Sore throat in GP Flashcards
What are the most common causes of sore throat in GP?
Viral infections (80%)
Eg. adenovirus, rhinovirus, influenza, RSV, EBV
What are the common causes of bacterial sore throat?
Mainly group A beta-haemolytic streptococci
Eg. strep pyogenes
What is the incidence of sore throat caused by bacteria in different age groups?
15% under 3
50% 4-13
10% adults
What are some suppurative complications of a sore throat?
Otitis media
Sinusitis
Quinsy
Rheumatic fever (rare)
What is Quinsy?
A peritonsillar abscess
- a complication of tonsillitis
Needs ENT referral for antibiotics and possible tonsillectomy
How can a sore throat cause rheumatic fever?
Mostly in 5-14 year olds
Caused by a antibody cross-reaction with heart, joints, brain, and skin
Only occurs if the sore throat infection isn’t treated properly
How can teeth cause a sore throat?
Dental abscesses can cause a sore throat
What is an aphthous ulcer?
AKA anker sores
Small, shallow lesions that develop on the soft tissues in your mouth or at the base of your gums
Caused by stress, acidic foods and minor injuries
What is mumps?
A viral infection that causes swelling of the parotid glands
What are the symptoms of oropharyngeal thrush?
-White patches that when wiped off leave red areas that may bleed slightly
-Loss of taste or an unpleasant taste in the mouth.
-Redness inside the mouth and throat
-Cracks at the corners of the mouth
- Painful, burning sensation in the mouth
-Pain on swallowing
What is glandular fever?
Caused by the Epstein-barr virus and mostly affects adults
What are the symptoms of Glandular fever?
-Fatigue
-Headache
-Loss of appetite
-Sore throat
-Cough
-Photophobia
-Swollen tonsils
-Swollen lymph nodes
-Enlarged spleen
-Nausea
-Abdo pain
-Chills and fevers
What are some causes of a deviated uvula?
Quinsy
Unilateral vagal nerve palsy
-Always note if uvula is central
What is a bifid uvula?
A split uvula occurring in 2% of population
It can swell up in an odd way but causes no other problems
When is a uvulectomy performed?
For snoring and sleep apnoea
-Usually done privately
Or done for cultural reasons (Somalia)
How long does it take for a sore throat to resolve?
3-7 days
What complications of sore throat do antibiotics protect against?
Suppurative complications
Not immunological effects like rheumatic fever or glomerulonephritis
What is the modified centor score used for?
It estimates the probability that the pharyngitis is streptococcal and suggests management plan
Criteria: age, exudate/ swelling of tonsils (+1) tender/enlarged cervical lymph nodes (+1)
, temp >38 (+1), absence of cough (+1)
Score 3-4 should be considered for antibiotics
What is scarlet fever?
A contagious bacterial infection
Symptoms: flu-like, erythematous rash that feels rough, strawberry tongue
It mostly affects young children
What is a notifiable disease?
Needs to be reported and interactions needs to be tracked to prevent spread because it’s a rare disease now
Should swabs be taken for sore throats
No, it doesn’t change the management, they’re expensive, and the results take too long to come back
What is the management of a sore throat in england?
-centor 1-3, try to resist antibiotics
-Simple management based
-Advise losangers, paracetamol, and fluids
Why can’t amoxicillin be given for a sore throat?
Because it could be glandular fever and it would cause a rash
Amoxicillin is also broad spectrum so had greater resistance
What antibiotics are prescribed for a sore throat?
1st-line:
Penicillin V 500mg 4 times a day for 7 days
If allergic:
Cephalosporins
But it causes an increased risk of C-diff especially in the elderly
When is the guidance for a tonsillectomy?
7+ in 1 year
OR
5+ in 2 years
OR
3+ in last 3 months
