throat

Question 1

tonsillitis causes

Answer 1

• Most commonly caused by rhinovirus, coronavirus and adenovirus
  
  • Influenza virus, parainfluenza virus, enterovirus, herpes virus
  • Associated with EBV
  • Bacterial- group A beta-haemolytic streptococci
    Most is viral but some are bacterial GABHS
    If fever, tonsillar exudate, absence of cough and tender / anterior cervical lymphadenopathy then likely to be GABHS

Exclude retropharyngeal abscess/acute epiglottitis/HIV/infectious mononucleosis

Question 2

tonsillitis clinical features

Answer 2

• Sudden onset of sore throat
• Pain on swallowing
• Fever
• Headache
• Abdo pain
• Nausea
• Vomiting
• Absence of cough-runny nose (bacterial) (viral if present)
• Tonsillar exudate
• Anterior cervical lymphadenopathy

Question 3

GABHS (group A beta-haemolytic streptococcus)

Answer 3

Fever, tonsillar exudate, absence of cough and tender anterior cervical lymphadenopathy

investigations:

- Rapid streptococcal antigen testing
- FBC: raised WBC (neutrophilia= bacterial)
- Raised WBC, neutrophilia

Question 4

Infectious mononucleosis

Answer 4

Triad: fever, pharyngitis, lymphadenopathy
Heterophile antibody and serological tests for antibodies against EBV

- Cervical - generalised lymphadenopathy
- Pharyngitis- strep pyogens, petechiae on soft palate, exudative/non exudative
- Malaise
- Fever
- Other: splenomegaly, hepatomegaly, rash, jaundice, myalgia

Question 5

IM investigations

Answer 5

Positive agglutination test= heterophile antibodies
FBC- lymphocytosis. Anaemia, reticulocytotic
Heterophile antibodies
EBV specific antibodies
Real-time PCR

Supportive care- paracetamol, ibuprofen
corticosteroid