Sore throat Flashcards
Probability diagnosis
Viral pharyngitis
Epstein–Barr mononucleosis (glandular fever)
Streptococcal (GABHS) tonsillitis
Chronic sinusitis with postnasal drip
Oropharyngeal candidiasis
Serious disorders not to be missed
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
Pitfalls (often missed)
- Foreign body (e.g. fish bone)
- Epstein—Barr mononucleosis (glandular fever)
- Candida:
- common in infants
- steroid inhalers
- STIs:
- gonococcal pharyngitis
- herpes simplex (type II)
- syphilis
- Irritants (e.g. cigarette smoke, chemicals)
- Reflux oesophagitis → pharyngolaryngitis
- Tonsilloliths
- Cricopharyngeal spasm
- Kawasaki disease
- Chronic mouth breathing
- Aphthous ulceration
- Thyroiditis
- Glossopharyngeal neuralgia
- Rarities:
- scleroderma
- Behçet disease
- sarcoidosis
- malignant granuloma
- tuberculosis
Masquerades checklist
Depression
Diabetes (Candida)
Drugs (e.g. NSAIDS, cytotoxics)
Anaemia (possible)
Thyroid disorder (thyroiditis)
Spinal dysfunction (cervical referred pain)
Is the patient trying to tell me something?
Unlikely, but the association with depression is significant.
Key history
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.
Key examination
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
Key investigations
throat swab
FBE
mononucleosis test
blood sugar
biopsy of suspicious lesions.
Diagnostic tips
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