Evaluation of Sore Throat

Physical Examination:

Neck

Stiffness, limitation of extension suggestive of retropharyngeal abscess.

Jaw

Trismus associated with peritonsillar cellulitis or abscess.

Oral Cavity

Dry mucous membranes suggest dehydration (from odynophagia) and indicates severity of symptoms.

Tongue elevation, sublingual/submental induration, poor dentition (particularly of mandibular molars) associated with Ludwig Angina.

Unilateral tonsillar enlargement with contralateral uvular deviation suggests peritonisllar abscess. Fluctuance may be palpated.

Tonsilar exudates suggest infectious pharyngitis (non-specific).

Palatal petechiae suggest bacterial pharyngitis.

Ulcerations of the anterior oral cavity are associated with herpes infection, lesions on the soft palate are suggestive of coxsackievirus infection.

Rarely, a grey membrane in the posterior pharynx will suggest diphtheria.

Lymphadenopathy

Tender anterior cervical lymphadenopathy may suggest bacterial pharyngitis.

Posterior cervical lymphadenopathy is associated with infectious mononucleosis.

Large, firm, non-mobile lymph nodes may suggest malignancy.

Eyes

Presence of conjunctivitis (also rhinorrhea, exanthema) associated with viral pharyngitis.

Skin

Ulcers involving the hands, feet, in addition to pharyngeal lesions suggest coxsackievirus infection.

Scarlatiniform rash associated with pharyngitis (particularly in school-age children) suggests streptococcal pharyngitis.

Abdomen

Splenomegaly is associated with infectious mononucleosis.

Centor Criteria (Modified)

• +1: Fever
• +1: Tonsillar Exudate
• +1: Tender anterior cervical lymphadenopathy
• +1: Absence of cough
• -1: Age >45yo

Incidence of GABHS by Centor Criteria

• 0, -1: 1%
• 1: 10%
• 2: 17%
• 3: 35%
• 4: 51%

References:

1. Newman, D., & Shreves, A. (2013). Sore Throat. In Rosen’s Emergency Medicine – Concepts and Clinical Practice (8th ed., Vol. 1, pp. 198-202). Elsevier Health Sciences.
2. King, B. R., & Charles, R. A. (2004). Pharyngitis In The ED Diagnostic Challenges And Management Dilemmas. Emergency medicine practice, 6(5), 1–24.