Pharyngitis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Patients with pharyngitis typically have low-grade fever and pharyngeal erythema, suggestive of viral etiology or pharyngeal exudate or petechia, suggestive of group A streptococcus. Additional signs include enlarged edematous tonsils, enlarged and/or tender cervical adenopathy, rash may or may not be present. Scarlatiniform rash, which is marked by multiple small red papules that are widely and diffusely distributed but spare the palms and soles, is suggestive of GAS.

Physical Examination

Vital Signs

• High/ low-grade fever

Skin

• Scarlatiniform rash associated with GAS, Arcanobacterium haemolyticum

HEENT

Viral pharyngitis

Streptococcal pharyngitis

Diphtherial pharyngitis

Diphtheria pharyngitis with pseudomembrane in the left side of posterior pharynx.

• Pharynx shows erythema, hypertrophy, tonsilar exudates, masses, Soft-palate petechiae (“doughnut” lesions), and beefy red, swollen uvula associate with Sterptococcal pharyngitis.
• Grayish brown diphtheritic pseudomembrane which may involve one or both tonsils or may extend widely to involve the nares, uvula, soft palate, pharynx, larynx, and tracheobronchial tree associate with Corynebacterium diphtheria.
• Conjunctivitis and periauricular lymphadenopathy associate with adenoviral infection.
• Blisters or ulcers in the anterior mouth or lips are seen in herpes simplex infection.

Heart

• Heart murmur associate with rheumatic fever due to streptococcal pharyngitis.

Abdomen

• Hepatospleenomegaly: associate with pharyngitis caused by group A streptococcus, infectious mononucleosis

Neck

• Cervical adenopathy