Throat pain

Question 1

Sore throat can encompass what conditions related to structures in the throat?

Answer 1

Pharyngitis

Tonsilitis

Laryngitis

Question 2

Should throat swabs and rapid antigen test be carried out routinely for pts with sore throat?

Answer 2

CKS say NO not routinely

Question 3

What is the management for sore throat?

Answer 3

Paracetemol / ibuprofen pain relief

AB not indicated routinely

Question 4

What are the indications for antibiotics for throat pain?

Answer 4

-Systemic upset secondary to acute sore throat

unilateral peritonsilitis

Hx of rheumatic fever

increased risk from acute infection e.g. child with diabetes / immunodeficiency

pts with acute sore throat/pharyngitis/tonsilitis with 3 or more Centor criteria

Question 5

Name 2 scoring systems we have for sore throat

Answer 5

Centor criteria

FeverPAIN criteria

Question 6

Outline the Centor criteria for sore throat

Answer 6

(1 point for each - max 4 points) SCORE of 3-4 makes likelihood of Strep 32-56%

• Tonsilar exudate
• Tender anterior cervical lymphadenopathy /lymphadenitis
• Hx of fever
• Absence of cough

Question 7

Outline the FeverPAIN criteria for sore throat

Answer 7

(1 point each - max 5 points) SCORE 4-5 makes likelihood of Strep 62-65%

• Fever >38
• Purulent pharyngeal /tonsilar exudate

-rapid attendance (3 days or less)

• severely inflammed tonsils
• no cough / coryza

Question 8

If antibiotics are indicated what should be given and for how long?

Answer 8

phenoxymethylpenicillin

clarithromycin (if the patient is penicillin-allergic)

7 or 10 day course

Question 9

Who gets tonsilitis?

Answer 9

Common infection in children and young adults

Question 10

What causes tonsilitis?

Answer 10

BACTERIAL + VIRAL

Bacterial:
Beta-haemolytic strep
Staphlocci
Strep pneumoniae
Haemophilius Influenzae
E. coli

Viral:
Rhinovirus
Adenovirus
Enterovirus
Epstein-Barr virus

Question 11

What are the clinical features of tonsilitis?

Answer 11

Pyrexia
dysphagia
lymphadenopathy
Odynophagia
Trismus
Swollen tonsils (+/- exudate)
Otaliga ( referred pain)

Question 12

How do you manage tonsilitis?

Answer 12

Analgesia
AB
Drain any peritonsilar abscess
Tonsilectomy if recurrent

Question 13

What AB should you avoid if cause of tonsilitis is EBV (epstein-Barr)

Answer 13

Avoid amoxicillin as will cause a maculopapular rash

Question 14

What should you advise a pt who has been diagnosed with EBV (Esptein-Barr)

Answer 14

avoid contact sports for 2-3 months as can cause hepatosplenomegaly - risk of splenic rupture/ trauma

Question 15

What are complications of tonsillitis?

Answer 15

Peri-tonsilar abscess (Quinsy)

Present with sore throat lateralised to one side and “hot potato” voice ( a thick, muffled voice)

Can drain under local anaesthetic

Question 16

Answer 16

1) Quinsy / peritonsilar abscess

2) Trismus

3) Strep pyogenes (Group A strep)

4) Needle aspiration
Surgical incision and drainage