Sore Throat
Sore Throat
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DDx
Aphthous Ulceration
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OE
SPOC
Stridor or respiratory distress
Muffled voice
Drooling
Torticollis
Asymmetric pharyngeal swelling / uvula deviation (Quinsy)
Grey-white pharyngo-tonsillar membrane
Bruising, petechial or other rash
Toxic appearance
Dehydration
Cervical lymphadenopathy > 2cms
Child with persistent fever for >48 hours
Trismus
Hot potato voice.
Modified Centor Clinical Scoring System (not valid <3yo)
Ix
Swab
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Rx
Antibiotics if (may only improve by 1 day)
Admission if
Factsheet
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(Summarises NSW Sore Throat CPG)
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DDx
- Pharyngitis
- Tonsillitis
- Peritonsillar abscess (asymmetrical pain / swelling)
- Retropharyngeal abscess
- Foreign body
- Epiglottitis
- Toxic ingestion
- Adenovirus (conjunctivitis)
- Rhinovirus
- Enterovirus
- Cytomegalovirus
- Coxsackie virus (posterior pharyngeal ulcers)
- Herpes Simplex virus (gingivostomatitis)
- EBV (tonsillitis (can have membrane), lymphadenopathy, splenomegaly)
- Parainfluenzae (barking cough)
- Influenza A and B (Myalgia)
- Group A beta haemolytic streptococci (GAS) infection (30% carriage >5yo, 60% >5yo ATSI)
- scarlet fever
- toxic shock syndrome
- acute glomerulonephritis (ATSI highest rate in world)
- acute rheumatic fever (ATSI highest rate in world)
- Diphtheria
- Grey membrane
Aphthous Ulceration
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OE
SPOC
Stridor or respiratory distress
Muffled voice
Drooling
Torticollis
Asymmetric pharyngeal swelling / uvula deviation (Quinsy)
Grey-white pharyngo-tonsillar membrane
Bruising, petechial or other rash
Toxic appearance
Dehydration
Cervical lymphadenopathy > 2cms
Child with persistent fever for >48 hours
Trismus
Hot potato voice.
Modified Centor Clinical Scoring System (not valid <3yo)
- Temperature > 38C (1)
- No cough (1)
- Tender anterior cervical adenopathy (1)
- Tonsillar swelling or exudate (1)
- Age 3 – 14 years (1)
- Age 15 – 44 years (0)
Ix
Swab
- MCS if starting ABs for (carriage high so false +, and surface culture may not show infective agent)
- GAS: ASOT, AntiDNase (consider for ATSI)
- EBV IgM/G, monospot
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Rx
Antibiotics if (may only improve by 1 day)
- Modified Centor score >2
- ATSI
- Hx exposure to known GAS
- Penicillin
- Phenoxymethylpenicillin (Penicillin V)
- 15 mg/kg/dose 12 hourly for 10 days
- max 250mg <10y
- max 500mg >10y
- 15 mg/kg/dose 12 hourly for 10 days
- Benzylpenicillin
- Phenoxymethylpenicillin (Penicillin V)
- Penicillin allergy
- Roxithromycin 4mg/kg/dose (max 150mg) 12 hourly for 10 days
- Paracetamol orally 15mg/kg/dose (maximum 1g) q6h PRN for 1-2 days
- Ibuprofen orally 5mg/kg/dose (maximum 400mg) q8h PRN for 1-2 days (avoid in GAS and Asthma)
- Xylocaine viscous
- Dexamethasone
- PO not routine
- IV if admitted
- PO / NG / IV
Admission if
- Airway compromise inc significant OSA
- Toxic
- Inability to tolerate fluids +/- dehydration
Factsheet
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(Summarises NSW Sore Throat CPG)