History - sore throat

Question 1

What are the differentials of a sore throat?

Answer 1

Respiratory - largyngitis, epiglottitis, oesophagitis, GORD, mallory weiss tears

I - pharyngitis, viral or bacterial, COVID, EBV, quinsy, tonsilllitis, strep throat

T - burn, cut

Neoplasm - oesphageal cancer, throat cancer

Iatrogenic - anti-cholinergic drugs reduce secretions,

Question 2

Investigations

Answer 2

Beside - sputum sample,

Bloods

The FeverPAIN criteria are: score 1 point for each (maximum score of 5)

Fever over 38°C.

Purulence (pharyngeal/tonsillar exudate).

Attend rapidly (3 days or less)

Severely Inflamed tonsils

No cough or coryza

A score of 0 or 1 is associated with a 13% to 18% likelihood of isolating streptococcus. A score of 2 or 3 is associated with a 34% to 40% likelihood of isolating streptococcus. A score of 4 or 5 is associated with a 62% to 65% likelihood of isolating streptococcus.

Centor criteria

Tonsillar exudate

Tender anterior cervical lymphadenopathy or lymphadenitis

History of fever (over 38°C)

Absence of cough

Each of the Centor criteria score 1 point (maximum score of 4). A score of 0, 1 or 2 is thought to be associated with a 3 to 17% likelihood of isolating streptococcus. A score of 3 or 4 is thought to be associated with a 32 to 56% likelihood of isolating streptococcus.

If the diagnosis of GAS needs to be confirmed with certainty (such as in people at high risk of rheumatic fever, vulnerable people such as the very old or young, or people who are at risk of immunosuppression, or people with very severe symptoms), arrange a rapid antigen test for group A streptococcus. A negative antigen test in a person (particularly a child) with suspected GAS should be followed up with a throat culture.

Bechets disease