Acute sore throat presentation Flashcards
history in acute sore throat presentation
- PAIN hx – SOCRATES
- Associated sx: cough, dysphagia, rash, stridor, fever, feeling systemically unwell
- Key associated sympoms: otalgia, coryzal, cough, night sweats, odynophagia, SOB
- Drooling, leaning forward, high temp = epiglottitis.
- Key signs: Fever (degree of), tachycardia, weight loss, dysphagia, drooling, stridor
- Any self-medication/OTC medications
- PMH – other comorbidities, prev risk factors/past infections
- DH and allergies - glandular fever reaction with amoxicillin
- FH anyone else affected
- SH - smoker, occupation
examination in acute sore throat presentation
Look = neck swelling, asymmetry, rash, uvula deviation, tongue, throat examination
Erythema, enlarged tonsils, presence of exudates
Feel = cervical lymphadenopathy
Move = neck movement, mouth opening, any trismus
Investigations in acute sore throat presentation
- Usually unnecessary
- Throat swabs – not advised for routine but may be helpful in high-risk groups, or where there is treatment failure
- FBC, LFT & monospot test – if glandular fever suspected
- Antistreptolysin O (ASO) titres – may be useful in excluding recent strep infection in patients who are systemically unwell/ have prolonged sx
viral infections & acute sore throat presentation + management
rhinoviruses, coronavirus,respiratory syncytial virus,parainfluenza virus – 80%
Adenovirus Orthomyxoviridae-influenza Epstein-Barr virus Herpes simplex virus Measles
Mx:
- Reassurance – self-limiting within 1 week
- Analgesia
- Fluids
- Symptomatic relief
Glandular fever: presentation and signs
Presentation: Sore throat pyrexia malaise anorexia
Signs:
- Posterior cervical lymphadenopathy
- splenomegaly
- hepatitis
- haemolysis
- diffuse rash
- soft palate petechiae
- exudative tonsils
80–90% of patients with acuteEpstein–Barr virusinfection treated with antibiotics develop a red, diffuse rash.
Glandular fever: diagnosis and management
Diagnosis:
- WCC - 50% lymphocytes with >10% atypical lymphocytes, raised ALT
- monospot - specific but not sensitive: (100% specific, 85% sensitive) – 1-2 weeks for ve+ results
- EBV Titre
Management:
- Supportive therapy (analgesia, fluids)
- Steroids
Delayed
- Safety advice – avoid contact sports for 6 weeks
- GP to re-check derranged LFTs on discharge
- ENT review if persistent symptoms
laryngitis: presentation, aetiology and management
Presentation:
Fever, Dysphonia
Aetiology:
Trauma (chemical/physical),
Infection (viral)
Management:
Voice rest
Humidification
Steroids
Epiglottitis (Supraglottitis): target group & presentation
Target group: children (epiglottitis), adults (supraglottitis), immunosuppressed; 1-4:100,000
Presentation: Sore throat difficulty speaking drooling leaning forward fever difficulty swallowing fast heart rate difficulty in breathing
Epiglottitis (Supraglottitis): aetiology
Aetiology:
Streptococcus pneumoniae, Haemophilus parainfluenzae,
Adult: Haemophilus influenza (25%); Strep pneumoniae; Group A Strep
Paeds: Hameophilus influenzae type B (Hib) is less common; Group A beta-haemolytic strep ; step penumoniae
Epiglottitis (Supraglottitis): management
Management: AIRWAY-E assessment broad spectrum antibiotics Steroids Secure airway - Adrenaline nebs - IV dexamethasone - Intubate - Cricothyroidotmy vs Tracheosotomy
Sore throat but normal looking tonsils = FNE
FNE
fiberoptic nasoendoscopy, commonly used in the treatment of epistaxis in assessing the nasal cavity after removal of nasal packs
bacterial infections & acute sore throat presentation
Strep sore throat - Streptococcus pyogenes (group A beta-hemolytic streptococcus)
Scarlet fever - erythrogenic toxin producing strains ofStreptococcus pyogenes
Diphtheria is caused by an exotoxin-producing gram-positive rod,Corynebacterium diphtheriae
(Pharyngo)tonsillitis presentation & aetiology
Presentation:
severe pain on swallowing, fever, toxic
GABS – anterior cervical and submandibular lymphadenopathy on examination
Aetiology:
Streptococcus pyogenes,
Staphylococcus aureus,
Haemophilus influenzae
Viral: 50-80%, 1-10% Epstein-Barr Virus
Bacterial: Group A B-haeomolytic strep (exudate)
(Pharyngo)tonsillitis management
Management:
-Antibiotics:
Phenoxymethylpenicillin for 5-10 days (clarithomycin in pen allergy)
Avoid amoxiciilin – cause rash in glandular fever
-Rehydration
-Analgesia
Centor criteria:
Centor criteria: Tonsillar exudate Tender anterior cervical LNs Absence of cough Hx of fever (>38)
score for Centor criteria
Score 3-4: 32-56% presence of GABS = Abx may be beneficial
Score 0,1 or 2: 3-17%
Fever Pain criteria
- Fever (last 24 hours)
- Pus on tonsils
- Attend rapidly (within 3 days after onset of Sx)
- Severely Inflammed tonsils
- No cough/coryzal sx
Fever Pain criteria score
Score 0-1: 13-18% of isolating streptococcus
2-3: 34-40%
4-5: 62-64%, give antibiotics
When to refer
Urgent same day: Stridor or respiratory difficulty Dehydration Quinsy Severe systemic illness Suspected kawasaki disease or epiglotitis
Routine referral for consideration tonsillectomy:
- More than 7 episodes in 1 year
- 5 per year for 2 years
- 3 per year for 3 years
*Bacterial infections, abx use, affecting school/work/debilitating sx
Complications of tonsillitis
- Quinsy (peritonsillar abscess)
- Scarlet fever
- Strep toxic shock syndrome
- Lemierre’s syndrome (rare – acute septicaemia & jugular vein thrombosis secondary to infection with fusobacterium spp.)
- Rheumatic fever
- Post-strep glomerulonephritis
Guttate psoriaris
Peritonsillar abscess (Quinsy): presentation and aetiology
Presentation:
- Severe unilateral pain
- Pyrexia
- Unilateral Earache
- Odynophagia
- Trismus
- muffled voice “hot potato” voice
- Foetor oris
- Halitosis
- deviated uvula
Aetiology:
aerobic:
Streptococcus pyogenes, Staphylococcus aureus
Occurs in space between tonsil and pharyngeal wall
as a complication of untreated tonsillitis
Peritonsillar abscess (Quinsy): investigations & management
Investigations: ENT opinion needed, Bloods (FBC, U+E, CRP, LFTs, monospot, clotting)
Management: broad spectrum antibiotics – BenPen - IV steroids - dexamethasone - Rehydration - Analgesia - Needle aspiration, may require incision and drainage
scarlet fever presentation
Notifiable disease
Prodromal sx: sore throat, fever, headache, myalgia
Rash – coarse texture ‘sandpaper’. Typically neck first chest & scapular regions trunk & legs
White Strawberry tongue – red papillae seen through a white ‘fur’ red, raw (desquamation)
Throat swab
management of scarlet fever
Mx: penicillin based for 10 days
Exclusion from school – can return after 24h of abx
Measles presentation, aetiology and complications
- RNA virus of the family Paramyxoviridae
- Contagious infection diseases – notifiable disease
Prodrome sx:
fever
cough
coryzal sx
conjuctivitis
Koplik’s spots – pathognomonic – opposite 2nd molar teeth – small, red spots, with a bluish-white speck
Morbiliform rash – forehead, neck trunks limbs
Complications: pneumonia, encephalitis
Pharyngitis: symptoms and aetiology
- Common
- Target Group: Child-Adult
symptoms:
- sore throat
- cough
- coryza
- oltalgia
- pyrexia
cervical lymphadenopathy
Causes
Viral: rhinovirus, adenovirus, para-influenza
Bacterial: Group A B-haeomolytic strep (exudate)
Fungal: candida (white spots)
pharyngitis: Investigations & management
Investigations:
- Examination,
- ECG if tachy
- CXR if persistent cough
- bloods if concerned other pathology - monospot for glandular fever etc
Management:
- Reassure
- Oral fluids
- analgesia
- antibiotics if bacterial infection suspected (penicillin V vs amoxicillin)
