Sore Throat/Tonsillitis

Question 1

What can sore throat be?

Answer 1

Acute pharyngitis (inflammation of the oropharynx)
Tonsillitis
Laryngitis

Question 2

What can cause sore throat?

Answer 2

Viral:
Common cold - rhinovirus, coronavirus, parainfluenza virus
Influenza type A and B
Adenovirus
Herpes simplex
EBV

Bacteria
Group A beta-haemolytic Streptococcus

Question 3

What investigation sin sore throat?

Answer 3

Throat swabs should not be taken routinely

Clinical diagnosis

Question 4

What is management of sore throat?

Answer 4

Reassure
Symptomatic relief: regular ibuprofen and paracetamol
Consider mouthwashes or spread
Do not routinely provide antibiotics

Question 5

What are the centor criteria

Answer 5

C - absence of cough
E - tonsillar exudates present
N - tender anterior cervical lymphadenopathy
T - history of fever

Presence of 3 or 4 of these criteria suggest infection due to Streptococcus and patients may benefit from antibiotics

Question 6

What are indications for antibiotics?

Answer 6

Centor criteria 3+
Features of marked systemic upset
Unilateral peritonsilitis
Hx of rheumatic fever
Increased risk from acute infection (child with DM/ immunocompromised)

Question 7

What antibiotics for sore throat?

Answer 7

Penicillin V (phenoxymethylpenicillin) for 10 days
Calrithromycin/erythromycin 5d if pen-allergic

Avoid amoxicillin which causes pathognomonoic rash in all EBV pharyngitis

Question 8

What are complications of tonsillitis?

Answer 8

Otitis media
Sinusitis
Peritonsillar abscess (quinsy)
Parapharyngeal abscess - swelling in neck - incise and drain under GA
Lemierre syndrome

Question 9

What is quinsy? Management?

Answer 9

Sore throat, dysphagia, peri-tonsillar bulge, uvular deviation, trismus (reduced opening of jaw) and muffled voice
Abx and aspiration required

Question 10

What is Lemierre syndrome

Answer 10

Acute septicaemia and jugular vein thrombosis sendoary to infection with Fusobacterium species and septic emboli

Question 11

What are indications for tonsillectomy?

Answer 11

All 3 of:

• Recurrent sore throat is due to tonsillitis
• Episodes of sore throat are disabling and prevents normal functioning
• 7+ well documented, clinically significant, adequately treated sore throats in preceding year, 5+ is each of last 2

Recurrent febrile convulsions secondary to tonsilitis
OSA, stridor, dysphagia due to tonsils
Peritonsillar abscess fi unresponsive

Question 12

What are complications of tonsillectomy?

Answer 12

Primary haemorrhage <24h - immediate return to theatre
Secondary haemorrhage (>24h but typically after 5-10 days) due to infection of tonsillar fossa
- Treat with IV antibiotics

Question 13

What causes Scarlett fever? Signs?

Answer 13

Endotoxins released by Strep progenies (GABHS)

Rash develops on chest, axilla, behind ears 12-48h after initial sore throat and fever

Red pin-prick blanching rash, facial flushing, strawberry tongue

Scarlett
SAUNA then RASH

Question 14

What is management for Scarlett fever?

Answer 14

Penicillin V (clarithromycin if pen allergic) for 10d

Question 15

What are complications of Scarlett fever?

Answer 15

Post-infective demyelinating disorder