A 15-year-old boy presented with a sore throat for 3 days and high fever. The document discusses potential causes including tonsillitis, pharyngitis, and influenza. It provides details on tonsillitis such as types, symptoms, complications, treatments including antibiotics and tonsillectomy. Differential diagnoses are provided. Key questions to ask in history are outlined to determine if the cause is bacterial vs viral. Management involves fluids, analgesics, and antibiotics if bacterial.

1. SORE THROAT AND FEVER

2. THROAT PAIN +/- FEVER
A 15 years old boy presented with history of sore throat for 3
days along with high grade fever.
1. What specific question you would ask in history to elicit the diagnosis?
2. Give your differential diagnosis.
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3. Introduction
• A sore throat is pain or irritation of the throat
that often worsens when you swallow.
• Fever is the temporary increase in the body's
temperature in response to a disease or illness.
• There are many clinical scenarios where sore
throat is associated with fever. E.g. pharyngitis,
tonsilitis, influenza, laryngitis.

4. TONSILLITIS
 Tonsills are secondary lymphoid organs
 They consist of stratified squamous
epithelium which invaginates to form
tonsillar crypts
 It is partly covered by a fibrous capsule
 It contains antigen presenting cells along
with T and B lymphocyte
 It provides immunity from pathogens in the
ingested food.
PRESENTATIONTITLE 4

5. 4 types on tonsils form the Waldeyer’s Ring:-
 Palatine tonsils
 Pharyngeal tonsils
 Lingual tonsils
 Tubal tonsils
BLOOD SUPPLY
1. Tonsillar branch of facial artery
2. Ascending pharyngeal artery from external
carotid.
3. Ascending palatine, a branch of facial artery.
4. Dorsal linguae branches of lingual artery.
5. Descending palatine branch of maxillary artery
PRESENTATIONTITLE 5

6. TYPES OF TONSILLITIS
PRESENTATIONTITLE 6
of duration)
 Recurrent tonsillitis (occurs several
 Acute tonsillitis (less than 4 weeks  Acute catarrhal tonsillitis: occurs due to viral
infection.It is a generalized infection of oral
mucosa.
 Acute cryptic tonsillitis: occurs when bacterial
infection gets entrapped in the crypts.
 Acute follicular tonsillitis occurs when
inflammation spreads to the tonsillar follicles with
purulent material. Presents at the opening of
crypts as yellow spots.
 Acute parenchymal tonsillitis: occurs when
bacterial infection spreads to the tonsillar
parenchyma. Tonsil are uniformly enlarged and red.
 Acute membranous tonsillitis :occurs when
exudates from the crypts coalesce to form a
membrane over the surface of the tonsils.
times a year)
 Chronic tonsillitis (more than 12
weeks of duration)
Bacterial Viral Fungal
Hemolytic
Streptococcus
Adenovirus Candida
Albicans
H.Influenza influenza
virus

8. PRESENTATIONTITLE 8

9. PATHOPHYSIOLOGY OF ACUTE
TONSILLITIS
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 Hemolytic streptococcus enter the oral cavity and attaches
to the tonsillar epithelium (stratified sq) especially in the
crypts.
 Next, the pathogen causes inflammatory response of the
host immune system leading to the release of cytokines
which not only attract WBC but also causes symptoms like
fever, cough and headache to appear.
 Pus is produced while Combating these pathogens which
oozes out of the crypts as multiple pus points.

10. SIGNS & SYMPTOMS OF
TONSILLITIS
Symptoms
Sore throat
Difficulty in swallowing
Fever
Earache



 General symptoms : headache,
Signs
Hyperemia of the pillars, Soft palate and
uvula
Red, swollen tonsils with yellowish spots of
Purulent material or
Whitish membrane on medial surface of
tonsils
bodyache, Malaise
Breath is fetid
 Coated tongue



 Enlarged and tender lymphnodes
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11. Risk Factors Acute Tonsillitis
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Predisposed factors of tonsillitis:-
 Extremes of age group
 Immunocompromised individuals (diabetics, organ transplant or
chemotherapeutic patients)
 Abnormal tonsils form previous recurrent tonsillitis
 Generalized pharyngitis
 Overcrowding, poor nutrition, inadequate ventilation
 Exposure to cold

12. COMPLICATIONS
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 Chronic tonsillitis
 Pharyngeal abscess
 Rheumatic fever
 Endocarditis
 Peritonsillar abscess
 Cervical abscess
 Acute Otitis media
 Sinusitis

13. PHARYNGITIS
It is the inflammation of the pharynx,
resulting in a sore throat
The symptoms in pharyngitis are
similar to that in tonsillitis including
pain, fever, dysphagia, swollen
lymph nodes in neck, and a
headache or earache
WHY WE INCLUDED WHY WE EXCLUDED
SYMPTOMS such as:
• Sudden onset
• Soreness
• High fever
• NO HISTORY OF:
• Allergy / post nasal
drip
• GERD
• Smoking
No sign of:
• Tonsillopharyngeal
petechiae
(streptococcal)
• Tonsillopharyngeal
exudate
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14. Differential diagnosis of sore
throat and fever
1. Tonsillitis
2. Influenza virus
3. Pharyngitis
4. Corona virus
5. Adenoiditis
6. Peritonsillar abscess
7. Trauma/foreign body.
8. Squamous cell carcinoma of tonsil.

15. Differentiate between viral upper respiratory tract
infection from bacterial pharyngitis / tonsillitis
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16. History questions to ask to elicit
such a diagnosis
1. What has been the duration of sore throat and how did it start?
2. Ask whether it is aggravated from anything or relieved by anything or
not?
3. If there is any sputum production along with sore throat or not?
4. Dysphagia?
5. Any associated symptoms or pain?
6. Did the fever start simultaneously or not?
7. If the fever was continuous ore intermittent?
8. History of allergies?
9. History of any previous URTIs?
10. Any smoking habits or not?

17. MANAGEMENT
History (points)
Examination
Lab Investigations
Management (medical
and surgical)
PRESENTATIONTITLE 15

18. LAB
INVESTIGATION
Complete Blood Count
To determine whether the
infection acute or chronic
Culture
To identify the causative organism
using throat swab
Rapid Antigen test
Involves a quick throat swab.
Within minutes, the test can show
the presence of group A
streptococcus bacteria
EXAMINATION
 Use a head mounted light to
inspect the patient
 Check for any swellings, scar
marks, discoloration or
discharge
 Gently palpate and look for any
tenderness or swollen lymph
nodes.
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19. Management Of Tonsillitis
MEDICAL
 Treatment of tonsillitis depends on the cause
 Provide adequate fluids intake to keep throat moist and prevent
dehydration.
 Saltwater gargle.
 Analgesics (paracetamol) is given according to patient’s age
to relieve fever and local pain.
 Antibiotics in case of bacterial infections
 Most of infections are due to streptococcus species. Penicillin or
Amoxicillin is the drug of choice and patient allergic to penicillin is
treated with Erythromycin or Azithromycin.
 Amoxicillin for 7 to 10 days. Azithromycin 3-5 days

22. SURGICAL
. Tonsillectomy:-
It is a surgical procedure to remove tonsils.
Indications :
 Tonsil / adenoid hypertrophy with sleep
apnea syndrome
 Hypertrophy causing dysphagia with
associated weight loss
 Excisional biopsy for suspected
malignancy (lymphoma)
 Recurrent tonsillitis
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23. Other methods for tonsillectomy.
PRESENTATIONTITLE 23
1. Electrocautery
2. Laser tonsillectomy
3. Intracapsular tonsillectomy
4. Harmonic scalpel
5. Plasma-mediated ablation technique
6. Coblation tonsillectomy
7. Cryosurgical technique

24. COMPLICATIONS OF TONSILLECTOMY
PRESENTATIONTITLE 24
A. IMMEDIATE
1.Primary haemorrhage
2.Reactionary haemorrhage
3.Injury to tonsillar pillars, uvula,
soft palate, tongue or superior
constrictor muscle due to bad
surgical technique
4. Injury to teeth
5. Aspiration of blood
6. Facial oedema
7. Surgical emphysema
B. DELAYED
1. Secondary haemorrhage.
2. Infection.
3. Lung complications
4. Scarring in soft palate and pillars.
5. Tonsillar remnants.

25. Prescription for viral URTI
The basic treatment for viral upper respiratory infections is :
Analgesics : acetaminophen, NSAIDs.
Antihistamine : CHLOPHEDIANOL, DEXBROMPHENIRAMINE is a cough
suppressant and antihistamine.
Nasal decongestant sprays: pseudoephedrine, and phenylephrine.

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