Sore Throat and Tonsillitis

Question 1

What are the two main causes of an acute sore throat?

Answer 1

Acute pharyngitis or tonsillitis

Question 2

What are the causes of a sore throat and which is more common?

Answer 2

1. Viral (more common) - rhinovirus, coronavirus, parainfluenza virus
2. Bacterial - group A beta-haemolytic streptococcus

Question 3

What is the criteria for identifying a bacterial cause of a sore throat?

Answer 3

Centor criteria:

1. Presence of tonsillar exudate
2. Presence of tender lymphadenopathy
3. Presence of fever
4. Absence of cough

Question 4

How is tonsillitis diagnosed?

Answer 4

1. Large, red tonsils
2. May or may not be coated in a tonsillar exudate
3. Tonsillar swab culture

Question 5

What is the treatment for viral tonsillitis?

Answer 5

Reassure, symptomatic relief (ibuprofen +/- paracetamol)

Question 6

What is the treatment for bacterial tonsillitis?

Answer 6

Symptomatic relief (ibuprofen +/- paracetamol), consider penicillin V for 10 days (macrolide for 5-days if allergic).

Question 7

What is the indication for tonsillectomy in tonsillitis?

Answer 7

More than 6 episodes per year that are severe enough to miss school or prevent normal functioning.

Question 8

What is the main complication of tonsillitis and how is it treated?

Answer 8

Peritonsillar abscess (Quinsy):

1. Extremely painful sore throat, dysphagia
2. Antibiotics and surgical drainage needed