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Related Subjects:
|Acute Epiglottitis
|Croup
|Acute Tracheitis
|Stridor
🌟 Sore Throat: Causes, Assessment & Red Flags
Sore throat is one of the most common reasons for primary care and emergency consultations.
Most cases are viral and self-limiting, but a small proportion may be life-threatening (e.g. epiglottitis, peritonsillar abscess, neutropenic sepsis).
Always assess airway, breathing, circulation first.
⚠️ If stridor, drooling, muffled voice, or respiratory distress → call for senior/anaesthetic/ENT help immediately.
📊 Causes of Sore Throat
Cause
Typical Features
Red Flags / Notes
🦠 Viral Pharyngitis (EBV, CMV, HSV1)
Fever, sore throat, tonsillar exudate, lymphadenopathy, fatigue, hepatosplenomegaly
Monospot + if EBV; avoid ampicillin (rash); splenic rupture risk → no contact sports
🧬 HIV Seroconversion
“Mono-like” illness, mucocutaneous ulcers, rash, lymphadenopathy
Always ask about risk factors; offer HIV testing in atypical cases
👶 Stomatitis / Herpangina (HSV1, Coxsackie)
Painful oral ulcers/vesicles, dysphagia, fever (young children)
Risk of dehydration due to pain on swallowing
🧫 Bacterial Pharyngitis (Strep pyogenes)
Sudden sore throat, fever >38.3°C, tonsillar exudates, tender anterior nodes
Use Centor/McIsaac; Scarlet fever rash may occur; antibiotics reduce rheumatic fever risk
💉 Diphtheria
Grey pseudomembrane, “bull neck”, fever
Rare in UK (vaccination); can cause myocarditis, neuropathy
😷 Epiglottitis
Rapid onset, severe sore throat, drooling, muffled voice, tripod posture
Airway emergency → anaesthetic + ENT input; thumbprint sign on X-ray
🪶 Croup (Laryngotracheobronchitis)
Infants/toddlers, barking cough, stridor, hoarseness
Parainfluenza commonest; unlike epiglottitis, no drooling
🧪 Bacterial Tracheitis
Post-viral, stridor, fever, toxic appearance, purulent secretions
Mimics epiglottitis; airway compromise risk
🧴 Chemical/Caustic Injury
Ingestion history, oral burns, drooling, severe throat pain
Urgent ENT + endoscopy; airway risk
🧬 Lemierre’s Syndrome
Severe sore throat, fever, neck pain/swelling
Septic IJV thrombophlebitis → septic emboli to lungs; IV antibiotics ± anticoagulation
🗣 Laryngitis
Hoarseness, mild sore throat, normal throat exam
Usually viral; persistent hoarseness → exclude malignancy
🔍 Clinical Approach
💊 Management Principles
🧑⚕️ Case Scenarios