Sore throat

Medicine > Infection

Differential Diagnosis Schema 🧠

Infectious Causes

Viral pharyngitis: Common cold viruses (e.g., rhinovirus, coronavirus), influenza, adenovirus, presenting with sore throat, cough, and runny nose.
Streptococcal pharyngitis (strep throat): Group A Streptococcus (GAS), presenting with sudden-onset sore throat, fever, and tonsillar exudate, often without cough.
Infectious mononucleosis (glandular fever): Epstein-Barr virus (EBV), with sore throat, marked lymphadenopathy, fever, and fatigue.
Diphtheria: Corynebacterium diphtheriae, rare due to vaccination, presenting with sore throat, greyish pseudomembrane, and systemic toxicity.
Herpangina: Coxsackievirus, presenting with small, painful ulcers in the throat and fever, typically in children.
Peritonsillar abscess (quinsy): Severeunilateral sore throat, trismus, and “hot potato” voice, often following untreated tonsillitis.

Non-Infectious Causes

Allergic rhinitis: Sore throat associated with postnasal drip, sneezing, and itchy eyes, often seasonal.
Gastroesophageal reflux disease (GORD): Chronic sore throat due to acid reflux, often worse in the morning, with heartburn and regurgitation.
Smoking-related irritation: Chronic sore throat in smokers, often with cough and hoarseness, risk factor for malignancy.
Malignancy: Persistent sore throat, particularly in older patients, with risk factors such as smoking and alcohol use; consider squamous cell carcinoma of the oropharynx.
Trauma: Sore throat following mechanical injury (e.g., endotracheal intubation) or chemical exposure (e.g., ingestion of caustic substances).

Key Points in History 🥼

Onset and Duration

Acute onset: Suggests infectious causes such as viral or bacterial pharyngitis.
Chronic sore throat: Consider non-infectious causes like GORD, allergies, or malignancy.
Intermittent symptoms: Associated with allergies or GORD, often triggered by specific factors.

Associated Symptoms

Fever and lymphadenopathy: Suggests infectious cause, particularly viral pharyngitis or mononucleosis.
Cough and rhinorrhoea: More indicative of viral causes or postnasal drip from allergies.
Dysphagia and trismus: Suggests peritonsillar abscess, particularly if unilateral.
Heartburn and regurgitation: Points towards GORD as a cause of chronic sore throat.
Hoarseness: Can be associated with vocal cord irritation from smoking, reflux, or malignancy.
Rash: Consider scarlet fever with Streptococcus pyogenes, or viral exanthems in children.

Background

Past Medical History: Previous episodes of tonsillitis, history of GORD, allergic rhinitis, or smoking.
Drug History: Use of inhaled corticosteroids, which may cause local immunosuppression and predispose to infections.
Family History: Family history of atopy or autoimmune diseases that may present with sore throat.
Social History: Smoking, alcohol use, and occupational exposure to irritants; recent travel or contacts with infectious diseases.

Possible Investigations 🌡️

Throat Swab and Culture

Indicated in suspected bacterial pharyngitis (e.g., GAS) to guide antibiotic therapy.
Consider in recurrent or severe cases to identify atypical pathogens or antibiotic resistance.

Monospot Test and EBV Serology

Monospot test: Rapid test for heterophile antibodies, used in suspected infectious mononucleosis.
EBV serology: Consider if Monospot test is negative and clinical suspicion remains high.
Other serologies: Consider cytomegalovirus (CMV) if EBV is negative and symptoms persist.

Laryngoscopy

Indicated if malignancy is suspected, particularly in patients with persistent hoarseness, dysphagia, or unexplained weight loss.
Can identify structural abnormalities such as vocal cord lesions or laryngeal inflammation.

Complete Blood Count (CBC)

To identify leukocytosis in bacterial infections, lymphocytosis in viral infections, or other haematologic abnormalities.
Useful in guiding further management in severe or atypical presentations.

No comments yet 😉

Leave a Reply Cancel reply

You must be logged in to post a comment.

Don't take our word for it

"The stations you provide are strikingly similar to those I came across during my medical school finals (some even verbatim!), and I have tried many other exam platforms. I'm truly grateful for your priceless support throughout my final couple of years at medical school!"

Raza Q 🇬🇧

"It has absolutely everything for medical school, so many histories with detailed differential diagnoses, how to approach emergencies, commonly prescribed drugs..every kind go examination you’ll ever need in osces"

John R 🇬🇧

"Thank you SO MUCH for the amazing educational resource. I’ve tried lots of platforms and books with mock OSCE stations and yours is by far and away the best I’ve tried"

Ed M 🇳🇿

"Get this right away. So helpful for OSCEs but also general clinical learning and understanding. Wish I had brought it sooner"

Emma W 🇬🇧

"Without a doubt, your platform outshines all other OSCE resources currently available. In all honesty, I can confidently attribute my success in securing a distinction in my finals to OSCEstop."

Harish K 🇬🇧

"OSCEstop distinguishes itself from many other platform banks by offering a wealth of questions that mimic the demanding and complex aspects of our finals. This platform played a crucial role in ensuring I was ready for the level of difficulty that awaited me in my final exams."

Natasha W 🇳🇿

😃 More:

📖 Learning notes: 247

🏥 Stations available: 207

🧠 Qbank questions: 2255