A sore throat is usually a symptom of an infective process. If a patient presents with a complaint of a sore throat, a number of differential diagnoses must be considered before determining a final diagnosis. Mononucleosis can also cause this, but since you didnt mention extreme fatigue, i wouldnt include this in the differential diagnosis. With increasing severity, there may be severe pain that increases with swallowing plus. Utilization management, medical and pharmaceutical services, b. Differential diagnosis for a respiratory disease outbreak. We present a systematic approach to differential diagnosis of painful thyroid disorder. It accounts for more than million visits to doctors offices each. Oct 19, 2016 sore throat is usually due to a viral infection. Differential dx strategies university of massachusetts. A sore throat, fever and rash wiley online library.
A sore throat, also called a throat infection or pharyngitis, is a painful inflammation of the back part of the throat pharynx. Dr nigel stollery compares four presentations and offers clues for their diagnosis. The diagnosis of strep throat in adults in the emergency room. The pain is described as sharp, 410 in severity, located on the. Differential diagnoses infectious mononucleosis im. Strep throat is a particular kind of pharyngitis that is caused by a bacterium known as group a streptococcus gas. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Its also not common in most parts of the united statesmainly the. Pharyngotonsillitis is the most common upper respiratory tract infection for which antibiotics are prescribed in sweden. Usually, a sore throat is the sign of another illness, such as a cold or the flu aamir et al. When evaluating a patient with a sore throat, it is important to differentiate pharyngitis caused by group a streptococcus gas from that caused by other pathogens. Describe the laboratory testing available to aid in the diagnosis of pharyngitis. Common signs and symptoms of streptococcal pharyngitis include sore throat, temperature greater than 100.
Differential diagnosis for a repiratory disesae outbreak. Sore throat is a very common complaint for which children and adolescents seek medical care. Pdf the differential diagnosis of painful thyroid disorders. Differential diagnoses oral and throat infections gponline. Oral cavity dry mucous membranes suggest dehydration from odynophagia and indicates severity of. When the examinee presses on your abdomen, say that it hurts a little bit all over. Neck stiffness, limitation of extension suggestive of retropharyngeal abscess. They are written by uk doctors and based on research evidence, uk and european guidelines. You may find the sore throat article more useful, or one of our other health articles. A clinical score to reduce unnecessary antibiotic use in patients with sore throat.
Viruses can cause a sore throat and other upper respiratory infections, such as the common cold. I also seem to recall the coxsackie viruses causing rashes, but these present with a very severe sore throat that last for about a week. Sore throat usually resolves on its own without complications in adults, although it is important to know when to seek medical attention. It is often recognized by ulcerative lesions which can be seen on the lips, in the anterior.
It refers to a painful problem of the child, usually in the pharynx and often begins as a swallowing complaint. Patients presenting with fever and swollen lymph glands with complaints of sore throat and recent fatigue provide rationale for this differential diagnosis. Sore throat caused by a virus is not treated with antibiotics but instead may be treated with rest, pain medication, and other therapies aimed at relieving symptoms. This definition does not include tonsillitis as part of infectious mononucleosis, although tonsillitis may occur in isolation or as part of a generalised pharyngitis. Tonsillitis symptoms, diagnosis and treatment bmj best. Explain the treatment of bacterial throat infections. Acute pharyngitis symptoms, diagnosis and treatment.
However, it is important to recognize and treat children with strep throat to prevent the spread of infection and also to prevent potentially serious complications of group a. Winner of the standing ovation award for best powerpoint templates from presentations magazine. A sore throat will spontaneously resolve by 3 days in about 40% of people. Which conditions should be included in the differential. The patient reports steadily worsening sore throat over the past 2 days, associated with a sensation of swelling. By 1 week, approximately 85% of people are symptomfree. However, it is important to recognize and treat children with strep throat to prevent the spread of infection and also to prevent potentially serious complications of group a streptococcus gas eg, rheumatic fever. Symptoms of heartburn and gerd are a burning feeling in the chest, throat, or mouth, nausea, and more.
Navigating the differential diagnosis two case histories demonstrate the vital importance of staying on your toes when dealing with this routine complaint. Table 301 shows the differential diagnosis with the estimated percentage of cases of sore throat and the associated clinical syndrome. Although current guidelines for the management of pharyngotonsillitis differ between countries, all guidelines recommend the use of. After generating a differential, you may decide that you would like to expand upon it. Strategies for generating differential diagnoses a number of different strategies can be used to generate a differential diagnosis. The published incidence of sore throat varies between 0% and 70%. Making a diagnosis of the cause of your sore throat is done during physical exam. A sore throat is a painful, dry, or scratchy feeling in the throat. Tonsillitis is painful swelling in the tonsils, causing sore throat, red tonsils, pain, fever, and more.
When evaluating a patient with a sore throat, it is important to differentiate pharyngitis caused by group a streptococcus gas from that caused by. Mar 29, 2020 antibiotic treatment of adults with sore throat by community primary care physicians. Chronic sore throat an overview sciencedirect topics. Make sure to use proper draping dont forget to tie back patients gown. Sore throat in children introduction to the clinical problem. The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as acute sore throat. Examination of patients who present with sore throat may reveal tonsillitis, tonsillopharyngitis, or nasopharyngitis.
The validity of a sore throat score in family practice. Unnecessary prescribing of antibiotics increases the risk of bacterial resistance, which is a threat to modern healthcare. Viral pharyngitis is a sore throat caused by a virus, and causes throat pain and coldlike symptoms. Dec 11, 2018 pharyngitis is a leading cause of pediatric ambulatory care visits. Pharyngitis is primarily caused by bacteria and viruses. A case of sore throat and fever wiley online library. In addition to the conditions listed in the differential diagnosis, other. Menachem gross, ron eliashar, in orofacial pain and headache, 2008. Sore throat in children clinical considerations and. Sore throat, exudative tonsillitis, vomiting, abdominal pain, lmphadenopathy, white then red strawberry tongue erythema infectiosum fifth disease human parvovirus type b19 spring 5 10 years none usually in children, may occur in adults none to lowgrade 2 4 starts as slapped cheek, maculopapular.
This paper considers three examples of potential diagnoses for this condition with an explanation of why such a diagnosis might be appropriate if other symptoms apply. Diagnosis and treatment of streptococcal pharyngitis. Rapid diagnostic tests are available to confirm this diagnosis. In a situation of a sore throat, the infective organisms must be considered also. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Pharyngitis is a leading cause of pediatric ambulatory care visits. In order to understand the clinical approach to history taking and examination of a child who has a sore throat, a differential diagnosis must be held in mind when approaching the problem. The emergency clinician must sort through the broad differential for this complaint using a systematic approach that protects against early closure of the diagnosis. At those times adding a different strategy often reveals more conditions.
Symptoms often include the abrupt onset of sore throat with high fever and myalgias. Signs and symptoms of severe sore throat, fever, tender anterior cervical lymphadenopathy, red pharynx with tonsillar swelling with or without exudate, and no cough indicate a higher probability of gas pharyngitis for both adults and children. Pain in the throat is one of the most common symptoms. You are going to observe and participate in the clinical encounter of a 17. If such patient has severe pain and poor dental hygiene, lemierres disease should be considered. Certain strategies work better for different symptoms. Strep throat is treated with a course of antibiotics. A polymicrobial bacterial population is observed in most cases, with. Management of patients with sore throats in relation to.
It may also be a symptom of influenza, or of infectious mononucleosis glandular fever. Credits can be earned by building a differential or looking up a diagnosis. Infectious mononucleosis may begin slowly with fatigue, a general ill feeling, headache, and sore throat. Group a betahemolytic streptococci gabhs is the most common cause of acute bacterial pharyngitis, accounting for 515% of sore throats in adults and 2030% in children.
Antibiotic treatment of adults with sore throat by community primary care physicians. You will have time to record your findings and receive feedback. Nov 01, 2011 discuss the causes of pediatric throat infections. Sore throat and left ear pain mdedge family medicine. Oral cavity dry mucous membranes suggest dehydration from odynophagia and indicates severity of symptoms. However, it may exist in its own right as a chronic bacterial infection in a patient with or without tonsils. Sore throat due to a viral or bacterial cause is a selflimiting condition which generally resolves within two weeks georgalas et al, 2014. Herpes simplex virus can lead to symptoms of a sore throat especially in adolescents and young adults. The differential diagnosis at the time included candidal vaginitis and cellulitis.
Mar 07, 20 17 yearold female presenting to the pediatric ed with sore throat for 2 days. All but two of the authors had been involved in implementing sore throat guidelines, nationally or locally. In patients with sore throat but clear throat, differential diagnosis should include subacute thyroiditis sat, epiglottitis, and deep neck infection. Explain the preliminary differential diagnoses and initial workup plan to the patient.
Mild abdominal pain, in the absence of other gastrointestinal symptoms, and gen. Pharyngitis can involve some or all of these parts of the throat. Identify the usual clinical presentation of pharyngitis in children. Professional reference articles are designed for health professionals to use. The problem is that the term sore throat clinically does not distinguish between acute tonsillitis and pharyngitis. Diagnosis and management of sore throat guideline keywords. Patients with chronic sore throat, those who do not have signs of infection, or those who do not respond to treatment should be evaluated for noninfectious causes of sore throat. Consult your doctor or your childs pediatrician if you or your child has a sore throat and in some instances your doctor may refer you to an ent that specializes in ear, nose and throat disorders, or an allergist that specializes in allergies. The pain is described as sharp, 410 in severity, located on the left side of her throat, and worsened with swallowing. Health history tell me your special concerns today. Warm liquids broth, caffeinefree tea or warm water with honey and cold treats such as ice pops can soothe a sore throat.
The organism usually responsible is a group a streptococcus. A sore throat pharyngitis is a common problem and usually is caused by a viral or bacterial infection. At the end of the podcast, listeners will be able to. Consult your doctor or your childs pediatrician if you or your child has a sore throat and in some instances your doctor may refer you to an ent that specializes in ear, nose and throat disorders, or an allergist that specializes in allergies bring a family member or a close friend with you. A useful framework for the differential diagnosis of acute sore throat is shown below. Use the checklists below for history, physical examination, and communication and.
Sore throat this video format is designed to help you prepare for objective structured clinical examinations, or osces. Jaw trismus associated with peritonsillar cellulitis or abscess. Rapid antigen detection tests allow immediate pointofcare assessment of group a streptococcus gas pharyngitis the goal of treatment of gas is to prevent acute rheumatic fever, reduce the severity and duration of symptoms, and prevent transmission. The differential diagnosis of this swelling might pose a serious problem to a less experienced clinician. Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Understand the complications of pharyngeal infections. Alex soto, a 19yearold male, comes to the urgent care clinic because of a sore throat. Chronic tonsillitis is characterized by chronic sore throat, halitosis, recurrent tonsillitis and persistent tender cervical lymph nodes. Avoid caffeine and alcohol, which can dehydrate you.
This framework divides the diagnoses into those caused by infection bacterial and viral and those caused by noninfectious processes. Make sure to explain each physical examination in laymans term to your patient. Fluids keep the throat moist and prevent dehydration. Using a sterile throat swab, contact the posterior pharyngeal wall and the surface of both. Since the patients skin was nonerythematous and she had vaginal discharge, she was treated for presumed severe candidal vaginitis with fluconazole and clotrimazole 1% cream. Viruses commonly implicated include rhinovirus, coronavirus, influenza and parainfluenza viruses and adenovirus. Chronic sore throat may be a symptom of other disorders, such as sinusitis. A throat swab should be taken when a diagnosis of strep throat is suspected from the clinical and epidemiological findings see table 1 above and the patient is not already taking antibiotics. In many cases, a sore throat is associated with the common cold. Infectious mononucleosis may begin slowly with fatigue, a. Sore throat, dry throat, pharyngeal erythema, and minor pharyngeal abrasions have been reported with the lma. Porche, md, and jennifer avegno, md p atients complaining of sore throats account for 1% to 2% of all visits to u.
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