Sore throat DDx

Overview

Sore throat can be more than a viral pharyngitis!

Causes

Common Causes:

• Tonsillitis
• Pharyngitis
• Peritonsilar Abscess (quinsy)
• Infectious mononucleosis

Most patients with sore throat will have a viral or short-lived bacterial infection. However, clinicians need to be able to identify patients at risk of having group A beta-haemolytic streptococcal infections as appropriate treatment may prevent complications.

Other less common bacterial causes of pharyngitis/ tonsilitis include:

• group C and G strep, Fusobacterium necrophorum, Neisseria gonorrhoea, Corynebacterium diphtheriae, Mycoplasma pneumoniae, and several chlamydial species

Less common and/or dangerous causes of a sore throat include:

• Lemierre syndrome due to Fusobacterium necrophorum
• Retropharyngeal abscess
• Epiglottis
• Scarlet fever
• Diphtheria
• Bacterial Tracheitis
• Ludwig’s Angina
• Angioedema or anaphylaxis
• Painful cervical lymphadenopathy
• Trauma, e.g. foreign body or caustic ingestion

References and Links

LITFL

• ENT Equivocation 001 — A nasty sore throat
• ENT Equivocation 002 — My throat hurts!
• Tropical Travel Trouble 011 – Tonsillitis and the Bull
• Paediatric Perplexity 016 – Frankly my dear, I do give a damn

Journal Articles and Textbooks

• Stewart, C. (2006). A “killer” sore throat: Inflammatory disorders of the paediatric airway. Pediatric Emergency Medicine Practice. (Vol3, No 6)

CCC Differential Diagnosis Series
NEURO	Anosmia, Ataxia, Blepharospasm, Bulbar and Pseudobulbar palsy, Central Pontine Myelinosis, Cerebellar Disease, Chorea, Cranial nerve lesions, Dementia, Dystonia, Exophthalmos, Eye trauma, Facial twitches, Fixed dilated pupil, Horner syndrome, Loss of vision, Meningism, Movement disorders, Optic disc abnormality, Parkinsonism, Peripheral neuropathy, Radiculopathy, Red eye, Retinal Haemorrhage, Seizures, Sudden severe headache, Tremor, Tunnel vision
RESP	Bronchial breath sounds, Bronchiectasis, High airway pressures, Massive haemoptysis, Sore throat, Tracheal displacement
CVS	Atrial Fibrillation, Bradycardia, Cardiac Failure, Chest Pain, Murmurs, Post-resuscitation syndrome, Pulseless Electrical Activity (PEA), Pulsus Paradoxus, Shock, Supraventricular tachycardia (SVT), Tachycardia, VT and VF, SVC Obstruction
GIT	Abdominal distension, Abdominal mass, Abdominal pain, Asterixis, Dysphagia, Hepatomegaly, Hepatosplenomegaly, Large bowel obstruction, Liver palpation abnormalities, Lower GI haemorrhage, Malabsorption, Medical causes of abdominal pain, Rectal mass, Small bowel obstruction, Upper GI Haemorrhage
GUT	Genital ulcers, Groin lump, Scrotal mass, Urine colour, Urine Odour, Urine transparency,
MSK	Arthritis, Shoulder pain, Wasting of the small muscles of the hand
DERM	Palmar erythema, Serious skin signs in sick patients, Thickened Tethered Skin, Leg ulcers, Skin Tumour, Acanthosis Nigricans
ENDO	Diabetes Insipidus, Diffuse Goitre, Gynaecomastia, Hirsutism, Hypoglycaemia, SIADH, Weight Loss
HAEM	Splenomegaly
PAEDS	Floppy infant
MISC	Anaphylaxis, Autoimmune associated diseases, Clubbing, Parotid Swelling, Splinter haemorrhages, Toxic agents and abnormal vitals, Toxicological causes of cardiac arrest
IMAGING	CHEST: Atelectasis, Hilar adenopathy, Hilar enlargement on CXR, Honeycomb lung, Increased interstitial markings, Mediastinal widening on mobile CXR, Pulmonary fibrosis, Pseudoinfiltrates on CXR, Pulmonary opacities on CXR, ABDO: Gas on abdominal X-ray, Kidney mass, BRAIN: Intracranial calcification, Intracranial structures with contrast, Ventriculomegaly, OTHER: Pseudofracture on X-Ray,
LABS	LOW: Anaemia, Hypocalcaemia, hypochloraemia, Hypomagnesaemia,  HIGH: Bilirubin and Jaundice, Hyperammonaemia, Hypercalcaemia, Hyperchloraemia, Hyperkalaemia, Hypermagnesaemia,  ACID BASE: Acid base disorders, Resp. acidosis, Resp. alkalosis, Creatinine, CRP, Dipstick Urinalysis, Laboratory Urinalysis, Liver function tests (LFTs), Pleural fluid analysis, Urea, Urea Creatinine Ratio, Uric acid, Urinalysis, Urine Electrolytes

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