Chapter 23 - Sore throat

Question 1

list 8 emergent diagnosis for sore throat?

Answer 1

1) epiglottis (typically with trismus, H,influenzB HiB)
2) bacterial tracheitis
3) ludwig’s angina
4) gonorrhea
5) foreign body
6) angioedema
7) peritonsillar abscess (won’t let you open their mouth -painful)
8) retropharyngeal abscess (painful neck/movement)
9) primary HIV
10 ) cancer

Question 2

List the common viral, bacterial and non-infectious causes of sore throat?

Answer 2

Viral: rhinovirus, adenovirus, HSV 1+2, EBV (mono), influenza, CMV, Varicella, hepatitis

Bacterial: GAS, non group A strep, Neisseria gonorrhea, neisseria meningitidis, atypical M. pneumonia, chalmydia, diptheria (non vaccinated children)

Non- infectious causes

1) Systemic disease
- Kawasaki Dx, SJS, cyclic neutropinia, thyroiditis
2) Trauma
- retained FB, laryngeal fracture, hematoma, caustic exposure (kid who swalloed bleech), post- tonsillectomy eschar
3) tumours
- tongue, larynx, thyroid,

Question 3

describe the centor score criteria and it’s use

Answer 3

• Hx of fever
• tonsillar exudates
• tender anterior cervical adenopathy
• absence of cough

all give +1 point
age <15 + 1 point (more common in young kids)
age >44: -1

4/4 : 51% GAS infection (flip a coin)
horrible decision tool

Question 4

Describe pro and cons of antibiotics for suspected or confirmed acute GAS pharyngitis?

Answer 4

Antibioitics for GAS reduce symptoms by only 16 hours
- antibiotics do NOT reduce the incidence of suppurative complications from sore throat (i..e peritonsillar abscess)
Abx do not really help therefore
Encourage symptomatic treatment: NSAIDS and steroids
Antibioitcs risk: anapbhylaxis, resistance, n/v/d, rash

Question 5

What are 6 agents, other than Group B strep that cause exudative tonsillopharyngitis?

Answer 5

Group A Streptococcus
1b) Non-group A strep
Neisseria gonorrhoea
EBV / Mono
Haemophilus influenzae
Cornybacterium diphtheriae
Candida species (?HIV infection)
Mycoplasma pneumoniae
Chlamydia trachomatis
Pneumoniae
Necrotizing tumour
Post tonsillectomy eschar

Question 6

Airway red-flags in patient with sore throat:

Answer 6

Rapidly progressive symptoms
Unwell, restless, distressed
Hypoxia
Drooling
Muffled voice (supraglottic threat - hot potato)
Stridor (means glottic problem – common in children <10 with croup)
Dehydration and systemic toxicity
“Brawny” induration on the floor of the mouth (hard wood feeling on palpation - think ledwig angina or cancer)
Direct visualization paramount
Trismus (epiglotitis) vs. bilateral tonsillar exudates vs. uvular deviation vs. signs of Peritonsillar abscess