Sore throat

Question 1

What are 3 aspects of the management of sore throat as recommended by NICE?

Answer 1

1. Paracetamol or ibuprofen for pain relief
2. Antibiotics not routinely indicated
3. Some evidence that sigle dose of oral corticosteroid may reduce severity and duration of pain - not incorporated into UK guidelines yet

Question 2

Overall what are the 5 NICE indications for antibiotics?

Answer 2

1. Features of marked systemic upset secondary to the acute sore throat
2. Unilateral peritonsilitis
3. History of rheumatic fever
4. Increased risk from acute infection e.g. child with diabetes or immunodeficiency
5. Patients with acute sore throat/acute pharyngitis/acute tonsillitus when 3 or more Centor criteria present

Question 3

What is the Centor scoring system/criteria?

Answer 3

• score 1 point for each (maximum score of 4)
• Nice recommend treating with antibiotics when 3 or more
  
  1. presence of tonsillar exudate
  2. tender anterior cervical lymphadenopathy or lymphadenitis
  3. history of fever
  4. absence of cough

Question 4

What are the FeverPAIN criteria for treating a sore throat with antibiotics?

Answer 4

• score 1 point for each of the following; if 4 or more treat
  
  1. Fever over 38
  2. Purulence (pharyngeal/tonsillar exudate)
  3. Attend rapidly (3 days or less)
  4. Severely inflamed tonsils
  5. No cough or coryza

Question 5

If antibiotics are indicated to treat a sore throat, what are the 2 options? What length course is given?

Answer 5

1. Phenoxymethylpenicillin or
2. Erythromycin (if penicillin allergic)

7 or 10 day course

Question 6

How long does an acute sore throat/pharyngitis/ tonsillitis usually last?

Answer 6

1 week

Question 7

What are 3 complications of tonsillitis?

Answer 7

1. Otitis media
2. Quinsy - peritonsillar abscess
3. Rheumatic fever and glomerulonephritis - very rarely

Question 8

What are the criteria for a ptient to undergo tonsillectomy for sore throat?

Answer 8

All 4 criteria must be met:

1. Sore throats are due to tonsillitis - i.e. not recurrent upper respiratory tract infections
2. 5 or more episodes of sore throat per year
3. Symptoms ahve been occurring for at least a year
4. Episodes of sore throat are disabling and prevent normal functioning

Question 9

What are 4 ‘other established indications’ for a tonsillectomy?

Answer 9

1. Recurrent febrile convulsions secondary to episodes of tonsillitis
2. Obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
3. Peritonsillar abscess (qinsy) if unresponsive to standard treatment

Question 10

What 2 groups can the complications of tonsillectomy be split into?

Answer 10

1. Primary: <24 hours
2. Secondary: 24 hours to 10 days

Question 11

What are the 2 most common complications of tonsillectomy for both primary and secondary complications?

Answer 11

1. Haemorrhage - usually due to inadequate haemostasis for primary, due to infection for secondary
2. Pain

Question 12

How do the causes of haemorrhage following tonsillectomy differ for primary and secondary haemorrhage?

Answer 12

1. Primary: usually due to inadequate haemostasis
2. Secondary: usually due to infection

Question 13

What is peritonsillar abscess?

Answer 13

accumulation of pus due to infection behind the tonsil - have trouble opening mouth and hot potato voice, fever and pain