Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Pharyngitis, Acute


Related Terms

  • Infective Pharyngitis
  • Sore Throat
  • Staphylococcal Pharyngitis
  • Strep Throat
  • Streptococcal Pharyngitis
  • Suppurative Pharyngitis

Differential Diagnosis

Specialists

  • Family Physician
  • Infectious Disease Internist
  • Internal Medicine Physician
  • Otolaryngologist

Comorbid Conditions

Factors Influencing Duration

Length of disability is variable and may be influenced by the underlying infectious organism (viral versus bacterial), the response to treatment, or the presence of complications.

Medical Codes

ICD-9-CM:
462 - Pharyngitis, Acute

Overview

Acute pharyngitis is a painful inflammation of the throat (pharynx); tonsils can also be involved. Approximately 40% to 60% of all cases of acute pharyngitis are caused by a viral infection, and 5% to 40% are caused by several types of bacteria (Acerra). Streptococcus pyogenes, which contains group A beta-hemolytic streptococci or GABHS, is the most frequent bacterial cause of acute pharyngitis, comprising 15% of all adult cases and up to 30% of pediatric cases (Acerra). Individuals with untreated GABHS are at risk of developing acute rheumatic fever. Groups C, G, and F streptococci comprise about 10% of cases, and clinical signs and symptoms cannot be distinguished from GABHS (Acerra). If the causative bacteria is Mycoplasma pneumoniae or Chlamydia pneumoniae, lower respiratory infection with a cough may be present as well as pharyngitis symptoms. Other bacterial causes of acute pharyngitis (e.g., Arcanobacterium haemolyticus, Neisseria gonorrhoeae, Corynebacterium diphtheriae) are rare.

Viral pharyngitis is associated with rhinovirus and adenovirus and is often associated with the common cold or influenza. It may also be an early feature of mononucleosis and not clinically distinguishable from GABHS except by testing for the Epstein-Barr virus responsible for mononucleosis.

Pharyngitis can also develop as the result of dry air, smoking, allergies, trauma to the throat (e.g., endotracheal intubation), gastroesophageal reflux disease (GERD), oral thrush in immunocompromised individuals, exposure to toxins, and neoplasia.

Incidence and Prevalence: Acute pharyngitis is a common condition, occurring half as often in adults as in children aged 4 to 7, who average about 5 upper respiratory infections every year and one strep infection in 4 years (Acerra). An estimated 12 million individuals are diagnosed with acute pharyngitis each year (Halsey). GABHS infection is diagnosed in about 15% percent of all individuals seeking emergency room care for a painful throat (Acerra).

GABHS pharyngitis is estimated to occur in 616 million individuals worldwide each year, with acute cases resulting in rheumatic heart disease in 6 million individuals (Halsey). The incidence of acute pharyngitis is reported to be higher internationally, primarily due to higher rates of resistance of bacterial pharyngitis to antibiotics (Acerra).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Streptococcal pharyngitis is most prevalent in late fall through early spring. It is quite contagious, and individuals in group work or living situations, such as long-term care centers, day care centers, schools, or hospitals, are at greatest risk of developing the infection (Acerra).

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of a sore throat of sudden onset and varying duration, difficulty with or discomfort on swallowing, chills, malaise, and a slight fever. In addition, the individual may also report neck pain, nasal discharge, nasal congestion, joint aches or stiffness, headache, swollen glands, and difficulty breathing. The individual may report contact with individuals diagnosed with GABHS or rheumatic fever. A history of rheumatic fever may be reported and is important in selecting appropriate treatment.

Physical exam: Upon examination, the throat will usually appear red, raw, and inflamed. A whitish exudate may be found on the tonsils. Breath odor may be noted. Tender or swollen lymph nodes may be found in the neck, suggestive of GABHS infection. It is impossible to accurately and reliably distinguish between viral and bacterial pharyngitis on the basis of clinical signs alone, but streptococcal pharyngitis is often associated with tonsillar swelling, swollen anterior cervical lymph nodes, a fever greater than 100.4° F (38.0° C) (and as high as 106° F), and no cough. If breathing is labored, lower respiratory tract infection and possible airway obstruction are investigated. Heart sounds are evaluated to detect murmur consistent with rheumatic fever. Dehydration may be noted, occurring as a result of reduced intake of food and liquids due to swallowing difficulty. Lesions found in the mouth may indicate coxsackie virus or herpes virus infection; similar lesions appearing also on the hands and feet may indicate hand-foot-and-mouth disease. A fine, sandpaper-like rash may be seen in GABHS infection. If the liver or spleen can be palpated, infectious mononucleosis must be ruled out.

Tests: A throat swab of the exudate will be cultured to determine whether the pharyngitis is bacterial and to identify the specific causative bacteria, as well as the antibiotic sensitivity. A streptococcal screen such as antistreptolysin-O titer (ASO) or rapid antigen test may be done to identify Group A streptococcal infections. Although sensitive for GABHS, these tests are not sensitive enough for detecting group C and G streptococci and will not identify other possible causative bacteria. A test for Epstein-Barr virus may be done to rule out infectious mononucleosis, which is clinically indistinguishable from GABHS. Throat culture is the definitive test. Other laboratory tests such as CBC, erythrocyte sedimentation rate, and C-reactive protein, although able to confirm inflammation and infection, are of little value in determining treatment and usually are not performed. Chest x-rays may be taken to rule out pneumonia, and neck images may be needed if epiglottis or airway compromise is suspected. CT scans of the soft tissue of the neck may be done to rule out an abscess, tumor, or deeper infection.

Source: Medical Disability Advisor



Treatment

Viral pharyngitis usually clears up on its own without medication. Treatment is directed toward pain relief and may include over-the-counter analgesics, such as ibuprofen or acetaminophen. The individual may gargle with warm salt water several times a day. Antibiotics are not useful in the treatment of viral pharyngitis.

If throat culture reveals a bacterial infection, treatment generally consists of a course of appropriate antibiotics (cephalosporins or penicillins for GABHS) along with symptomatic treatment as described above. GABHS is typically self-limited, and signs and symptoms will resolve within 3 to 4 days.

Dehydrated individuals will require rehydration, usually by consuming more liquids, but intravenous fluid replacement may be needed if swallowing is severely compromised.

Source: Medical Disability Advisor



Prognosis

The prognosis is excellent for most cases. Most individuals recover fully within 10 days, often without any treatment. Viral pharyngitis, in particular, usually clears up on its own. Bacterial pharyngitis responds well to appropriate antibiotic treatment. Antibiotics may shorten duration by a day or two, but the principal reason for giving them is to prevent rheumatic fever or other complications from the bacterial infection.

Source: Medical Disability Advisor



Complications

Untreated streptococcal throat infections may lead to acute rheumatic fever, peritonsillar abscess, peritonsillar cellulitis, retropharyngeal abscess, toxic shock syndrome, and airway obstruction due to swelling of the larynx. Acute rheumatic fever is reported to result from one of every 400 untreated GABHS infections (Acerra). An unusual complication of group C streptococcal pharyngitis is a serious inflammation of the kidneys (poststreptococcal glomerulonephritis). Other complications include sinusitis, ear infections, epiglottitis, mastoiditis, pneumonia, and recurrence due to bacterial resistance or failure to complete the full course of antibiotics.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations are not usually necessary for an individual with acute pharyngitis. Contact with coworkers should be minimized during the first few days of an infection to limit spread of the infection to others.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual work or live in a group environment where individuals have or recently have had similar symptoms?
  • Did individual experience symptoms associated with acute pharyngitis?
  • Was there a history of an infectious exposure or ingestion of or exposure to an irritant?
  • Does individual have a history of rheumatic fever?
  • Did individual have physical findings consistent with the diagnosis of strep throat? If so, was a throat culture or rapid antigen test done to confirm the diagnosis? Was the causative organism GABHS or another organism?
  • If the diagnosis was uncertain, were other conditions with similar symptoms ruled out?
  • Was a neck CT performed to evaluate for possible abscess or deep tissue infection?

Regarding treatment:

  • Were symptoms relieved with conservative measures?
  • Were appropriate antibiotics administered as indicated for bacterial infections?
  • Has individual been compliant with treatment recommendations?

Regarding prognosis:

  • If individual was not recovering as expected, were neck or chest x-rays performed to rule out epiglottitis, or airway compromise and pneumonia?
  • Did individual take the entire course of antibiotics (for bacterial pharyngitis) exactly as prescribed?
  • If bacterial pharyngitis was present, was the infection resistant to certain antibiotics?
  • Is individual immunocompromised?
  • Was any streptococcal infection treated promptly and appropriately? If not, has individual suffered any secondary inflammation resulting from lack of treatment, such as serious inflammation in the kidneys (poststreptococcal glomerulonephritis), rheumatic fever, peritonsillar abscess, toxic shock syndrome, or airway obstruction due to swelling of the larynx? Have these secondary conditions been addressed in the treatment plan?

Source: Medical Disability Advisor



References

Cited

Acerra, John R., and Andrew Aronson. "Pharyngitis." eMedicine. Eds. Jerry Balantine, et al. 5 Nov. 2007. Medscape. 26 Jun. 2009 <http://emedicine.medscape.com/article/764304-overview>.

Halsey, Eric. "Pharyngitis, Bacterial." eMedicine. Eds. Klaus-Dieter Lessnau, et al. 19 May. 2009. Medscape. 26 Jun. 2009 <http://emedicine.medscape.com/article/225243-overview>.

Source: Medical Disability Advisor






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