This post is part of a series called “Cardinal Presentations”, based on Rosen’s Emergency Medicine (8th edition).
Evaluation of Sore Throat
- Stiffness, limitation of extension suggestive of retropharyngeal abscess.
- 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.
- 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.
- Presence of conjunctivitis (also rhinorrhea, exanthema) associated with viral pharyngitis.
- 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.
- 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%
- 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.
- King, B. R., & Charles, R. A. (2004). Pharyngitis In The ED Diagnostic Challenges And Management Dilemmas. Emergency medicine practice, 6(5), 1–24.