Sore Throat Symptoms and Treatment PDF

Sore Throat Etiology Commonly caused by viral infections (70-80%), associated with: ○ Common cold symptoms: low-grade fever, headache, hoarse voice, cough, nasal congestion, inflammation, viral rash. 20% are bacterial, e.g., Streptococcus pyogenes (Strep...

Sore Throat Etiology Commonly caused by viral infections (70-80%), associated with: ○ Common cold symptoms: low-grade fever, headache, hoarse voice, cough, nasal congestion, inflammation, viral rash. 20% are bacterial, e.g., Streptococcus pyogenes (Strep throat). Resolves in 3–7 days. Less Common Causes Airway obstruction or deep neck infections (e.g., cancer). Epstein–Barr virus (glandular fever): sore throat, fever, swollen glands, splenomegaly, rash, fatigue. Oral herpes (in children 2 weeks, systemic infection symptoms. Treatment Symptomatic relief: ○ Simple analgesia. ○ Anti-inflammatory medications. ○ Local anesthetics and lozenges. Oral Thrush (Oropharyngeal Candidiasis) Background Opportunistic fungal infection caused by Candida albicans. Risk higher in denture wearers, neonates (~5%), older adults, or immunocompromised individuals. Clinical Features White/creamy patches in mouth/throat that can be wiped off. Can cause discomfort, irregular in size, may extend to the pharynx. Risk Factors Diabetes (poor glycemic control), dry mouth, dentures, inhaled corticosteroids, smoking, poor oral hygiene, HIV. Red Flags for Referral Immunocompromised patients requiring systemic treatment. Rare in healthy adults without risk factors—requires investigation. Symptoms persisting >3 weeks or OTC treatment failure. Management Adults and Children >2 years: ○ Miconazole gel (1st line): 2.5 mL QID for 7–14 days; continue 7 days post-resolution. ○ Nystatin (2nd line): 1 mL QID for 7–14 days; continue 3 days post-resolution. Children 14 days, chest pain, dyspnea, or systemic symptoms. Treatment Non-pharmacological: Rest, hydration, hygiene. Symptomatic relief: ○ Paracetamol/ibuprofen for fever/pain. ○ Nasal decongestants (limited short-term use). ○ Antihistamines (first-generation for sneezing/congestion; less effective for children). Communications in Pharmacy Practice Principles of Effective Communication Use open-ended questions to gather more information (e.g., "How have you been feeling since starting this medication?"). Active listening: Maintain eye contact, nod, and avoid interrupting. Use simple, jargon-free language tailored to the patient’s health literacy level. Verify understanding with teach-back techniques (e.g., "Can you repeat how you will take this medicine?"). Non-Verbal Communication Body language: Maintain an open posture, avoid crossing arms. Tone and facial expressions: Be empathetic and approachable.  Avoid multitasking during conversations to show attentiveness. Dealing with Barriers Language differences: Use interpreters or translated materials. Hearing impairment: Speak clearly, ensure face is visible, or provide written instructions. Low health literacy: Use visual aids and check understanding frequently. Handling Sensitive Topics Build rapport and create a non-judgmental environment. Use empathy statements (e.g., "That sounds very challenging."). Respect patient autonomy and privacy (e.g., discussing sensitive issues in private areas). Counseling on Medications Explain: ○ What the medication is for. ○ How to take it (dose, frequency, duration). ○ Potential side effects and what to do if they occur. ○ Storage instructions. Provide written information if needed and encourage questions. Fever Definition and Causes Definition: A temperature >38°C.  Commonly caused by infections (viral, bacterial). Other causes: inflammatory conditions, drug reactions, malignancies. Assessment Red Flags for Referral: ○ Fever >38°C persisting for >3 days or recurring. ○ In children: Lethargy, rash, stiff neck, or seizures. ○ Suspected systemic infection (rigors, confusion, low blood pressure). ○ Dehydration or inability to keep fluids down. Non-Pharmacological Management Rest and adequate hydration. Use cool compresses if comfortable, but avoid rapid cooling. Pharmacological Management Paracetamol: First-line for reducing fever and discomfort. ○ Adult dose: 500–1000 mg every 4–6 hours (max 4g/day). ○ Pediatric dose: 15 mg/kg every 4–6 hours (max 60 mg/kg/day). Ibuprofen: Alternative or adjunct, particularly if inflammation is suspected. ○ Adult dose: 200–400 mg every 4–6 hours (max 1200 mg/day). ○ Pediatric dose: 5–10 mg/kg every 6–8 hours (max 30 mg/kg/day). Avoid aspirin in children (risk of Reye’s syndrome). Self-Care Advice Monitor temperature regularly. Seek medical advice if symptoms worsen or new symptoms (e.g., rash, difficulty breathing) appear. Pain Types of Pain 1. Acute Pain: Sudden onset, sharp, usually temporary (e.g., injury, post-surgery). 2. Chronic Pain: Lasts >3–6 months, associated with conditions like arthritis or neuropathy. 3. Referred Pain: Pain perceived in a different location from the source (e.g., heart attack causing arm pain). Assessment PQRST Framework: ○ P: Provoking/relieving factors (e.g., what makes it better/worse?). ○ Q: Quality (e.g., sharp, dull, burning). ○ R: Region/radiation (where is the pain, does it spread?). ○ S: Severity (rate 1–10 scale). ○ T: Timing (onset, duration, frequency). Consider patient history, including medications and comorbidities. Red Flags for Referral Severe, sudden, or worsening pain. Pain with systemic symptoms (fever, weight loss, night sweats). Suspected fractures, nerve involvement (e.g., numbness, weakness), or chest pain. Pharmacological Management Mild Pain: Paracetamol (first-line).  Mild to Moderate Pain: Non-steroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen or naproxen. Severe Pain: Prescription medications (e.g., opioids, under medical supervision). Non-Pharmacological Strategies Heat or cold packs: For muscular or joint pain. Physical therapy: Stretching, massage, posture correction. Cognitive-behavioral therapy (CBT): For chronic pain. Patient Counseling Emphasize correct dosing and duration. Warn about side effects of NSAIDs (e.g., stomach upset, kidney effects). For opioids: Highlight risks of dependency and provide a clear tapering plan. Nose Conditions: Rhinitis and Rhinosinusitis Rhinitis Definition: Inflammation of the nasal mucosa. Types of Rhinitis 1. Allergic Rhinitis (AR): ○ Triggered by an IgE-mediated immune response to allergens (seasonal or perennial). ○ Affects ~19% of the population. ○ Associated conditions:  ~30% have asthma. ~80% of asthma patients have AR. 2. Non-Allergic Rhinitis: ○ No identifiable allergen. ○ Can be due to overactive parasympathetic or hypoactive sympathetic responses. 3. Other Types: ○ Vasomotor rhinitis: Triggered by climatic or environmental changes. ○ Drug-induced rhinitis: Caused by medications (e.g., aspirin, NSAIDs, nasal decongestants with overuse). ○ Pregnancy-related rhinitis: Hormonal changes cause nasal congestion in ~10% of pregnancies. ○ Infectious rhinitis: Associated with viral or bacterial infections. Clinical Features of Allergic Rhinitis 1. Symptoms: ○ Rhinorrhoea (runny nose). ○ Nasal congestion and sneezing. ○ Nasal itch. ○ Altered sense of smell (rare). 2. Diagnostic Features Suggesting Alternative Conditions: ○ Unilateral symptoms. ○ Nasal obstruction without other features. ○ Pain or purulent discharge. ○ Recurrent nosebleeds.  ○ Loss of sense of smell. Pathophysiology 1. Early-phase reaction: ○ Immediate response to allergen exposure. ○ Symptoms: rhinorrhoea, sneezing, nasal itch, and congestion. 2. Late-phase reaction: ○ Occurs 4–12 hours later. ○ Main symptom: nasal congestion. 3. Nasal priming: ○ Repeated exposure reduces the allergen threshold needed to trigger symptoms, worsening the condition. Questions to Ask Patients Is it seasonal or perennial? Family/personal history of asthma, eczema, or hayfever? Exposure to specific triggers (e.g., pets, dust, pollen)? Are symptoms worse indoors or outdoors? Treatment First-Line Therapy: Avoidance of triggers where possible.  Intranasal corticosteroids (anti-inflammatory): Most effective. Second-Line Therapy: Oral antihistamines: ○ Less sedating: cetirizine, loratadine, desloratadine, fexofenadine. Other Treatments: ○ Ocular antihistamines (for associated conjunctivitis). ○ Mast cell stabilizers. ○ Immunotherapy for severe cases (e.g., desensitization therapy). Practice Points Educate on proper nasal spray technique to maximize efficacy and minimize side effects like bleeding. Ensure medication adherence, especially for corticosteroids, as they work best with consistent use. Red Flags for Referral Signs of respiratory distress (e.g., cyanosis, stridor). Unilateral nasal obstruction or discharge. Blood in nasal discharge. Failure to respond to treatment. Suspected foreign body obstruction, especially in children. Rhinosinusitis Definition: Inflammation of one or more paranasal sinuses, often following a viral upper respiratory tract infection (URTI). Clinical Features 1. Acute Rhinosinusitis: ○ Symptoms lasting 3 days. ○ Symptoms worsening after initial improvement. ○ Symptoms >7 days with unilateral tenderness and purulent discharge. First-line antibiotic: Amoxicillin (or doxycycline if allergic to penicillin). Red Flags for Referral Persistent symptoms >10 days. High fever (≥39°C). Swelling around the eyes. Neurological symptoms (e.g., altered mental status). Symptoms worsening after initial improvement ("double sickening"). Prevention and Self-Care Avoid exposure to allergens or irritants. Stay hydrated to maintain sinus drainage. Use humidifiers or saline nasal sprays to keep nasal passages moist. Summary of Key Points Allergic Rhinitis: Affects ~19% of the population. Trigger avoidance and intranasal corticosteroids are first-line therapies. Rhinosinusitis: Often follows viral URTI. Most cases are viral and self-limiting; antibiotics are reserved for severe or complicated cases. Eye Conditions Dry Eye Disease Pathophysiology: ○ Caused by reduced tear production or increased tear evaporation. ○ Can involve inflammation of the ocular surface. ○ Contributing factors include aging, medication, contact lens wear, and systemic conditions (e.g., Sjögren’s syndrome). Symptoms: ○ Dryness, burning, stinging, and scratchiness. ○ Blurred or fluctuating vision. ○ Feeling of heavy or fatigued eyes.  ○ Reflex tearing (paradoxical excessive tearing due to irritation). Treatment: ○ Aqueous-based eye drops: Carboxymethylcellulose (CMC), hyaluronic acid (HA). ○ Lipid-based eye drops: For evaporative dry eye (e.g., containing castor oil, glycerin). ○ Manuka honey ointments: Limited evidence but may offer relief. ○ Oral supplementation: Omega-3 fatty acids for tear production. ○ Advanced treatments: Prescription anti-inflammatories like cyclosporine (refer if OTC fails). Self-Care: ○ Avoid dry or windy environments. ○ Use humidifiers indoors. ○ Rest eyes during prolonged screen use. ○ Blink exercises to enhance tear spread. ○ Preservative-free eye drops for frequent use. When to Refer: ○ Chronic symptoms unresponsive to OTC treatments. ○ Symptoms affecting daily life. ○ Severe pain or vision changes. Bacterial Conjunctivitis Pathophysiology: ○ Infection of the conjunctiva by bacteria (e.g., Staphylococcus aureus, Haemophilus influenzae in children).  ○ Spread through contact with contaminated hands or objects. Symptoms: ○ Red eye, gritty sensation, and discomfort. ○ Purulent (yellow-white) discharge, leading to crusted eyelids upon waking. ○ No significant vision changes. Treatment: ○ Empirical antibiotics: Chloramphenicol 0.5% drops: 1 drop every 2-4 hours. Chloramphenicol 1% ointment: Applied at night. ○ Self-resolving in 7-10 days without treatment, but antibiotics hasten recovery. When to Refer: ○ Severe or worsening symptoms despite treatment. ○ Suspected gonococcal or chlamydial conjunctivitis (requires urgent referral). ○ Immunocompromised patients or recurrent cases. Viral Conjunctivitis Pathophysiology: ○ Often caused by adenoviruses. ○ Highly contagious, spread through droplets or contact with infected individuals. Symptoms: ○ Red eye with watery discharge. ○ Mild itching or burning sensation. ○ Preauricular lymph node enlargement (near the ear). ○ Often starts in one eye and spreads to the other.  Treatment: ○ Supportive care only (self-limiting): Cold compresses for symptom relief. Artificial tears to reduce discomfort. ○ Hygiene to prevent spread (avoid sharing towels, touching eyes). When to Refer: ○ Persistent or worsening symptoms. ○ Suspected corneal involvement (keratitis). Contact Lens-Related Conditions A. Keratitis (Corneal Infection) Pathophysiology: ○ Infection of the cornea caused by bacteria (e.g., Pseudomonas aeruginosa), fungi, or protozoa (Acanthamoeba). ○ Often linked to poor lens hygiene or wearing lenses overnight. Symptoms: ○ Pain, redness, and sensitivity to light. ○ Decreased vision or blurry vision. ○ White or opaque spots on the cornea. Treatment: ○ Immediate cessation of lens use. ○ Refer for an urgent eye examination. ○ Topical antimicrobials prescribed based on pathogen identification. Prevention:  ○ Avoid overnight wear. ○ Never expose lenses to tap water. ○ Regularly replace storage cases. B. Dry Eye from Contact Lenses Symptoms: Discomfort, dryness, and blurry vision during lens wear. Management: ○ Use low-viscosity, preservative-free lubricating drops. ○ Consider switching to daily disposable lenses. ○ Consult an optometrist for alternative lens types. When to Refer: Red, painful eyes or symptoms unresponsive to self-care. Acute Angle Closure Glaucoma Pathophysiology: ○ Sudden increase in intraocular pressure (IOP) due to blockage of aqueous humor drainage. ○ A medical emergency requiring urgent intervention. Symptoms: ○ Severe eye pain, redness, and headache. ○ Blurred vision with haloes around lights. ○ Nausea and vomiting. Treatment: ○ Immediate referral to an ophthalmologist. ○ Initial management may include IOP-lowering medications (e.g., acetazolamide).  When to Refer: Always. It is an ophthalmic emergency. Allergic Conjunctivitis Pathophysiology: ○ Allergic reaction to environmental allergens (e.g., pollen, dust mites). ○ IgE-mediated response causing histamine release. Symptoms: ○ Itchy, watery eyes with redness. ○ Associated nasal symptoms (e.g., sneezing, rhinorrhea). ○ Seasonal or perennial occurrence. Treatment: ○ Topical antihistamines: Olopatadine or azelastine. ○ Mast cell stabilizers: Cromoglycate (used prophylactically). ○ Oral antihistamines: Loratadine, cetirizine for systemic relief. Self-Care: ○ Avoid known allergens. ○ Cool compresses for soothing. ○ Use preservative-free artificial tears to flush allergens. When to Refer: ○ Persistent symptoms despite treatment. ○ Suspected secondary infection. Subconjunctival Hemorrhage  Pathophysiology: ○ Rupture of small blood vessels under the conjunctiva, often due to trauma, coughing, or sneezing. Symptoms: ○ Bright red patch on the sclera (white of the eye). ○ No pain, discharge, or vision changes. Treatment: ○ Self-resolving in 1-2 weeks. ○ Reassurance and monitoring. When to Refer: ○ Recurrent hemorrhages or associated systemic symptoms (e.g., bleeding tendencies). Red Eye: Differential Diagnosis and Red Flags Key Red Flags for Immediate Referral: ○ Pain with light sensitivity (keratitis or uveitis). ○ Decreased vision. ○ Severe eye pain (acute glaucoma). ○ White or cloudy corneal spot (keratitis). ○ History of trauma or recent eye surgery. Summary Common Conditions: Dry eye, conjunctivitis, contact lens-related issues.  When to Refer: Severe symptoms, red flags (pain, vision changes, photophobia), or unresponsive cases. Key Treatments: ○ Lubricating drops for dryness. ○ Antibiotics for bacterial infections. ○ Antihistamines/mast cell stabilizers for allergies. Ear Conditions Ear Wax Impaction (Cerumen Impaction) Background: ○ Earwax (cerumen) naturally protects the external ear canal by trapping foreign particles. ○ The ear canal is self-cleaning, moving earwax from the canal to the external surface. Symptoms of Impaction: ○ Gradual hearing loss. ○ Feeling of fullness in the ear. High-Risk Groups: ○ Young children. ○ Older adults. ○ Hearing aid users. ○ Individuals with cognitive impairments. ○ Residents of aged care facilities. Treatment: ○ Cerumenolytic agents: Olive oil, docusate, carbamide peroxide, saline to soften and disperse wax.  ○ Irrigation: Performed by a GP or nurse using gentle pressure, but not recommended for self-use. ○ Manual removal: ENT specialists may use microsuction or manual tools. Red Flags for Referral: ○ Pre-existing ear pathology. ○ History of ear surgery. ○ Perforated eardrum or grommets. ○ Suspected infection (e.g., fever, malaise). ○ Trauma or pain. ○ Foreign body in the ear. ○ Sudden loss of hearing or treatment failure. Self-Care Tips: ○ Avoid using cotton buds or electronic ear cleaner devices with cameras. ○ Over 30% of impacted ears clear naturally within 5 days. Acute Otitis Externa (Swimmer’s Ear) Background: ○ Inflammation of the ear canal, often following water exposure (e.g., swimming). ○ Symptoms include pain, itchiness, and hearing loss. ○ Referral is recommended for otoscopy to rule out bacterial or fungal infections. Prevention: ○ Gently clear water from the external ear after swimming or bathing: Lie on the affected side to let water drain naturally.  Use gravity or a towel to remove excess water. Create a vacuum by pressing the palm against the ear and then releasing. ○ Use OTC ear drops (acidifying or alcohol-based) to prevent water retention and bacterial growth. Triggers to Avoid: ○ Prolonged water exposure. ○ Abrasive cleaning methods (e.g., cotton buds). Red Flags for Referral: ○ Suspected infection. ○ Pain unrelieved by simple analgesia. ○ History of surgery or perforation (e.g., grommets). Acute Otitis Media (Middle Ear Infection) Pathophysiology: ○ Commonly occurs in children following an upper respiratory tract infection (URTI). ○ Viral infections can spread to the middle ear via the Eustachian tube, leading to fluid/pus accumulation and tympanic membrane inflammation. Symptoms: ○ Ear pain (primary symptom). ○ Irritability, ear tugging/rubbing (in children). ○ Hearing loss or blocked sensation. ○ Fever, sometimes associated with fluid discharge if the eardrum ruptures. Treatment:  ○ Symptomatic relief: Paracetamol or ibuprofen for pain and fever. ○ Antibiotics: Typically not required, as most cases resolve within 2–3 days. Antibiotics may be considered for: Infants