Sore throat

Question 1

If a pt presents with swollen anterior cervical glands, high grade fever and absence of a cough, what could this suggest? Should this pt be referred?

Answer 1

bacterial infection - streptococcal sore throat

Only if the pt experiences 3 or all four symptoms

Question 2

What symptoms do pts get when they have glandular fever?

Answer 2

pharyngitis, fever, cervical lymphadenopathy, general malaise

Question 3

What questions would you ask someone who has a sore throat and why?

Answer 3

1. Age of pt - streptococcus is uncommon under 3 years, glandular fever is common in adolescents
2. Tender cervical glands - glandular fever and streptococcal sore throat have markedly swollen glands
3. Tonsillar exudate present - more bacterial than viral
4. Ulceration - herpes simplex ulcers

Question 4

Which drugs can cause a sore throat and may be associated with agranulocytosis?

Answer 4

Captopril, carbimazole, cytotoxics, neuroleptics, penicillamine, sulfasalazine, sulphur-containing antibiotics

Question 5

When would you refer a pt with a sore throat?

Answer 5

1. Sore throat lasting more than 10 days or 2 weeks
2. extreme pain especially in the absence of a cold cough and catarral symptoms and symptoms lasting over 1-2 days
3. difficulty in swallowing
4. certain drugs like the ones that can cause agranulocytosis
5. white plaques in the throat gums or tongue
6. Red and swollen tonsils and/or swollen lymph glands

Question 6

What are tx options for pts with a sore throat? Name exmaples.

Answer 6

1. local anaesthetics - lidocaine, benzocaine sprays or lozenges
   2.

Question 7

What ages can lidocaine and benzocaine be given? How often would you use it? Is it safe to use in pregnancy and BF?

Answer 7

1. > 12 years - three sprays every 3 hours when needed up to a max of 6 times a day
2. lozenge >3 years (tyrozets - child:1 lozenge every 3 hours max of 6, adults: max of 8 in 24 hours), spray >6 years - ultrachloraseptic spray - one spray every 2-3 hours

YES

Question 8

Name an anti-inflammatory sore throat medicine and what ages can it be used?

Answer 8

benzydamine
rinse >12 years - rinse every 1.5 -3 hours when required
spray >6years - same ^ 6-12 years use 4 puffs, adults: 4-8 puffs

Question 9

Name lozenge anti-inflammatory.

Answer 9

flurbiprofen (strefen) - suck one every 3-6 hours with a maximum of 5 lozenges in 24 hours

Question 10

What are the age restrictions and who should you avoid using flurbiprofen lozenge?

Answer 10

> 12 years

avoid in pts with peptic ulcers and in pregnancy