Sore Throat

Question 1

What is the most common cause of tonsillitis?

Answer 1

Viral

Question 2

3 examples of viruses causing tonsillitis

Answer 2

EBV, HSV, adenovirus

Question 3

What is the most common bacterial cause of tonsillitis?

Answer 3

Group A strep (strep pyogenes)

Question 4

Centor criteria: purpose

Answer 4

Determines likelihood of bacterial tonsillitis (group A Strep)

Question 5

4 parts of the centor criteria

Answer 5

1. Tonsillar exudate
2. Acute cervical lymphadenopathy
3. Fever >38
4. ABSENCE of cough

Question 6

What centor score = strep infection likely?

Answer 6

3 or 4

Question 7

5 parts of the feverPAIN score

Answer 7

1. Fever >39
2. Prurulence (exudate)
3. Attend rapidly (<3 days)
4. Inflamed tonsils
5. No cough

Question 8

For confirmed bacterial tonsillitis, what is the first line?

What would you give in penicillin allergy?

Answer 8

Phenoxymethylpenicillin (PEN V)

Pen allergy: clarithromycin

Question 9

Which abx do you avoid in sore throat & why?

Answer 9

Avoid amoxicillin!! (can cause rash in EBV)

Question 10

What mouthwash/ spray can be offered in tonisillitis?

Answer 10

Difflam mouthwash/ spray

Question 11

What are the indications for referral for elective tonsillectomy?

Answer 11

> 7 episodes in the last year

OR >5 every year for past 2 years

Question 12

What is quinsy?

Answer 12

AKA peritonsillar abscess

pain localised to one side of throat

Question 13

Appearance of tonsils & uvula in quinsy

Answer 13

Bulging tonsil

Uvula displaced to one side

Question 14

How is quinsy managed?

Answer 14

IV benzylpenicillin 1.2g (clarithromycin in allergy)

ENT referral for aspiration/ drainage

Question 15

Sore throat differentials

Answer 15

Cold
Influenza
Glandular fever
Epiglottitis

Question 16

Features of glandular fever

Answer 16

Pharyngitis >days

Adenopathy & splenomegaly

Question 17

Investigations in suspected glandular fever

Answer 17

MONOSPOT test & FBC for atypical lymphocytes = suggestive of glandular fever