Acute Sore Throat Flashcards
Complications of GAS (strep A)
Rheumatic fever
Quinsy (peritonsillar abscess)
Post step glomerulonephritis
Meningitis
Supporative- direct spread to adjacent structure- ear, sinus, tonsil
Acute otitis media
Sinusitis
Quinsy
Non-supporative
Rheaumatic fever- significant in developing world
Definition of sore throat- ddx
Sore throat- pharyngitis (back of throat) or tonsillitis
Pharyngitis- URTI- complication sinusitis, Acute otitis media
Sore throat, fever, runny nose, cough, headache, hoarse voice
O/E: red throat +/- swollen tonsils
Use Fever- Pain Scoring sx
Ddx: epiglottis, quinsy, retropharyngeal abscess
What is Fever - Scoring system
Fever
Purulence
Attended within 3 days
Severely inflamed tonsils
No cough/ Coryza
0-1 no abx
2-3- no or delayed abx
4-5- immediate abx
Management of sore throat
Sore throats can last up to a week
Regular paracetamol and ibuprofen
Difflam (Benzydamine 0.15%) every 1.5-3hrs to aid E+ D
Drink little and often
Ice lolly or ice cream
Throat swab
Pen V (phenoxymethypenicillin) QDS for 10 days , Clari if allergic or erythro if pregnant
Try avoid amox as can cause maculopapulae exanthems in EBV
Severe pain- dex (IP)
Admit if sign of dehydration (unable to swallow, upper airway obstruction/ stridor)
Common cold- runny nose, coryza, cough
Scarlet fever- notifiable disease
EBV- teenager/ young adults, take weeks to months to resolve, HIV test, avoid kissing, sharing towels and spoons- avoid heavy lifting or contact sports for 1 months due to risk of splenic rupture- return to ED if sudden abdo pain
Examination
Fever tachycaruda
Heart murmur in rheumatic fever
Neck stiffness- lymphadenopathy or rarely retropharyngeal abscess
Hepatosplenomegaly in EBV
Scarlet fever- sandpaper rash, strawberry tongue, red cheek with perioral sparing
Strawberry tongue
Kawasaki
Scarlet fever
Grey pseudo membrane on pharynx
Diphtheria
Unilateral peritonsillar swelling
Quinsy
Tonsillipharynge or palatal petechiae
GABHS infection or EBV
Investigation
Rapid strep antigen testing
ASOT- antistreptolysin O titre
Throat swab
Covid swab
Unable to swallow- cannula
Deranged LFT- infectious mononucleosis
Stridor- ENT- FNE (fibre optic nasal endoscopy)
Lateral soft tissue neck X R for retropharyngeal abscess and epiglottis
Symptoms of epiglottis/ supraglottis
Stridor
Muffled voice
Rapid clinical course
Diabetes
Abx- 3rd generation cepharosporon and metronidazole
Dex/ adrenaline nebuliser to reduce swelling
Hib immunisation- more common in adults
Serious signs of sore throat
Unable to swallow
Tripod position
Neck stiffness
Systemic u well
Severe throat pain
Stridor
