Outpatient clinic

• History.
• Examination.
• Investigations.
• Prescription.
• Communication skills.
 History
• Full
• Concise
• Most probably affected system
• Most probable disease
• Complications of this disease
• Drug intake
 Examination
• Thorough
• Suitable place
• Suitable equipments
• Targeted
 Investigations

• Consult!!!
Prescriptions
 Communication skills

• Attitude
• Terminology
– Localities
– Common concept
• Pharyngitis is an inflammatory illness of the
mucus membrane and underlying structures
of the throat.
• It includes:
– Tonsillitis
– Tonsillopharyngitis
– Nasopharyngitis usually viral
 Nasopharyngitis
Clinical Manifestations:
• Chilliness on exposure to cold
• Dryness and irritation in the nose and scratchy
throat
• Nasal obstruction, sneezing, watery discharge, eye
irritation, cough
• Low grade fever! !
• Infants ! ! !
 Nasopharyngitis
Physical Examination
• Mostly healthy!!
• Colour and thickness of discharge
• In allergic rhinitis → edematous turbinates? colour
• Pharynx: 3 patterns of viral nasopharyngitrs:
1. Erythema alone
- Rhino viruses - Parainfluenza
- R.S.V - Influenza
- Rotavirus
1. Cobblestone or follicular
- Adenovirus - Some enterovirses
1. vesicular or ulcerative
- Enteroviruses - Herpes simplex
 Nasopharyngitis
Treatment

• The best : no pharmacologic ttt .

– Not working -Cost -side effects
• Explanation and assurance
• Therapy against the most annoying symptom
– Fever and malaise
– Rhinorrehea or nasal congestion.
– Persistent cough.
 Tonsillopharyngitis
Bacterial

Common
Sterptococuus pyogenes

Uncommon
Corynebacterium diphtheriae
Haemophilus influenza
 Tonsillopharyngitis
Clinical Manifestations

• Onset: usually sudden with fever, sore throat and

anorexia.
• Headache, nausea, vomiting, abdominal pain !!
• Cervical L.N. are enlarged and tender.
• May be follicles, ulcers, petechiae and generalized
exudate.
 Tonsillopharyngitis

Viral or Bacterial

• Nasal infection
• Ulceration viral
• Conjunctivitis
• Child under 4 Y, no exudate
• Child older than 4 Y, pharyngitis with exudate or
fever is most likely caused by S. Pyogenes.
 Tonsillopharyngitis
Treatment

• Symptomatic relief
– Drinking warm fluids
– Saltwater gargle
– Analgesic if discomfort is troublesome
• Paracetamol 10mg/kg/dose 4-6 hourly.
– Decongestants and antihistamines, no place.
• Antibiotics
– Penicillin -Erythromycine - Cephalosporines.
 The only reason that anyone
would ever hate you,

Is because they want to be just

like you.
Infantile crying