Sore throat in GP

Question 1

What are the most common causes of sore throat in GP?

Answer 1

Viral infections (80%)
Eg. adenovirus, rhinovirus, influenza, RSV, EBV

Question 2

What are the common causes of bacterial sore throat?

Answer 2

Mainly group A beta-haemolytic streptococci
Eg. strep pyogenes

Question 3

What is the incidence of sore throat caused by bacteria in different age groups?

Answer 3

15% under 3
50% 4-13
10% adults

Question 4

What are some suppurative complications of a sore throat?

Answer 4

Otitis media
Sinusitis
Quinsy
Rheumatic fever (rare)

Question 5

What is Quinsy?

Answer 5

A peritonsillar abscess
- a complication of tonsillitis

Needs ENT referral for antibiotics and possible tonsillectomy

Question 6

How can a sore throat cause rheumatic fever?

Answer 6

Mostly in 5-14 year olds

Caused by a antibody cross-reaction with heart, joints, brain, and skin

Only occurs if the sore throat infection isn’t treated properly

Question 7

How can teeth cause a sore throat?

Answer 7

Dental abscesses can cause a sore throat

Question 8

What is an aphthous ulcer?

Answer 8

AKA anker sores

Small, shallow lesions that develop on the soft tissues in your mouth or at the base of your gums

Caused by stress, acidic foods and minor injuries

Question 8

What is mumps?

Answer 8

A viral infection that causes swelling of the parotid glands

Question 9

What are the symptoms of oropharyngeal thrush?

Answer 9

-White patches that when wiped off leave red areas that may bleed slightly
-Loss of taste or an unpleasant taste in the mouth.
-Redness inside the mouth and throat
-Cracks at the corners of the mouth
- Painful, burning sensation in the mouth
-Pain on swallowing

Question 10

What is glandular fever?

Answer 10

Caused by the Epstein-barr virus and mostly affects adults

Question 11

What are the symptoms of Glandular fever?

Answer 11

-Fatigue
-Headache
-Loss of appetite
-Sore throat
-Cough
-Photophobia
-Swollen tonsils
-Swollen lymph nodes
-Enlarged spleen
-Nausea
-Abdo pain
-Chills and fevers

Question 12

What are some causes of a deviated uvula?

Answer 12

Quinsy
Unilateral vagal nerve palsy

-Always note if uvula is central

Question 13

What is a bifid uvula?

Answer 13

A split uvula occurring in 2% of population

It can swell up in an odd way but causes no other problems

Question 14

When is a uvulectomy performed?

Answer 14

For snoring and sleep apnoea
-Usually done privately

Or done for cultural reasons (Somalia)

Question 15

How long does it take for a sore throat to resolve?

Answer 15

3-7 days

Question 16

What complications of sore throat do antibiotics protect against?

Answer 16

Suppurative complications

Not immunological effects like rheumatic fever or glomerulonephritis

Question 17

What is the modified centor score used for?

Answer 17

It estimates the probability that the pharyngitis is streptococcal and suggests management plan

Criteria: age, exudate/ swelling of tonsils (+1) tender/enlarged cervical lymph nodes (+1)
, temp >38 (+1), absence of cough (+1)

Score 3-4 should be considered for antibiotics

Question 18

What is scarlet fever?

Answer 18

A contagious bacterial infection

Symptoms: flu-like, erythematous rash that feels rough, strawberry tongue

It mostly affects young children

Question 19

What is a notifiable disease?

Answer 19

Needs to be reported and interactions needs to be tracked to prevent spread because it’s a rare disease now

Question 20

Should swabs be taken for sore throats

Answer 20

No, it doesn’t change the management, they’re expensive, and the results take too long to come back

Question 21

What is the management of a sore throat in england?

Answer 21

-centor 1-3, try to resist antibiotics
-Simple management based
-Advise losangers, paracetamol, and fluids

Question 22

Why can’t amoxicillin be given for a sore throat?

Answer 22

Because it could be glandular fever and it would cause a rash

Amoxicillin is also broad spectrum so had greater resistance

Question 23

What antibiotics are prescribed for a sore throat?

Answer 23

1st-line:
Penicillin V 500mg 4 times a day for 7 days

If allergic:
Cephalosporins
But it causes an increased risk of C-diff especially in the elderly

Question 24

When is the guidance for a tonsillectomy?

Answer 24

7+ in 1 year
OR
5+ in 2 years
OR
3+ in last 3 months