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Sore throat (Aetiology (Infection (commonest) Viral: cold viruses…
Sore throat
Aetiology
Infection
(commonest)
Viral:
cold viruses (rhinovirus, coronavirus, parainfluenzavirus), influenza, adenovirus, EBV, HSV, HIV, enteroviruses, measles
Bacterial:
Group A B-haemolytic strep, HiB, Gonorrhoea, Yersinia
Fungal:
Candida
Trauma
NG tube
Smoke inhalation
Autoimmune
Kawasaki disease
Iatrogenic
Chemo, RT
Drugs
Cytotoxics
Haematological
Leukaemia
Aplastic anaemia
Idiopathic
GORD
Hayfever
Diagnosis
(clinical)
Examination
ENT
Ears: erythema, may have otitis media
Nose: discharge, erythema
Throat: erythema, inflamed tonsils, pus
LNs: may have enlarged LNs
Resp
Often nil, may have wheeze/crackles
Investigations
Swabs
Not routine
Bedside
Obs (sats, RR, HR, BP, temp)
Bloods
FBC (only if immunosuppressed/suspect sepsis),
CRP, U+E, ABG, blood cultures (suspecting sepsis),
History
PMH
Previous episodes
Medical conditions, surgeries
DH
Regular medications
Allergies (abx)
PC/HPC
Sore throat, onset, fever,
swallowing difficulty, nausea and vomiting
FH
H+N disease e.g. cancers
SH
Smoking, alcohol,
social support,, occupation
Criteria
Centor
Score 1 for each of tonsillar exudate,
tender anterior cervical LNs, fever history, no cough
Score 3-4=likely strep throat
FeverPain
Score 1 for each of fever >38, purulence,
onset <3d, inflamed tonsils, no cough/coryza
Score 4-5= very likely strep throat
Definition
Pharyngitis
Inflammation of the oropharynx
Tonsilitis
Inflammation of the tonsils
Laryngitis
Inflammation of the larynx
Epidemiology
Common
1/3 adults/yr
Children/YA
Clinical
presentation
Sore throat
Fever
Coryzal symptoms
(viral)
Management
Medical
Abx
Indication: likely bacterial (Centor 3-4)
E.g. penicillin V 5d, clarithromycin 5d (check local guides)
NB avoid amoxicillin (rash in EBV patients)
Analgesia and antipyretic
Indication: pain and fever
E.g. paracetamol, ibuprofen
Surgical
Tonsillectomy
Indication: recurrent tonsillitis (7/1y)
MOA: removal of tonsils
SEs: bleeding, infection, failure
Conservative
Information, advice, support
Plentiful fluids
Rest
Salt water gargling
Complications
Local spread
Otitis media
Acute sinusitis
Acute RF
Tonsilitis
Abscesses
Peritonsillar abscess (quinsy)
Parapharyngeal abscess (rare)
Lemierre syndrome
Acute sepsis and jugular vein thrombosis
plus systemic septic emboli (rare)
Prognosis
Viral/bacterial generally
resolve in <2wk