RIME  -  Sore Throat

Kevin Chang, MSIII

November 26, 2010

 

History Intake

·         Duration, severity, improving/worsening

·         Onset (abrupt or gradual)

·         Respiratory distress / difficulty breathing

·         Fever (how high, how long, getting better or worse)

·         Fatigue

·         Immunization history (important for C. diptheriae)

 

Physical Exam

·         Mucosal injection / Erythema

·         Exudates / Swelling

·         Stridor / Drooling

·         Vesicles / Lesions

·         Assymetry of tonsils / Deviation of uvula

 

Differential Diagnosis of and Management

 

Pharyngitis- Viral

Pharyngitis- Bacterial

Abscess- Bacterial

Other Conditions

Causes

-Rhinovirus, coronavirus, RSV, adenovirus, coxsackie A, influenza, parainfluenza

 

-EBV (infectious mononucleosis)

 

 

-Group A Streptococcus, Corynebacterium diphteriae, Neisseria gonorrhea, Chlamydia pneumoniae, Mycoplasma pneumoniae

-Retropharyngeal, Lateral pharyngeal, Peritonsillar

 

-Group A Strep, Staph aureus, respiratory anaerobes, Haemophilus

-Epiglottitis

 

-Inflammatory conditions: Kawasaki’s disease, Steven-Johnson syndrome, Behcet’s syndrome

 

-Chemical exposure

 

-Irritative pharyngitis (dry heat)

 

-Foreign body

 

-HSV (herpetic stomatitis)

Symptoms

And Signs

-Sore throat, difficulty speaking, difficulty swallowing, neck tenderness / swollen lymph nodes, fever, headache

 

-Adenovirus: pharyngoconjunctival fever

-Coxsackie: herpangina, hand/foot/mouth

-EBV: excessive fatigue, chronic duration, lymphadenopathy, splenomegaly

-Sore throat, difficulty speaking, difficulty swallowing, neck tenderness / swollen lymph nodes, fever, headache

 

*Note: Mostly indistinguishable from viral sx, though may have a more prolonged course or purulent exudate)*

 

-Difficulty swallowing, drooling, unwillingness to move neck (torticollis), change in voice, respiratory distress, neck swelling/mass, trismus

 

 

Treatment

-Self limited, tx symptomatic

- acetaminophen, NSAIDs (no aspirin)

- warm liquids (honey/lemon tea)

-gargle with warm salt water

-throat lozenges (not in young children)

 

-Rapid strep test, if normal, then throat culture

-For GAS:

   -10 day course of oral

   penicillin

   -OR single dose IM

   benzathine penicillin G

-Antibiotics (empiric until culture results), eg. Augmentin, clindamycin

 

- Surgical drainage

 

Sources:  Nelson Textbook of Pediatrics, AAP Pediatrics in Review, UpToDate