Doctor, My child is having fever and severe throat pain. She is unable to eat food for last 2 days. Did she have a similar attack in the past? "Yes, 2 months back.” (this could be recurrent acute tonsillitis)Does she have cough? "No" Touch the forehead and neck w3ith the back of the fingers to look for fever. Where does it pain? Show me the exact site. (In tonsillitis, the child points to just below the angle of mandible on both the sides)Gently of palpate below the mandibular angles, to feel for the tonsillar lymph nodes, and whether they are tender (Tender tonsillar nodes is also sign of tonsillitis)Ask the child to open the mouth and say ‘Ah’. Using a tongue depressor and a bright torch, inspect the tonsils and pharynx. Swollen, mildly red tonsils = chronic tonsillitis.Angry rd mucosa and swollen, reduces extends beyond the tonsil = suspect tonsillar abscess. If there is a white patch, suspect diphtheria and refer the patient to a hospital. Auscultate the chest – CVS & RS look for crepts and Rhonchii.Key points forThroat pain: Tonsillitis, tonsillar lymph nodes, pharyngitis, Diphtheria, RS, CVS Action:Use penicillin or Erythromycin routinely for throat infections. (as a preventive measure against Rheumatic fever)Salt water gargles, steam inhalations. Antipyretic and NSAIDs – syrup or injection If attacks are recurrent, then refer to an ENT surgeon or Tonsillectomy.
