Throat infections

Question 1

Most common cause of tonsilitis

Answer 1

Viral infection

Question 2

Most common bacterial cause of tonsilitis

Answer 2

Group A strep (strep pyogenes)

Question 3

Treatment of bacterial tonsilitis

Answer 3

Penicillin V for 10 days

Question 4

Which tonsils are typically affected in tonsilitis

Answer 4

Palatine tonsils

Question 5

Presentation of tonsilitis

Answer 5

Sore throat, fever and pain on swallowing

Question 6

What is the centor criteria

Answer 6

Used to estimate the probability that tonsilitis is due to bacterial infection

Question 7

Features of centor criteria

Answer 7

Fever, tonsilar exudates, absence of cough and tender anterior cervical lymph nodes

Question 8

Score of centor criteria

Answer 8

Score of 3 or more gives 40-60% chance it is due to bacteria

Question 9

What is the feverPAIN score

Answer 9

Alternate to centor criteria - estimate probability that tonsilitis is due to bacterial infection

Question 10

Features of fever pain score

Answer 10

Fever - during prev 24 hours.
Purulence
Attended within 3 days of onset of symptoms
Inflamed tonsils
No cough or coryza

Question 11

Score of feverPAIN score

Answer 11

2-3 gives 34-4-% probability and 4-5 gives 62-65% chance of bacterial

Question 12

Management of tonsilitis

Answer 12

Safety net
Analgesia

Question 13

When should patients return

Answer 13

Return if pain has not settled after days or the fever rises above 38 degrees. Starting Abx should be considered

Question 14

What to prescribe if penicillin allergy

Answer 14

Clarithromycin

Question 15

Complications of tonsilitis

Answer 15

Peritonsillar abscess (quinsy), otitis media, scarlet fever, rheumatic fever, post strep GN, post strep reactive arthritis

Question 16

Causes of quinsy

Answer 16

Bacterial infection - common is strep pyogenes (group A strep), but also by staph aureus and H.influenza

Question 17

What is quinsy

Answer 17

Peritonsilar abscess

Question 18

What can quinsy be a complication of

Answer 18

Tonsilitis

Question 19

Additional symtoms of quinsy

Answer 19

Trismus (unable to open their mouth), change in vioce due to pharyngeal swelling (hot potato voice), swelling and erythema in area beside the tonsils

Question 20

Presentation of quinsy

Answer 20

Sore throat, painful swallowing, fever, neck pain, referred ear pain, swollen tender lymph nodes.

Question 21

Management of qiunsy

Answer 21

Needle aspiration or surgical incision and drainage to remove pus from the abscess. Abx before and after surgery

Question 22

Antibiotics used in quinsy

Answer 22

Co-amoxiclav

Question 23

Cause of glandular fever

Answer 23

EBV

Question 24

Presentation of glandular fever

Answer 24

2-3 weeks general malaise, sore throat, septic, fever, white/green tonsils, petechial haemorrhage on palate, cervical lymphadenopathy, hepatosplenomegaly

Question 25

Management of glandular fever

Answer 25

Abx, analgesia, no contact sports or alcohol for 3 months

Question 26

Symptoms of viral or bacterial pharyngitis

Answer 26

Diffuse sore throat and UTRI symptoms, diffuse erythema and oedema of the oral and nasopharyngeal mucosa.

Question 27

Treatment of pharyngitis

Answer 27

Supportive care, saline gargles, hydration, abx if bacterial

Question 28

Symptoms of lingual tonsilitis

Answer 28

Pain in upper throat, garbled voice and odynophagia is prominent, enlarged lingual tonsils with exudate

Question 29

Treatment of lingual tonsilitis

Answer 29

10 day course of penicillin

Question 30

Symptoms of candidiasis

Answer 30

Oral and pharyngeal pain, erythema, oedema with multiple white patches, where removal shows ulcerated mucosa

Question 31

Diagnosis of candidiasis

Answer 31

KOH prep which reveals budding yeast forms