44. Sore throat

Question 1

Examination sore throat

Answer 1

Vital signs:
ENT:
Cervical lymph nodes:
Hydration:
Abdomen: (splenomegaly in EBV)

Calculate FEVER PAIN

Question 2

history taking sore throat

Answer 2

PC: when did it start? site, onset, timing, alleviating factors
HoPC: pain, redness, pus, eating and drinking?, paracetamol etc., cough? Rashes? bleeding?
MHx: ever had it before? How many times in what space of time? Any recent chest infections?
DHx: any immunosuppressing medications? Allergies to abx?
ICE: what is your opinion on change in how your tonsils look?

Question 3

ddx sore throat

Answer 3

Tonsillitis
Pharyngitis
Laryngitis
Paratonsillar abscess (quinsy)
Epiglottitis/laryngitis in children

Question 4

features of peritonsillar abscess (quinsy)

Answer 4

severe throat pain, which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility

Question 5

Management quinsy

Answer 5

urgent review by an ENT specialist

Management
- needle aspiration or incision & drainage + intravenous antibiotics
- tonsillectomy should be considered to prevent recurrence

Question 6

haemorrhage post tonsillectomy? causes? management?

Answer 6

Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.

Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics. Severe bleeding may require surgery. Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.

Question 7

features laryngitis

Answer 7

“lost voice”

Question 8

causes laryngitis

Answer 8

• infection
• overuse