Sore Throat

Question 1

Sequence of events and symptom analysis

Answer 1

OSOCRATES

Open question 
Site- point to it 
Onset- when did you first notice this, how did symptoms start, have things changed, getting better or worse 
Radiation 
Associated features- see systems review 
Timing- always there 
Exacerbating or relieving factors 
Severity- stopping you from eating or drinking

Question 2

Systems review

Answer 2

Constitutional- FWARJCNL, tiredness 
Airway- problems breathing, voice changed 
Neck- difficulty moving neck, any lumps 
Full ENT systems review 
Gastro eg. Any dysphagia etc. 
URTI- cough, runny nose etc. 
recent travel

Question 3

Sore throat red flags

Answer 3

Stridor
Drooling
Dyspnoea
Trismus
Neck stiffness
voice changes
Persistent sore throat
Smoking, alcohol
INABILITY TO EAT AND DRINK

Question 4

Patients perspective

Answer 4

Feelings and impact
ICE
CAN YOU EAT AND DRINK

Question 5

Background information

Answer 5

PMH- tonsillitis before?
DH- allergies, OTC etc, have you tried anything so far for it
FH
SH

Question 6

Pharyngitis

Answer 6

Common self limiting URTI

Coryzal symptoms- cough, runny nose, blocked nose, blocked ears, headache

Question 7

Epiglottis

Answer 7

Sore throat, fever, muffled voice, decreased range of neck movement
Strider, dyspnoea, drooling
Suspected when symptoms don’t fit the clinical picture (severe sore throat and odynophagia in absence of significant tonsillitis)

Question 8

Tonsillitis

Answer 8

Sore throat may radiate to respective ear
May have had previous episodes
Viral or bacterial
FEVER PAIN criteria

Question 9

Infectious mononucleosis (glandular fever)

Answer 9

Mimics tonsillitis
Viral (EBV)
Sore throat, fever, fatigue, tender cervical lymphadenopathy, Splenomegaly (ASK ABOUT ABDOMINAL PAIN AND FULLNESS)
Palatal petechiae

Question 10

Peritonsillar abscess (quinsy)

Answer 10

Complication of tonsillitis
Uvula deviation
Trismus and a hot potato voice

Question 11

Pharyngeal malignancy

Answer 11

Persistent sore throat in older patients, smoking and alcohol excess are risk factors
Weight loss, loss of appetite, fatigue, hard cervical lymphadenopathy, dysphagia
If older person diagnosed with tonsillitis, follow up to ensure resolution

Question 12

GORD

Answer 12

Reflux

Throat clearing, acid brash, previous reflux history

Question 13

Dental or mouth cause

Answer 13

If no medical cause, consider whether it could be dental
Dental abscess typically present with localised pain around one tooth
Trismus may be present

Question 14

Investigations

Answer 14

Examination or oropharynx
If cause unclear or red flags refer to ENT
Flexible nasoendoscopy
Bloods- FBC UE LFT CRP monospot (glandular fever)