Throat Infections

Question 1

Define acute pharyngitis

Answer 1

Inflammation of the oropharynx

Question 2

Define tonsillitis

Answer 2

Inflammation of tonsils

Question 3

What microorganisms are the most common cause of a sore throat

Answer 3

Rhinovirus etc (common cold)
Influenza
Streptococci

Question 4

What infection should you consider in a patient aged 15-25 with a sore throat

Answer 4

Infectious mononucleosis (glandular fever, EBV)

Question 5

Name 4 non-infectious causes of a sore throat

Answer 5

GORD, smoking irritation, alcohol irritation, hay fever etc

Question 6

Pharyngitis & tonsillitis complications

Answer 6

Otitis media
Peritonsillar abscess (quinsy)
Parapharyngeal abscess
Lemierre syndrome

Question 7

What is Lemierre syndrome

Answer 7

suppuration thrombophlebitis of jugular vein

Question 8

What is the most common bacterial cause of a sore throat

Answer 8

Strep pyogenes (group A beta haemolytic strep)

Question 9

Strep pyogenes throat infection treatment

Answer 9

Penicillin

Question 10

Strep pyogenes (strep throat) late complications

Answer 10

Rheumatic fever
- 3 wks post infection,
- fever, arthritis, pancarditis

Glomerulonephritis
- 1-3 wks post infection
- haematuria, albuminuria, oedema

Guttate psoriasis

Question 11

What should you do if a patient who is taking DMARDs presents with a sore throat & why

Answer 11

Withhold treatment & contact specialist
Carry out an urgent FBC
Provide symptomatic relief & consider antibiotics

… as risk of neutropenia with DMARDs

Question 12

Diptheria clinical presentation

Answer 12

Severe sore throat
Pseudomembrane (grey/white) in posterior pharynx

Question 13

What microorganism causes diptheria

Answer 13

Corynebacterium diphtheria

Question 14

Diphtheria management

Answer 14

Treat - antibiotic or antitoxin & supportive
Prevent - Vaccination

Question 15

Why is diphtheria a concern

Answer 15

Pseudomembrane can obstruct the airway
It produces a potent exotoxin that is cardio & neurotoxic

Question 16

What causes infectious mononucleosis

Answer 16

Epstein-Barr Virus (part of herpes family)

Question 17

What is infectious mononucleosis aka

Answer 17

Glandular fever
Kissing disease

Question 18

Infectious mononucleosis presentation

Answer 18

Sore throat, pharyngitis, lymphadenopathy (classic triad)
Malaise, lethargy, fever (general)

Other
- jaundice/hepatitis, splenomegaly
- lymphocytosis, atypical lymphocytes, anaemia
- palatal petechia, rash

Question 19

Infectious mononucleosis investigations

Answer 19

EBV IgM serology (1st line)
Heterophile antibody (less commonly used)

+/- FBC & film & LFTs

Question 20

Infectious mononucleosis treatment

Answer 20

Supportive/ self limiting
Anti virals NOT effective
If severe - systemic steroids

Question 21

What 3 infections can present similar to infectious mononucleosis

Answer 21

Cytomegalovirus
Toxoplasmosis
Primary HIV infection

Question 22

Where does EBV target/ infect

Answer 22

epithelial cells, notably in the pharynx

Question 23

Why should patients worth infectious mononucleosis stop sports for 6 weeks

Answer 23

Due to risk of pelvic rupture

Question 24

What is a downside of EBV serology

Answer 24

Not always elevated right at the start of infection

Question 25

Infectious mononucleosis complications

Answer 25

• Anaemia, thrombocytopenia
• Splenic rupture
• Upper airway obstruction
• Increased risk of lymphoma, especially in immunosuppressed

Question 26

Thrush causative microorganism

Answer 26

Candida albicans

Question 27

Candida/ thrush presentation

Answer 27

White patches on red, raw mucous membrane

Question 28

Name some common triggers of candida/ thrush

Answer 28

Antibiotics, immunosuppression, smoking, inhaled steroids

Question 29

Candida/ Thrush treatment

Answer 29

Nystatin or fluconazole