Sore Throat

Question 1

Define acute pharyngitis

Answer 1

Pharyngeal inflammation with rapid onset sore throat

Self-limiting condition, resolving in 2 weeks

Question 2

Epidemiology of pharyngitis

Answer 2

School age children
Winter - bacterial
Summer/autumn - viral

Question 3

Aetiology of pharyngitis

Answer 3

Bacterial: Group A Streptococcus
Viral: EBV, adenovirus, enterovirus, influenza A and B
Candida - in immunocompromised
STI - sexual abuse
Diphtheria, Measles - low income countries

Question 4

Clinical classification of pharyngitis

Answer 4

GAS:
Absence of cough (+ cervical adenopathy = highest specificity)
presence of fever, sore throat, pharyngeal exudate, cervical adenopathy
Diagnosed by positive rapid antigen test or culture

Viral:
May of may not have pharyngeal exudate
EBV Accompanied by lymphadenopathy and splenomegaly
Diagnosis supported by negative culture

Diphtheria:
Grey membrane in nose and throat that bleeds when dislodged

Measles:
Koplik spots - white raised lesions on erythematous base in buccal mucosa
Associated with conjunctivitis, rhinitis, cough, exanthem (widespread rash)

Question 5

Clinical features of pharyngitis

Answer 5

Sore throat 
Pharyngeal exudate - bacterial and viral 
Cervical adenopathy 
Fever 
Headache 
N+V, abdo pain 
Viral, nasal congestion, cough 
Measles: conjunctivitis, maculopalular rash, Koplik spots

Question 6

Investigations for pharyngitis

Answer 6

Rapid antigen test for GAS

Throat swab culture

Question 7

Management of pharyngitis

Answer 7

Supportive:
paracetamol, ibuprofen
(Avoid aspirin - Reye’s syndrome, ibuprofen safer)

WO confirmed GAS: delayed or no abx therapy

Confirmed GAS:
Phenoxymethylpenicillin PO 10 days
Or Benzylpenicillin IM single dose

Question 8

Define tonsillitis

Answer 8

Acute infection of palatine tonsils

Can occur in isolation or as part of generalised pharyngitis

Question 9

Aetiology of tonsillitis

Epidemiology

Answer 9

Viral: rhinovirus, Coronavirus, adenovirus, influenza virus, enterovirs, herpes virus, EBV
Bacteria: Group A beta-haemolytic streptococci

School age

Question 10

Clinical features of tonsillitis

Answer 10

Pain on swallowing 
Fever >38
Tonsillar exudate
Acute sore throat 
Presence of cough or runny nose
Tonsillar erythema
Tonsillar enlargement
Cervical lymphadenopathy 
Headache 
N+V 
Abdominal pain

Question 11

What is Centor Criteria

Answer 11

Signs and symptoms to that indicate likelihood of bacterial tonsillitis

Hx of fever >38
Tonsillar exudate
Absence of cough
Tender anterior cervical lymphadenopathy

3-4: 60% positive predictive value
<3: high negative predictive value
Allows to confine microbiological testing

Question 12

Investigations for tonsillitis

Answer 12

Throat culture

Rapid streptococcal antigen test

Question 13

Management of tonsillitis

Answer 13

Analgesia - paracetamol, ibuprofen, topical Lidocaine

If GABHS:
Phenoxymethylpenicillin PO 10 days, Benzylpenicillin IM single dose
Dexamethasone IM single dose: if >12yo and inability for oral intake, symptoms of airway obstruction, and already receiving abx

Tonsillectomy

Question 14

Indications for tonsillectomy

Answer 14

7 episodes/year in 1 year
5 episodes/year for 2 years
3 episodes/year for 3 years
No other explanation for recurrent symptoms 
obstructive sleep apnoea 
peri-tonsillar abscess

Question 15

Complications of tonsillitis

Answer 15

Scarlet fever - diffuse erythematous rash due to skin sensitivity to pyrogenic exotoxin produced by streptococcal species
Acute sinusitis
Acute otitis media
Peri-tonsillar and retropharyngeal abscess
Rheumatic fever - autoimmune complication of streptococcal tonsillitis, of arthritis, carditis, chorea, subcutaneous nodules, erythema