Sore Throat

Question 1

What does a sore throat mean?

Answer 1

Encompasses pharyngitis, tonsilitis or a combination of both

Question 2

Common causes - 2 - one might have been in the news recently

Answer 2

URT viruses - rhinovirus, coronavirus, parainfluenza virus

Group A strep (GAS)

Question 3

Rarer causes:

Viral - 5

Bacterial - 2 - 1 is STI

Answer 3

EBV
Influenza
Adenovirus 
HSV1 
HIV

Gonorrhoea - from oral sex
Chlamydophila pneumonia

Question 4

Peak age group - 2 age ranges

Answer 4

5-10 yrs

15-25 yrs

Question 5

Associated symptoms - just think about what you could get in bacterial or viral infections

Answer 5

Painful swallow - dysphagia 
Coryza
Tonsillar exudate, enlargement and erythema 
Fever 
Anterior cervical lymphadenopathy 
Headache 
Abdo pain, N&V
Lethargy

Question 6

Investigations:

What is usually done?

What is done in severe, atypical, recurrent cases?

Answer 6

Nothing - it is a clinical diagnosis

Throat swabs for culture

Question 7

Management:

Symptomatic relief - what is first line in kids and adults?

What mouthwash can you provide?

Answer 7

Paracetamol - relieve pain and fever

Ibuprofen

Difflam Oral Rinse - Analgesic and anti-inflammatory treatment

Question 8

Management:

Antibiotics - what is important to realise about a sore throat?

What does the CENTA criteria include? - mnemonic

What does meeting 4-5 parts of the criteria indicate?

Answer 8

It is usually caused by a virus - rarely bacterial

Modified Centor Criteria - CENTA:

• Tender anterior (c)ervical lymph nodes
• Tonsillar (e)xudate
• (N)o cough
• Raised (t)emperature
• (A)ge 3-14

GAS - group A strep - most self resolve so not always needed, give if moderately symptomatic

Question 9

Management:

What antibiotics are recommended?

What can be used if allergic?

What should be done for severe, recurrent tonsillitis?

Answer 9

Phenomethylpenicillin (Pen V) - 5-10 days

Macrolide if penicillin allergic - erythromycin and clarithromycin

Tonsillectomy

Question 10

Complications

• ears
• sinus
• Where can you get abscesses and what are some S+S you might find?
• What can a sore throat be an early sign of in children ?

Answer 10

Otitis media - travel of infection through eustachian tube

Acute sinusitis - same as above

Peritonsillar abscess - fever, sore throat, difficulty opening mouth, dysphagia etc.
Retropharyngeal abscess

Scarlet fever

Question 11

Complications

What are some autoimmune complications of have GAS?

Answer 11

Rheumatic fever

Guttate psoriasis

Post-glomerulonephritis

Question 12

Scarlet Fever

What is it?

What is the prodrome? - 2

Presentation:

• Describe the rash
• What happens to the tongue?
• What about the cheeks?

Answer 12

GAS infection which follow a throat or skin infection

Fever
Sore throat

Red, sandpapery rash
Strawberry tongue
Red cheeks and circumoral pallor

Question 13

Scarlet Fever

Management - what ab’s are given?

When can children return back to ski?

Answer 13

Phenoxymethylpenicillin PO (Pen V)

24 hrs after starting treating