Sore throat Flashcards

1
Q

Probability diagnosis

A

Viral pharyngitis

Epstein–Barr mononucleosis (glandular fever)

Streptococcal (GABHS) tonsillitis

Chronic sinusitis with postnasal drip

Oropharyngeal candidiasis

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2
Q

Serious disorders not to be missed

A

Cardiovascular:

  • angina
  • myocardial infarction

Neoplasia/cancer:

  • cancer of oropharynx, tongue
  • Blood dyscrasias (e.g. agranulocytosis, acute leukaemia)

Infection:

  • acute epiglottitis (children and adults)
  • peritonsillar abscess (quinsy)
  • pharyngeal abscess
  • diphtheria (very rare)
  • HIV/AIDS
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3
Q

Pitfalls (often missed)

A
  1. Foreign body (e.g. fish bone)
  2. Epstein—Barr mononucleosis (glandular fever)
  3. Candida:
  • common in infants
  • steroid inhalers
  1. STIs:
  • gonococcal pharyngitis
  • herpes simplex (type II)
  • syphilis
  1. Irritants (e.g. cigarette smoke, chemicals)
  2. Reflux oesophagitis → pharyngolaryngitis
  3. Tonsilloliths
  4. Cricopharyngeal spasm
  5. Kawasaki disease
  6. Chronic mouth breathing
  7. Aphthous ulceration
  8. Thyroiditis
  9. Glossopharyngeal neuralgia
  10. Rarities:
  • scleroderma
  • Behçet disease
  • sarcoidosis
  • malignant granuloma
  • tuberculosis
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4
Q

Masquerades checklist

A

Depression

Diabetes (Candida)

Drugs (e.g. NSAIDS, cytotoxics)

Anaemia (possible)

Thyroid disorder (thyroiditis)

Spinal dysfunction (cervical referred pain)

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5
Q

Is the patient trying to tell me something?

A

Unlikely, but the association with depression is significant.

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6
Q

Key history

A

First determine whether the patient has a;

  • sore throat
  • deep pain in the throat
  • neck pain

Enquire about relevant associated symptoms such as;

  • metallic taste in the mouth
  • fever
  • upper respiratory infection
  • postnasal drip
  • sinusitis
  • cough
  • other pain such as ear pain

Note whether pt is an asthmatic and uses a steroid inhaler

or is a smoker or exposed to environmental irritants.

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7
Q

Key examination

A

On inspection note the general appearance and look for;

  • toxicity
  • the anaemic pallor of leukaemia
  • nasal stuffiness of infectious mononucleosis
  • halitosis of a streptococcal throat

Palpate the neck for soreness and lymphadenopathy

Check the sinus area

Then inspect the oral cavity and pharynx

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8
Q

Key investigations

A

throat swab

FBE

mononucleosis test

blood sugar

biopsy of suspicious lesions.

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9
Q

Diagnostic tips

A

Tonsillitis with a covering membrane may be caused by Epstein–Barr mononucleosis.

Admit if any suspicion of epiglottitis—and do not examine the throat.

The triad of pharyngeal cancer;

  • hoarseness, pain on swallowing and referred ear pain
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