From the Guidelines
When examining a patient with a sore throat, look for several key signs that help determine the cause and severity, including a red and inflamed throat, tonsillar enlargement, petechiae on the soft palate or uvula, and cervical lymphadenopathy, as these signs can suggest bacterial infection, particularly streptococcal pharyngitis 1. The throat may appear red and inflamed (erythema), with possible white or yellow exudates on the tonsils suggesting bacterial infection, particularly streptococcal pharyngitis.
- Tonsillar enlargement can be graded on a scale of 1-4, with grade 3-4 indicating significant swelling that may narrow the airway.
- Petechiae on the soft palate or uvula often suggest streptococcal infection.
- The uvula may be swollen or deviated in cases of peritonsillar abscess.
- Cervical lymphadenopathy, particularly tender anterior cervical nodes, frequently accompanies infectious pharyngitis.
- Assess for fever, which typically suggests infection rather than allergic or irritant causes.
- Look for vesicular lesions suggesting viral etiologies like herpes or coxsackie virus.
- Note any palatal or pharyngeal asymmetry that might indicate abscess formation.
- Examine for conjunctivitis, skin rash, or strawberry tongue which may indicate specific conditions like Kawasaki disease or scarlet fever.
- Also observe for signs of airway compromise such as stridor, drooling, or difficulty handling secretions, which require immediate intervention, as suggested by the American College of Physicians and the Centers for Disease Control and Prevention 1. A complete examination helps distinguish between viral, bacterial, and non-infectious causes, guiding appropriate treatment decisions, and clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis by rapid antigen detection test and/or culture for group A Streptococcus, and treat patients with antibiotics only if they have confirmed streptococcal pharyngitis 1.
From the Research
Signs on Examination of a Patient with a Sore Throat
The signs on examination of a patient with a sore throat can be identified through various clinical features and diagnostic tests. Some of the key signs include:
- Fever, which is often defined as a temperature greater than 100.4 degrees F (38 degrees C) 2
- Tonsillar exudates, which are a visible accumulation of pus or debris on the tonsils 3, 4, 2
- Anterior cervical lymphadenopathy, which is the enlargement of lymph nodes in the front of the neck 3, 4
- Lack of cough, which can help distinguish streptococcal pharyngitis from viral pharyngitis 3, 4
- Sore throat, which is the primary symptom of pharyngitis 5, 6, 4, 2
Diagnostic Tests
Diagnostic tests can also be used to confirm the presence of a sore throat and identify the underlying cause. These tests include:
- Throat culture, which is considered the diagnostic standard for streptococcal pharyngitis 3, 2
- Rapid antigen detection testing, which has improved sensitivity and specificity and can be used to quickly diagnose streptococcal pharyngitis 3, 6, 4, 2
- Modified Centor score, which can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 2