| Things to consider when having a sore throat: Sore throat diagnostic strategy model |
| Probability diagnosis • Viral pharyngitis • Chronic sinusitis with postnasal drip |
| Serious disorders not to be missed • Cardiovascular –Angina –MI • Neoplasia –Carcinoma of oropharynx, tongue –Blood dyscrasias (e.g. agranulocytosis, acute leukaemia-pharyngitis) • Severe infections –Acute epiglottitis (sudden onset in children) –Peritonsillar abscess –Pharyngeal abscess –Diphtheria –HIV / AIDS (candidiasis) |
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| Pitfalls (Often missed) • Foreign body (sore throat in the afternoon after meals) • Epstein Barr mononucleosis • Candida (fungal infection) • S.T.I.s (gonococcal, herpes simplex type 2) • Irritants (chronic sore throat – e.g. smoking, alcoholics, environmental irritant, postnasal drip, GERD) • Reflux esophagitis • Mouth breathing (e.g. morning sort throat due to nasal congestion-lack of humidification) • Thyroiditis Rarities (some are not, depends on the country u come from) • systemic sclerosis • sarcoidosis • malignant granuloma • tuberculosis |
| Seven masquerades checklist • Depression • Diabetes • Drugs • Anaemia • Thyroid disorder • Spinal dysfunction History taking: •Personal history •Determine the nature of sore throat –Sore throat –Deep pain in the throat –Neck pain •Character, onset, progression, severity, aggravating & relieving factors, seen a doctor(?). Associated symptoms –Fever –Chills & rigors –Headache –URTI –Difficulty swallowing –Ear pain –Nasal congestion / discharge –Cough –Tender cervical LN –Metallic taste in the mouth (candida) –Malaise –Bone pain (leukemaia) –GI symptoms (nausea, vomiting, abdo. Relevant Past Medical History: –Asthmatic on corticosteroid inhaler –CVS diseases –HIV / AIDS –DM –STIs –Reflux esophagitis –TB Family history: –Atophy –CVS diseases –Neoplasia Socail history: –Smoker & excessive alcohol beverage consumption –Living environment (environmental irritants, diseases) --History of travel |
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