sore throat
| most sore throats are viral.... and yet. | |
|---|---|
| History | Duration of illness Immunocompromise → indication f |
| Examination | Specific signs - palatal petechiae - Group A strep - uvular deviation - peritonsillar abscess (quinsy) - grey pseudomembrane on tonsil - diphtheria - posterior pharyngeal swelling - retropharyngeal |
| Diagnostic investigations | Rapid strep antigen testing, ASOT - may be useful - Lymphocytosis, deranged liver function suggest infectious mononucleosis → Monospot, Paul Bunnell - Lateral soft |
| Differentials | - tonsillitis/pharyngitis (viral/bacterial) - Epiglottitis |
| Management | Resuscitation Is there airway concern? Get ENT and anaesthetics/ICU - ?tracheostomy, AFOI (!) In the meantime, adrenaline nebs (5ml 1:1000) and IV dex can help. Well patient - tonsillopharyngitis Abx shortens duration of illness by 16 hours - NICE advises giving only if FeverPAIN >= 4, or CENTOR >= 3 |
scoring systems
basically everyone's asking "do i need antibiotics???" because pen V cures everything
centor
- tonsillar exudate
- tender anterior cervical lymphadenopathy
- history of fever
- absence of cough
score of 3-4 = 32-56% liklihood of isolating streptococcus
feverPAIN
- fever in last 24h
- purulence (pharyngeal or tonsillar)
- attend within 3 days
- severely inflamed tonsils
- no cough/coryza
score 4-5 = 62-65% likelihood of isolating streptococcus
when to give abx
Well.
FeverPAIN 2-3 = "more likely to benefit from abx"
- backup abx
FeverPAIN 4-5 or Centor 3-4 = most likely to benefit from abx
red flags (ENT)
- quinsy
- retropharyngeal or parapharyngeal abscess
- sepsis
red flags i.e. other horrifying things that can happen
- retrograde spread - e.g. cerebral abscesss
- invasive GAS → toxic shock syndrome
- post-strep glomerulonephritis
- mediastinitis - via spread through 'danger space' (deep to retropharyngeal space?)
- Lemierre syndrome - thrombophlebitis of internal jugular vein (!!!) - Fusobacterium necrophorum