Thursday, 7 July 2016

Approach to sore throat

Sore throat: diagnostic strategy model

Probability diagnosis

  • Viral pharyngitis
  • Streptococcal tonsillitis
  • Chronic sinusitis with postnasal drip
  • Oropharyngeal candidiasis
Serious disorders not to be missed
  • Cardiovascular 
    • angina
    • myocardial infarction 
  • Neoplasia
    • cancer of oropharynx, tongue
  • Blood dycrasias (e.g. agranulocytosis, acute leukaemia)
  • Severe infections:
    • acute epiglottitis 
    • peritonsillar abscess
    • pharyngeal abscess
    • diphtheria 
    • HIV/AIDS
Pitfalls (often missed)
  • Foreign body 
  • Epstein-Barr mononucleosis
  • Candida
    • common in infants
    • steroid inhalers
  • STIs:
    • gonococcal pharyngitis
    • herpes simples (type II)
    • syphilis
  • Irritants (e.g. cigarette smoke, chemicals)
  • Reflux oesophagitis --> pharyngolaryngitis
  • Tonsilloliths
  • Cricopharyngeal spasm
  • Kawasaki disease
  • Chronic mouth breathing 
  • aphthous ulceration 
  • Thyroiditis
  • Rarities
    • scleroderma
    • behcet disease
    • sarcoidosis 
    • malignant granuloma 
    • tuberculosis

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