Sore Throat

Question 1

Sore throats account for about ______of consultations

in general practice per annum

Answer 1

5%

Question 2

MCC of sore throat

Answer 2

The common causes are viral pharyngitis
(approximately 60–65%) and tonsillitis due to
Streptococcus pyogenes (approximately 20%).

Question 3

A very important cause is tonsillitis caused by
___________. Treating
this cause with penicillin can produce adverse
effects.

Answer 3

Epstein–Barr mononucleosis (EBM)

Question 4

At least 50% of sore throats, mainly pharyngitis, will

be caused by a______

Answer 4

virus

Question 5

It is vital to be aware of _______
infection in children, especially between 2 and 4 years,
when the deadly problem of epiglottitis can develop
suddenly

Answer 5

Haemophilus influenzae

Question 6

There are many pitfalls, the classic being to diagnose
the exudative tonsillitis of EBM as _________and prescribe one of the penicillins, which
may precipitate a severe rash

Answer 6

streptococcal

tonsillitis

Question 7

What are the red flags in sore throats

Answer 7

• Persistent high fever
• Failed antibiotic treatment
• Medication-induced agranulocytosis
• Mouth drooling: consider epiglottitis (don’t examine
the throat)
• Sharp pain on swallowing (? foreign body)
• Marked swelling of quinsy
• Candidiasis: consider diabetes or
immunosuppression

Question 8

_______ are concretions of debris entrapped
within deep tonsillar crypts. They are a common
cause of halitosis, vague sore throat and possibly
recurrent bouts of tonsillitis

Answer 8

Tonsilloliths

Question 9

Small patches of exudate on the palate or other

structure indicate________

Answer 9

Candida albicans (oral thrush)

Question 10

A large whitish-yellow membrane virtually

covering both tonsils indicates _______

Answer 10

EBM

Question 11

A generalised red, swollen appearance with

exudate indicates_______

Answer 11

GABHS infection

Question 12

Throat swabs are about _____ effective in isolating

GABHS from the infected throat

Answer 12

90%

Question 13

Swabs are seldom helpful because the isolation of

GABHS often represents ________

Answer 13

asymptomatic carriage

Question 14

Generally, throat cultures are not necessary
except to verify the presence of _______ especially
in closed institutions such as boarding schools, or if
diphtheria is suspected in the non-immunised

Answer 14

S. pyogenes,

Question 15

What is dxtc of GABHS

Answer 15

A positive culture and
a fourfold rise in the ASO titre are necessary for a
precise diagnosis.

Question 16

What test should be done if suspicious for EBM

Answer 16

If suspected, an
IgM antibody test should be ordered, rather than the
older tests, such as a Paul–Bunnell test.

Question 17

Analgesic for children

Answer 17

analgesia: adults—2 soluble aspirin; children—
paracetamol elixir (not alcohol base) or ibuprofen

Question 18

What age group to consider bacterial cause of sorethroat

Answer 18

A bacterial cause is more common in

children aged 3–13 years than in children <3 years

Question 19

Sore throat in the elderly may be caused by a ________ but otherwise needs to be treated with considerable
respect

Answer 19

viral infection

Question 20

painful swallowing + referred ear pain + hoarseness

Answer 20

pharyngeal cancer

Question 21

This infection may involve the pharynx only and vary
from mild to severe, or it may involve both tonsils
and pharynx. It is uncommon under 3 years or over
40 years.

Answer 21

Streptococcal tonsillopharyngitis

Question 22

Dxtic features of streptococcal throat

Answer 22

• constitutional symptoms:
— fever ≥ 38°C
— toxicity
• tender anterior cervical lymphadenopathy
• tonsillar swelling and exudate
• absence of cough

Question 23

Indications for antibiotic therapy in strep throat

Answer 23

• existing rheumatic heart disease at any age
• severe tonsillitis with above features of GABHS
scarlet fever
• peritonsillar cellulitis or abscess (quinsy)
• patients 2–25 years with presumptive GABHS
from special communities

Question 24

INdication for abx in strep throat

Answer 24

If there is a sore throat with no cough, but
fever >38 ° C, tender neck glands and white spots
in the throat, antibiotics are indicated

Question 25

Antibiotic treatment has a variable effect on the
resolution of symptoms. It does not protect against
glomerulonephritis but does protect against ______

Answer 25

rheumatic

fever

Question 26

_______ should be avoided in tonsillitis
because of confusion caused should mononucleosis be
present

Answer 26

Amoxycillin

Question 27

Treat with prophylactic penicillin for patients with

________

Answer 27

more than five episodes of presumptive bacterial

tonsillitis in a year

Question 28

When to give prophylaxis for recurrent tonsilitis?

Answer 28

The decision should be based
on the severity of the episode, time lost from work
or school, infectivity and response to antibiotics

Question 29

In children this is a life-threatening infection. It
may be overlooked in adults where, unlike children,
the airway is usually not obstructed and the patient
presents with a severe sore throat, dysphagia,
drooling of saliva and a tender neck

Answer 29

Acute epiglottitis

Question 30

What may modify the presentation of Diphtheira

Answer 30

The
clinical presentation may be modified by previous
immunisation or by antibiotic treatment.

Question 31

What are the ssx of pts with Diphtheria

Answer 31

• Insidious onset
• Mild to moderate fever
• Mild sore throat and dysphagia
• Patient looks pale and ill
• Enlarged tonsils

Question 32

Unique feature of Diphtheia

Answer 32

Pseudomembrane (any colour but usually grey–
green) can spread beyond tonsils to fauces, soft
palate, lateral pharyngeal wall and downwards to
involve larynx

Question 33

Appearance of neck of pts with Diphtheria due to soft tissue swelling

Answer 33

‘bull neck’ appearance

Question 34

Mx of Diphtheria

Answer 34

• Throat swabs
• Antitoxin
• Penicillin or erythromycin 500 mg qid for 10 days
• Isolate patient

Question 35

The ________ is a real trap and must
be considered in patients aged 15–25 years (peak
incidence) with a painful throat that takes about
7 days to reach its peak

Answer 35

angiose form of EBM

Question 36

SSx of EBM

Answer 36

Petechiae on palate (not pathognomonic)
• Enlarged tonsils with or without white exudates
(looks, but isn’t, purulent)
• Peri-orbital oedema

Question 37

Dx of EBM

Answer 37

• Blood film—atypical lymphocytes
• White cell count—absolute lymphocytosis
• Heterophil antibodies

Question 38

Alternatives to the Heterophil Antibodies

Answer 38

Monospot test
or
• EBV IgM test (more specific

Question 39

An uncommon infection caused by the Coxsackie
virus. Presents as small vesicles on soft palate, uvula
and anterior fauces. These ulcerate to form small
ulcers. The problem is benign and rapidly self-limiting

Answer 39

Herpangina

Question 40

How is Herpes simplex pharyngitis different from streptococcal pharyngitis

Answer 40

In adults primary infection is similar to severe
streptococcal pharyngitis but ulcers extend beyond
the tonsils.

Question 41

__________ typically presents as milky-white
growths on the palate, buccal and gingival mucosae,
pharynx and dorsum of the tongue

Answer 41

Oral candidiasis

Question 42

When to refer for tonsillectomy

Answer 42

• Repeated attacks of acute tonsillitis
• Enlarged tonsils and/or adenoids causing airway
obstruction, including OSA
• Chronic tonsillitis
• More than one attack of peritonsillar abscess
• Biopsy excision for suspected new growth

Question 43

Consider severe tonsillitis with a covering

membrane as _________

Answer 43

EBM.

Question 44

If an adult presents with an intensely painful throat
with a heavy exudate and seems toxic, consider
______ and ______

Answer 44

primary herpes simplex as well as streptococcal

throat

Question 45

Reserve swabs of the throat for___________where it is important to do so,
for suspected diphtheria and for suspicion of other
serious infections such as tuberculosis

Answer 45

verification of a streptococcal throat

Question 46

The triad: hoarseness, pain on swallowing and

referred ear pain = _________

Answer 46

pharyngeal cancer.