and discrete ulcerative stomatitis

What are two findings on the physical examination of viral pharyngitis?

No exudates

Do viral pharyngitis cases typically present with exudates?

Anterior lymphadenopathies

What finding in levels 1 and 2 is usually absent in viral pharyngitis?

Self limiting

What is the typical clinical course of viral pharyngitis?

5 to 7 days

After how many days is the virus usually undetectable?

Up to 3 weeks

How long may inflammation and symptoms persist in viral pharyngitis?

NSAIDs and antipyretics

What are the two most useful pharmacological treatments for viral pharyngitis?

Sprays, lozenges, and rinses

Name three topical aids that may relieve irritation or pain.

Undefined

What is the current status of the role of corticosteroids in viral pharyngitis?

No effect

What does the Cochrane Review state about the effect of Vitamin C on the incidence of colds in the ordinary population?

Extreme physical stress

Vitamin C reduced the risk of common colds in people exposed to short periods of what?

No consistent effect on severity and duration

What is the effect of high dose Vitamin C intake at the onset of cold symptoms?

Routine supplementation is not justified

What was the conclusion of the meta analysis regarding routine Vitamin C supplementation?

Illusory truth effect

What is the effect where repeated statements are more likely to be perceived as true?

Reduces duration

What effect does zinc have on a cold when taken at the onset?

No effect on severity

What effect does zinc have on the severity of a cold?

75 mg

What is the recommended dose of zinc lozenge in the Cochrane review?

Within 24 hours

Zinc should be taken within how many hours of symptom onset?

Bad taste and nausea

What are two downsides of taking zinc?

Prophylactic treatment

Data is insufficient to recommend zinc for what type of treatment?

Symptom relief

What is the main role of oral gargles, lozenges, and sprays?

antibacterial and antiviral effects

What does in vitro evidence show regarding antiseptic rinses and lozenges?

Faster resolution of infection

There is no solid evidence yet that oral rinses lead to what outcome?

Ice cream, sweets, chocolate, honey, tea, ginger ale, candies, and menthol

Name eight items traditionally thought to be risk factors for sore throat.

Sugar acts as food for bacteria

What is the hypothesized reason sugar causes sore throat?

Cold temperature constricts blood vessels

What is the hypothesized reason ice cream causes sore throat?

Prevents protective immune responses

According to the cold temperature hypothesis, what is the result of blood vessel constriction?

Single stranded RNA

What type of virus is the Influenza virus?

Types A and B

Which two types of Influenza are usually responsible for pandemics?

Type C

Which Influenza type is generally non symptomatic?

8th

Where does Influenza rank as a leading cause of death in the US?

1.1 percent

What is the flu mortality rate in the Philippines?

1 out of 100

How many deaths in the Philippines are caused by the flu annually?

1 billion

How many Influenza cases occur globally each year?

290,000 to 650,000

How many global deaths were attributed to the flu as of 2019?

Influenza A

Which Influenza type causes more morbidity and mortality?

Young patients, patients over 50, and those with underlying comorbidities

Name three high risk populations for Influenza.

Immunosuppression, cardiopulmonary disease, and diabetes

Name three comorbidities that increase flu risk.

Primary viral or secondary bacterial pneumonia

What is usually the cause of death in Influenza patients?

Airborne route from respiratory droplets and hands or fomites

What are the two modes of transmission for Influenza?

Respiratory epithelium

Which specific tissue does the Influenza virus invade?

Tracheobronchial tree

Where in the respiratory tract does the Influenza virus initially invade?

Abrupt

Describe the onset of Influenza symptoms.

Fever, headache, and myalgia

What are the three hallmark abrupt symptoms of Influenza?

Malaise, chills, sweats, cough, and rhinorrhea

Name five other systemic symptoms of Influenza.

Mild hyperemia and edema without exudates

What does the oropharynx look like in an Influenza patient?

Uncommon

Is lymphadenopathy common or uncommon in Influenza?

Antiviral therapy

What may be indicated for high risk flu patients or those with severe disease?

Within 2 days

Antiviral therapy should be started within how many days of flu symptom onset?

Neuraminidase inhibitors

What class of drugs includes Zanamivir and Oseltamivir?

Amantadine

What is an example of an M2 ion channel blocker?

Better than M2 ion channel blockers

How do neuraminidase inhibitors compare to amantadine in efficacy?

Reduce complications and fatality in high risk populations

What benefit do neuraminidase inhibitors have that amantadine does not?

Yearly immunization with inactivated virus vaccine

What is the key prevention method for Influenza?

70 to 100 percent

How effective is the flu vaccine as a mode of prevention?

SARS CoV 2

What virus causes COVID 19?