EENT - Throat

Question 1

symptoms of sore throat - children

Answer 1

lethargy and fever

Question 2

symptoms of sore throat

Answer 2

a painful throat, especially when swallowing
a dry, scratchy throat
redness in the back of the mouth
bad breath
a mild cough
swollen neck glands

Question 3

causes of sore throat

Answer 3

laryngitis
tonsillitis
strep throat (a bacterial pharyngitis)
glandular fever

Question 4

define Pharyngitis

Answer 4

inflammation of the pharyngeal mucosa

Question 5

how is acute pharyngitis characterised as

Answer 5

rapid onset of sore throat and pharyngeal inflammation (with or without exudate).

Question 6

what does the absence of cough, nasal congestion and discharge suggest?

Answer 6

bacterial aetiology

Question 7

types of acute pharyngitis (aeotiology)

Answer 7

Viral pathogens (almost always): e.g., rhinovirus
Bacterial pathogens: e.g., group A Streptococcus (GAS)
Fungal pathogens: e.g., Candida albicans

Question 8

inflammation of the tonsillar tissues, what is it called?

Answer 8

tonsillitis

Question 9

facts about tonsillitis

Answer 9

Self-limiting condition
Common cause is viral
Bacterial cause is suspected if lasting ˃ 3 days

Question 10

symptoms of tonsillitis

Answer 10

Swollen/ erythematous tonsils
Exudate on tonsils
Cervical lymphadenopathy
Stertor (noisy breathing )
Pyrexia
Sore throat
Odynophagia & dysphagia
Cough

Question 11

diagnosis of sore throat

Answer 11

History taking (e.g., other symptoms, previous episode, other medical condition, other medications)
Diagnostic tools
FeverPain criteria or Centor criteria
Rapid antigen detection tests (RADT) – allow immediate point of care assessment of GAS pharyngitis

Question 12

Differential diagnosis
of sore throat

Answer 12

Hand, foot, and mouth disease
Epiglottis
COVID-19
HIV
Gonorrhoea
Measles
Leukaemia
Oropharyngeal cancer
Lemierre syndrome
Kawasaki disease

Question 13

Red flags symptoms
of sore throat

Answer 13

difficulty breathing

difficulty swallowing

dehydration

rash

excessive drooling

blood in saliva or phlegm

patient severely unwell

immunosuppressant use

Question 14

FeverPAIN criteria (max 5 points)

Answer 14

Higher scores suggest more severe symptoms and likely bacterial (streptococcal) cause.
0 or 1 score – 13 to 18% likelihood of isolating GAS
2 or 3 score – 34 to 40% likelihood of isolating GAS
4 or 5 score – 62 to 65% likelihood of isolating GAS

Question 15

Centor criteria max 4 points

Answer 15

A score of 0, 1 or 2 – associated with a 3 to 17% likelihood of isolating GAS
A score of 3 or 4 – associated with a 32 to 56% likelihood of isolating GAS

Question 16

treatment of sore throat

Answer 16

Self-care
Oral analgesia: e.g., paracetamol or ibuprofen
Medicated lozenges – help to reduce pain
Other interventions: e.g., mouth wash
Antibiotics (based on FeverPAIN or Centor score)
Corticosteroids is NOT recommended for the treatment of acute pharyngitis (lack of evidence)

patient education

managing symptoms

safety netting

severe?&raquo_space; tonsillectomy

Question 17

can i prescribe antibiotic therapy for acute sore throat?

Answer 17

YES

antibiotics target against common pathogen

Streptococcus pyogenes
Phenoxymethylpenicillin –
first line
Clarithromycin – penicillin allergy
Erythromycin – penicillin allergy in pregnancy

Question 18

Complications of streptococcal pharyngitis/tonsillitis

Answer 18

Scarlet fever
Suppurative complications
Otitis media (most common).
Acute sinusitis — rare
Peri-tonsillar abscess (quinsy)
Non-suppurative complications include acute rheumatic fever, acute glomerulonephritis and reactive arthritis, although these are rare in developed countries.

Question 19

Fungal infection of the mouth

Answer 19

Management depends on the types of oropharyngeal candidiasis
Pseudomembranous candidiasis (Thrush) – Antifungal
Acute erythematous candidiasis – Antifungal
Denture stomatitis – Denture cleanse with disinfectant solution, brushing, Miconazole?

Question 20

Pseudomembranous candidiasis (thrush)

Answer 20

acute infec

Question 21

symptoms of thrush

Answer 21

Patches of curd-like, white or yellowish plaques
Burning & itching sensation (minimal)
Dysphagia and chest pain (chronic form)

Question 22

Risk factors
of thrush

Answer 22

Extremes of age
Immunocompromise or systemic immunosuppression
Patients with serious systemic disease associated with reduced immunity (e.g., leukaemia, other malignancies, and HIV infection)
Patient receiving chemotherapy and radiotherapy
Recent or concurrent use of drugs that promote candida growth
Patient receiving ICS, chemotherapy, broad-spectrum antibiotics
Diabetes mellitus
Dental prostheses and poor dental hygiene
Smoking
Local trauma
Poor diet and nutritional deficiencies
Impaired salivary function

Question 23

management of oral candidiasis in primary care - adult

Answer 23

• no risk factor > prescribe antifungal
• risk factor > refer

Question 24

mild infec - thrust treatemnt

Answer 24

Localised and mild infection
Topical antifungal for 14 days
Miconazole oral gel – 1st line
Life style advice

Question 25

Extensive and severe infection

Answer 25

Systemic antifungal for 14 days
Oral fluconazole
Life style advice
Review & extend Tx for 7 days

Question 26

What to prescribe for children

Answer 26

prescribe TOPICAL anti-fungal

Miconazole oral gel for 14 days (children ≥ 4 months) – 1st line
Or
Oral Nystatin suspension (if miconazole is unsuitable)
Give life style advice

or refer to a paediatrician

Question 27

Non-pharmacologic management

Answer 27

good dental hygiene
inhaler technique/ rinse mouth
smoking cessation
denture cleanse and removal
brush mucosal surface w soft brush

Question 28

what are the don’ts of thrush

Answer 28

do not wear your dentures at night

do not keep wearing dentures if they don’t fit properly

don’t smoke