3. CAUSES Viruses 20% (rhino/adeno/parainfluenza) Viruses 20% (rhino/adeno/parainfluenza) Bacteria 17% (GABHS) Bacteria 17% (GABHS) Thrush (post Abx/immunosupressants) Thrush (post Abx/immunosupressants) Chemical irritation (inhaler technique) Chemical irritation (inhaler technique) Allergy (dust) Allergy (dust) Smoking (chronic sore throat) Smoking (chronic sore throat) Cancer Cancer TB TB Tonsillitis Tonsillitis Glandular Fever Glandular Fever ….which is the most common cause?

5. Treatment Stall them! See if it goes away: Stall them! See if it goes away: Paracetamol gargle/Ibuprofen Paracetamol gargle/Ibuprofen Difflam Difflam Lozenges Lozenges Penicillin V 500mg qds 10days Penicillin V 500mg qds 10days Delayed scripts Delayed scripts More likely to reattend if given Abx More likely to reattend if given Abx Tonsillectomy if >3/y, >5/2y Tonsillectomy if >3/y, >5/2y

6. Glandular Fever 98% sore throat, lymphadenopathy, fever + tonsillar enlargement 98% sore throat, lymphadenopathy, fever + tonsillar enlargement Self Limiting (rest, fluids, antipyretics) Self Limiting (rest, fluids, antipyretics) Don’t give Amox as risk rash Don’t give Amox as risk rash Older people more likely to get hepatomegaly + jaundice Older people more likely to get hepatomegaly + jaundice

7. Pretty geeky song… I heard there’s sore throat going round That brings most people to the ground But actually, it’s just tonsillitis… It starts with pain and fever too Anterior lymph node tenderness And all the stuff in Centor’s criteria… And you look inside and see the pus It’s sore and it’s red And then you say, my god, you got tonsillitis… My poor sore throat Could be tonsillitis Or glandular fever Or just a virus My poor sore throat Needs penicillin…