Sore throat

Question 1

OVERVIEW
i) which three areas of infection does sore throat cover?
ii) what is the mainstay of tx? what is not usually indicated?
iii) name four things that are in the NICE indicator for abx?
iv) name three conservative mx?

Answer 1

i) laryngitis, pharyngitis, tonsilitis
ii) analgesia (paracetamol/ibuprofen)
abx not usually indicated
iii) abx - features of marked systemic upset, unilateral peritonsilitis, hx of rheumatic fever, inc risk of infection eg child with diabetes or immcomp, centor score 3 or more
iv) salt gargles, difflam spray, analgesia, maintain fluid intake

Question 2

SCORING SYSTEMS
i) what does the centor score test? what are the four components
ii) what does the feverPAIN criteria test?
iii) name two other differentials for soe throat

Answer 2

i) likelihood to isolate streptococci
presence of tonsillar exudate, tendor LNs, hx of fever, absence of cough
ii) also tests likelihood is isolating strep (group A strep)
Purulence (pharyngeal or tonsilar exudate)
Attended rapidly (<3d)
Inflamed tonsils
No cough or coryza
iii) pharyngitis, tonsilitis, allergic rhinitis

Question 3

INFECTIOUS MONONUCLEOSIS
i) what is it aka? what virus is it caused by?
ii) what classic triad of symptoms is seen in 98% of patients?
iii) name three other features? when may a rash develop? how long do symptoms typically take to resolve?
iv) how is it diagnosed?
v) how is it managed?

Answer 3

i) glandular fever caused by EBV
ii) pyrexia, sore throat and lymphadenopathy
iii) malaise, anorexia, headache, palatal petichiae, splenomegaly, hepatitis, lymphocytosis, macular papular rash if patients take amoxicillin
iv) dx by heterophil antibody test (monospot test) - do monospot annd FBC in second week of illness to confirm glandular fever
v) mx conservatively - rest, drink fluid, avoid alcohol, analgesia, avoid contact sport for 4 weeks due to risk of splenic rupture

Question 4

TONSILITIS
i) what is the most common cause? what is the most common cause of bacterial tonsilitis? how is this treated?
ii) what bacteria is most common cause of otitis media, rhinosinusitis and other cause of tonsilitis?
iii) which tonsils are usually infected and enlarged in tonsilitis? where are these kocated
iv) name three common presentations? how may a younger child present?
v) name two other areas that should also always be examined in suspcted tonsilitis

Answer 4

i) viral
bacterial > group A strep (strep pyogenes)
treat with Pen V (phenoxymethylpenicillin)
ii) strep pneumoinae
iii) palatine tonsils at either side at the back of the throat
iv) fever, sore throat, painful swallow
younger child - fever, poor oral intake, headache, vomiting, abdo pain
v) always examine eats and cervical LNs

Question 5

MX OF TONSILITIS
i) what does a centor score of 3 or more mean?
ii) what score is used to assess likelyhood of bacterial tonsilitis
iii) name three important serious conditions that need to be excluded?
iv) when should a patient be asked to return if pain hasnt settled? over what temperature?
v) what type of prescription may be considered?
vi) which abx is first line? what is given in pen allergy?

Answer 5

i) 40-60% likelihood of bac tonsilitis
ii) fever pain score
iii) epiglotitis, meningitis, peritonsilar abscess
iv) return if pain hasnt settled in three days or fever rises over 38.3
v) may give a delayed prescription - educate patients and take if symptoms worsen in 2-3 days
vi) pen V or clarithromycin if allergic

Question 6

QUINSY
i) what is it aka? what causes it to form? what are they usually a compliaction of?
ii) name four presenting symptoms? what is trismus? what may occur due to pharyngeal swelling?
iii) what bacteria is it usually caused by? name two others it may be caused by
iv) how should a patient be managed? are abx given?

Answer 6

i) peritonsillar abscess - usually a complication of tonsilitis
ii) px with sore throat, painful swallow, fever, neck pain, referred ear pain, swollen LNs
trismus = pt unable to open mouth
change in voice due to pharyngeal swelling
iii) usually caused by strep pyogenes but can also be caused by staph aureus and haemoph influenzae
iv) mx by ENT > incision and raining of abscess under GA
abx generally given pre and post op due to bacterial cause > broad spec abx eg co amox