Acute Sore Throat

Question 1

Causes of a Sore Throat - 4

Answer 1

• Most commonly due to viral organisms such as rhinovirus, influenza
• Streptococcus pyogenes
• less commonly, EBV, Herpes Simplex 1

Non-infectious causes are uncommon, but include physical irritation, GORD, hayfever.

Question 2

Diagnosing the cause - 5

Answer 2

Examine:
- Pharyngitis presents with exudate and cervical lymphadenopathy
- Tonsilitis is tonsillar exudate, tonsil enlargement and red tonsils
- EBV presents with longer onset, enlarged tonsils, exudate and extreme fatigue.

History:
- Fever associated with infectious cause (tonsilitis OR pharyngitis)
- Rhinorrhoea, nasal congestion and cough present in viral causes NOT bacterial

Question 3

What is the scoring system for determining the likelihood of Streptococcal Infection

Answer 3

FeverPAIN
F - fever during last 24hours
P - purulence
A - attended rapidly (within 3 days)
I - inflammed tonsils
N - no cough or coryza

Question 4

When do admit someone with sore throat - 4

Answer 4

• Stridor
• Breathing difficulty
• Dehydration
• Signs pointing to epiglottitis (drooling, sniffing position, stridor)

Question 5

When to prescribe antibiotics?

Answer 5

FeverPAIN score of 4 or 5

Question 6

1st line antibiotic for tonsilitis

Answer 6

7- or 10-day course of phenoxymethylpenicillin