sore throat

Question 1

does this patient need hospitlaisation?

Answer 1

patients with airway obstruction or a deep neck space infection require urgent transfer

Question 2

clinical features associated with airway obstruction or deep neck space infection

Answer 2

muffled voice
stertor (snoring type sound)
stridor
trismus
drooling
neck swelling
torticollis
severe neck pain
unilateral throat pain
respiratory distress
signs of sepsis or septic shock

Question 3

differentials associated with airways obstruction or deep neck space infection

Answer 3

acute epiglottitis
peritonsillar abscess (quinsy) and peritonsillar cellulititis
retropharyngeal abscess
parapharyngeal abscess
pharyngeal diptheria
sevre EBV
severe croup
spreading odontogenic infections
septic jugular thrombophlebitis

Question 4

most common causes

Answer 4

viral pahryngitis and tonsillitis are the most common causes of sore throat in patients of all ages
common viruses include RSV, rhinovirus, adenovirus, influenza and parainfluenza

Question 5

strep pyogenes pharyngitis and tonsillitis

Answer 5

more common in school aged children and adolescents
clinical features include abrupt onset of symptoms, fever, tender cervical lymph nodes, tonsillar exudate, absence of cough, rhinorrhoea or nasal congestion

Question 6

EBV

Answer 6

common in adolescents and young adults
clinical features include severe sore throat, fever, nausea, lymphadenopathy, splenomegaly, hhepatomegaly, rash and fatigue
consider EBV serology

Question 7

primary oral mucocutaneous herpes

Answer 7

more common in children younger than 5 years, but can occur in older children and adolescents
clinical features include fever, intraoral or hypopharyngeal lesions, apthous tonsil ulcers and cervical lymphadenopathy

Question 8

hand, foot, mouth disease

Answer 8

common in children
usually caused by coxsackie virus
clinical features include vesicular or ulcerative mucosal eruptions in the mouth and throat, loss of appetite, and rash or skin lesions

Question 9

patients at high risk of acute rheumatic fever

Answer 9

a throat swab for culture is useful to provide evidence of preceding S progenies infection if the patient is later suspected to have acute rheumatic fever
if possible, collect a throat swab before starting antibiotic therapy

Question 10

when is someone at high risk of acute rheumatic fever

Answer 10

if they are younger than 40 plus any of the following:
- an aboriginal or torres strait islander living in a rural or remote area
- a first nations person living in a household affected by overcrowding or experiencing socioeconomic disadvatage
- a person with a history of acute rheumatic fever or rheumatic heart disease
- a part of a family or household where a member has a recent history of acute rheumatic fever or RHD

Question 11

symptomatic therapy for sore throat

Answer 11

paracetamol and NSAIDs
medciated lozenges with antiseptic, anti-inflammatory or aneasthetic drugs
or medicated throat sprays
for patients with severe sore throat, consider a corticosteroidd

Question 12

antibiotic therapy for streptococcal pharyngitis and tonsilitis

Answer 12

phenoxymethylmenicillin for 10 days

Question 13

when is antibiotic therapy indicated for streptococcal pharyngitis and tonsillitis

Answer 13

for patients not at rsk of acute rheumatic fever when
- symptoms are severe
- the patient has a scarlett fever type rash