Sore Throat

Sore Throat
Presentation by:Richard Usatine, MD

What are causes of sore throats?

* Infectious - viral, bacterial, mycoplasma, chlamydiae, candida
* Allergic - allergic rhinitis
* Acid Reflux - GERD
* Trauma – e.g., swallowing a chicken bone
* Chemical irritants or burns
* Epiglottitis
* Thyroiditis
* Retropharyngeal abscess


Infectious Causes of Pharyngitis
Cause
Strep throat versus viral pharyngitis
Why do we want to diagnose and treat GABHS?
Downside of using antibiotics

Case 1
What is the differential diagnosis in order of likelihood?

* Strep
* Viral
Sensitivity and Specificity
True negative
False negative

False positive
True positive
Positive Predictive Value (PPV)

* Changes based on the prevalence in the population
* True positives/all positives
* Higher prevalence increases the PPV
How well does PE predict strep throat?
Injected Pharynx
Tonsillar Swelling
Tonsillar Exudate
Anterior Cervical adenopathy
Positive Predictive Value
Specificity
Sensitivity
How well does history predict strep throat?
History and Physical
Clinical Prediction Rule for Strep Throat
Fever over 38 C
Absence of cough
Tender ant. cervical adenopathy
Tonsillar swelling or exudate
McIsaac modification of the Centor Criteria
Probability of Strep throat based on points (pretest probability)
How many points does our patient have?
Tender ant. cervical adenopathy
Tonsillar swelling or exudate
What are the tests?
* Rapid strep test
o Done in minutes in the office
* Throat culture
o Gold standard – how can you get false negatives or positives?
* ASO titer – not useful for practicing medicine
How to swab for rapid strep test or culture.
Rapid Strep Test Done
Antibiotic treatment
What symptomatic treatment could you offer the patient?
* Acetaminophen
* gargling with warm salt water
* throat lozenges
* fluids, warm or cold, can be soothing

Case 2
Case 3
Case 4
Case 5
Peritonsillar Abscess
Case 6
Case 7
Strep Throat
Candida in a man with AIDS
Viral
Herpangina
Coxsackie A16 Virus

Summary

* Use of clinical prediction rule to diagnose sore throat (useful in other diseases)
* Clinical prediction rule helps to establish pretest probability and put patient in one of three categories
o No test, no treat
o Test and treat based on result
o No test, just treat
* Use antibiotics for sore throat when probability of strep throat is above your treatment threshold

Sore Throat.ppt