Sore Throat

Question 1

Causes of acute pharyngitis

Answer 1

• viral causes (more common): rhinovirus, influenza, coronavirus
• bacterial cause: streptococcus, diphteria
• fungal: candida albicans
• parasite: toxoplasmosis

Question 2

Acute pharyngitis
- signs and symptoms
- ix
- tx

Answer 2

Signs and symptoms
-mild: throat discomfort, low grade fever, congested pharynx
-moderate-severe: dysphagia, high fever, pharynx shows erythema, exudate
-severe: edema of soft palate and uvula, enlarge cervical lymph nodes

ix
- throat swab c&s (GOLD STANDARD)
- culture media

Tx
- symptomatic: bed rest, adequate hydration
- throat gargle: warm saline, anti-inflammatory, antiseptic
- analgesia: paracetamol, NSAIDs
- antibiotic: strep (penicillin)

Question 3

Chronic pharyngitis
- causes
- symptoms and signs
- treatment

Answer 3

Causes
- persistent infection: chronic rhinosinusitis
- mouth breathing: obstruction in nose
- chronic irritants: tobacco

Symptoms
- throat discomfort/pain
- foreign body sensation
-frequent throat clearing
- dry cough

Signs
- catarrhal pharyngitis: congestion of posterior pharyngeal wall, engorge vessels
- granular pharyngitis: pharyngeal wall thickened and edematous

Treatment:
- warm saline gargle
- treat cause; rhinosinusitis
- avoid irritant
- avoid bad habit (throat clearing)
- voice rest and speech therapy

Question 4

Acute tonsillitis
Causes
Symptoms
Grading
Tx
Cx

Answer 4

Causes: streptococcus (most common), staphylococci

Symptoms
- sore throat
- odynophagia, dysphagia
- fever: high grade, chills and rigors
- refer otalgia
- muffled voice
- halitosis

Grading:
- I: tonsils confined in between pillars
- II: tonsils extend out of pillars but just up to half distance to uvula
- III: tonsils enlarged up to level of uvula
- IV: tonsils in contact with each other, kissing tonsils

Treatment
- adequate hydration
- antibiotic: penicillin
- analgesic/ antipyretic
- throat gargle

Signs
- enlarged tonsils, inflamed
- follicular/exudative tonsillitis; contain pus
- enlarged jugulodigastric lymph nodes
- dehydration

Complications
- chronic tonsillitis with recurrent acute tonsillitis
- peritonsillar abscess
- acute otitis media
- acute rhinosinusitis

Question 5

Diphteria
- organism involved
- transmission
- incubation period
- symptoms
- cx
- ix
- tx
- oree

Answer 5

Organism: corynebacterium diphtheriae

Transmission: droplets and close contact

Incubation period: 2/6 days

Symptoms:
- greyish white pseudomembrane forms over the tonsils and spreads to soft palate and posterior pharyngeal wall
- hoarness
- bull neck appearance
- low grade fever

Cx
- acute airway obstruction cause by thick pseudomembrane

Ix
- throat swab for C&S
- CXR

Tx
- isolate
- assess and secure airway
- antibiotic - penicillin, erythromycin
- notify contact tracing

Prevention
- diphteria vaccination
- booster every 10 years

Question 6

Chronic tonsillitis
- signs and symptoms
- tx

Answer 6

Signs and symptoms
- halitosis
- muffled voice
- enlarged tonsils
- cheesy materials in tonsillar crypts

Tx
- tonsillectomy. If recurrent attacks, affect speech, swallowing or respiration

Question 7

Peritonsilar abscess (Quinsy)
- definition
- organism
- symptoms
- PE
- tx
- cx

Answer 7

Definition: collection of pus in peritonsillar space

Organism: strep pyogenes, staph aureus

Symptoms: fever, chills, rigors, severe sore throat, odynophygia, muffled voice ‘hot potato voice’, halitosis, referred otalgia

Examinations: tonsil, pillars and soft palate congested and swollen, uvula edematous and push to the opposite side

Tx: incision and drainage, antibiotic

Cx: parapharyngeal abscess, laryngeal edema

Question 8

When to consider tonsillectomy

Answer 8

Absolute indication
- recurrent tonsillitis (>7 in a year)
- peritonsillar abscess

Relative indication
- >3/years despite adequate medical therapy
- diphteria carriers

Contraindication
- anaemia Hb < 10
- acute infection

Question 9

Retropharyngeal abscess
- signs and symptoms
- ix
- tx

Answer 9

Signs and symptoms
- dysphagia
- dyspnea
- stridor if airway obstruction
- torticollis

Ix
- lateral neck soft tissue xray
- CECT neck

Tx
- incision and drainage
- antibiotic

Question 10

Parapharyngeal abscess
- causes
- symptoms
- investigation
- tx

Answer 10

Causes
- pharynx: tonsil, adenoid
- teeth: lower molar tooth
- ear: petrositis

Symptoms
- fever, odynophagia, sore throat, torticollis
- lateral neck swelling - behind angle of mandible
- trismus - irritation of pterygoid muscle

Investigation
- CECT neck

Tx
- incision and drainage
- broad spectrum antibiotic