Sore Throat Flashcards
Sore throats account for about ______of consultations
in general practice per annum
5%
MCC of sore throat
The common causes are viral pharyngitis
(approximately 60–65%) and tonsillitis due to
Streptococcus pyogenes (approximately 20%).
A very important cause is tonsillitis caused by
___________. Treating
this cause with penicillin can produce adverse
effects.
Epstein–Barr mononucleosis (EBM)
At least 50% of sore throats, mainly pharyngitis, will
be caused by a______
virus
It is vital to be aware of _______
infection in children, especially between 2 and 4 years,
when the deadly problem of epiglottitis can develop
suddenly
Haemophilus influenzae
There are many pitfalls, the classic being to diagnose
the exudative tonsillitis of EBM as _________and prescribe one of the penicillins, which
may precipitate a severe rash
streptococcal
tonsillitis
What are the red flags in sore throats
• Persistent high fever • Failed antibiotic treatment • Medication-induced agranulocytosis • Mouth drooling: consider epiglottitis (don’t examine the throat) • Sharp pain on swallowing (? foreign body) • Marked swelling of quinsy • Candidiasis: consider diabetes or immunosuppression
_______ are concretions of debris entrapped
within deep tonsillar crypts. They are a common
cause of halitosis, vague sore throat and possibly
recurrent bouts of tonsillitis
Tonsilloliths
Small patches of exudate on the palate or other
structure indicate________
Candida albicans (oral thrush)
A large whitish-yellow membrane virtually
covering both tonsils indicates _______
EBM
A generalised red, swollen appearance with
exudate indicates_______
GABHS infection
Throat swabs are about _____ effective in isolating
GABHS from the infected throat
90%
Swabs are seldom helpful because the isolation of
GABHS often represents ________
asymptomatic carriage
Generally, throat cultures are not necessary
except to verify the presence of _______ especially
in closed institutions such as boarding schools, or if
diphtheria is suspected in the non-immunised
S. pyogenes,
What is dxtc of GABHS
A positive culture and
a fourfold rise in the ASO titre are necessary for a
precise diagnosis.
What test should be done if suspicious for EBM
If suspected, an
IgM antibody test should be ordered, rather than the
older tests, such as a Paul–Bunnell test.
Analgesic for children
analgesia: adults—2 soluble aspirin; children— paracetamol elixir (not alcohol base) or ibuprofen
What age group to consider bacterial cause of sorethroat
A bacterial cause is more common in
children aged 3–13 years than in children <3 years
Sore throat in the elderly may be caused by a ________ but otherwise needs to be treated with considerable
respect
viral infection
painful swallowing + referred ear pain + hoarseness
pharyngeal cancer
This infection may involve the pharynx only and vary
from mild to severe, or it may involve both tonsils
and pharynx. It is uncommon under 3 years or over
40 years.
Streptococcal tonsillopharyngitis
Dxtic features of streptococcal throat
• constitutional symptoms: — fever ≥ 38°C — toxicity • tender anterior cervical lymphadenopathy • tonsillar swelling and exudate • absence of cough
Indications for antibiotic therapy in strep throat
• existing rheumatic heart disease at any age
• severe tonsillitis with above features of GABHS
scarlet fever
• peritonsillar cellulitis or abscess (quinsy)
• patients 2–25 years with presumptive GABHS
from special communities
INdication for abx in strep throat
If there is a sore throat with no cough, but
fever >38 ° C, tender neck glands and white spots
in the throat, antibiotics are indicated
Antibiotic treatment has a variable effect on the
resolution of symptoms. It does not protect against
glomerulonephritis but does protect against ______
rheumatic
fever
_______ should be avoided in tonsillitis
because of confusion caused should mononucleosis be
present
Amoxycillin
Treat with prophylactic penicillin for patients with
________
more than five episodes of presumptive bacterial
tonsillitis in a year
When to give prophylaxis for recurrent tonsilitis?
The decision should be based
on the severity of the episode, time lost from work
or school, infectivity and response to antibiotics
In children this is a life-threatening infection. It
may be overlooked in adults where, unlike children,
the airway is usually not obstructed and the patient
presents with a severe sore throat, dysphagia,
drooling of saliva and a tender neck
Acute epiglottitis
What may modify the presentation of Diphtheira
The
clinical presentation may be modified by previous
immunisation or by antibiotic treatment.
What are the ssx of pts with Diphtheria
- Insidious onset
- Mild to moderate fever
- Mild sore throat and dysphagia
- Patient looks pale and ill
- Enlarged tonsils
Unique feature of Diphtheia
Pseudomembrane (any colour but usually grey–
green) can spread beyond tonsils to fauces, soft
palate, lateral pharyngeal wall and downwards to
involve larynx
Appearance of neck of pts with Diphtheria due to soft tissue swelling
‘bull neck’ appearance
Mx of Diphtheria
- Throat swabs
- Antitoxin
- Penicillin or erythromycin 500 mg qid for 10 days
- Isolate patient
The ________ is a real trap and must
be considered in patients aged 15–25 years (peak
incidence) with a painful throat that takes about
7 days to reach its peak
angiose form of EBM
SSx of EBM
Petechiae on palate (not pathognomonic)
• Enlarged tonsils with or without white exudates
(looks, but isn’t, purulent)
• Peri-orbital oedema
Dx of EBM
- Blood film—atypical lymphocytes
- White cell count—absolute lymphocytosis
- Heterophil antibodies
Alternatives to the Heterophil Antibodies
Monospot test
or
• EBV IgM test (more specific
An uncommon infection caused by the Coxsackie
virus. Presents as small vesicles on soft palate, uvula
and anterior fauces. These ulcerate to form small
ulcers. The problem is benign and rapidly self-limiting
Herpangina
How is Herpes simplex pharyngitis different from streptococcal pharyngitis
In adults primary infection is similar to severe
streptococcal pharyngitis but ulcers extend beyond
the tonsils.
__________ typically presents as milky-white
growths on the palate, buccal and gingival mucosae,
pharynx and dorsum of the tongue
Oral candidiasis
When to refer for tonsillectomy
• Repeated attacks of acute tonsillitis
• Enlarged tonsils and/or adenoids causing airway
obstruction, including OSA
• Chronic tonsillitis
• More than one attack of peritonsillar abscess
• Biopsy excision for suspected new growth
Consider severe tonsillitis with a covering
membrane as _________
EBM.
If an adult presents with an intensely painful throat
with a heavy exudate and seems toxic, consider
______ and ______
primary herpes simplex as well as streptococcal
throat
Reserve swabs of the throat for___________where it is important to do so,
for suspected diphtheria and for suspicion of other
serious infections such as tuberculosis
verification of a streptococcal throat
The triad: hoarseness, pain on swallowing and
referred ear pain = _________
pharyngeal cancer.
