RIME - Sore Throat
Kevin Chang, MSIII
November 26, 2010
History Intake
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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. diphtheria)
Physical Exam
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Mucosal injection / Erythema
Exudates / Swelling
Stridor / Drooling
Vesicles / Lesions
Asymmetry of tonsils / Deviation of uvula
Differential Diagnosis of and Management
Causes
Pharyngitis- Viral
Pharyngitis- Bacterial
Abscess- Bacterial
-Rhinovirus, coronavirus, RSV,
adenovirus, coxsackie A,
influenza, parainfluenza
-Group A Streptococcus,
Corynebacterium
diphteriae, Neisseria
gonorrhea, Chlamydia
pneumoniae,
Mycoplasma
pneumoniae
-Retropharyngeal,
Lateral pharyngeal,
Peritonsillar
-EBV (infectious
mononucleosis)
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
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)
-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)*
-Rapid strep test, if
normal, then throat
culture
-For GAS:
-10 day course of oral
penicillin
-OR single dose IM
benzathine penicillin G
-Group A Strep,
Staph aureus,
respiratory
anaerobes,
Haemophilus
-Difficulty
swallowing, drooling,
unwillingness to
move neck
(torticollis), change
in voice, respiratory
distress, neck
swelling/mass,
trismus
Other
Conditions
Epiglottitis
Inflammatory
conditions:
Kawasaki’s
disease, StevenJohnson
syndrome,
Behcet’s
syndrome
Chemical
exposure
Irritative
pharyngitis (dry
heat)
Foreign body
HSV (herpetic
stomatitis)
-Antibiotics (empiric
until culture results),
eg. Augmentin,
clindamycin
- Surgical drainage
Sources: Nelson Textbook of Pediatrics, AAP Pediatrics in Review, UpToDate