What are the physical findings characteristic of pharyngitis (sore throat)?

Updated: May 06, 2020
  • Author: John R Acerra, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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See the list below:

  • Airway patency must be assessed and addressed first.

  • Temperature: Fever is usually absent or low-grade in viral pharyngitis, but fever is not reliable to differentiate viral or bacterial etiologies.

  • Hydration status: Oral intake usually is compromised because of odynophagia; therefore, various degrees of dehydration result.

  • Head, ears, eyes, nose, and throat (HEENT)

    • Conjunctivitis may be seen in association with adenovirus.

    • Scleral icterus may be seen with infectious mononucleosis.

    • Rhinorrhea usually is associated with a viral cause.

    • Tonsillopharyngeal/palatal petechiae are seen in GAS infections and infectious mononucleosis.

    • A tonsillopharyngeal exudate may be seen in streptococcal infectious mononucleosis and occasionally in M pneumoniae, C pneumoniae, A haemolyticus, adenovirus, and herpesvirus infections. Therefore, exudate does not differentiate viral and bacterial causes.

    • Oropharyngeal vesicular lesions are seen in coxsackievirus and herpesvirus. Concomitant vesicles on the hands and feet are associated with coxsackievirus (hand-foot-and-mouth disease).

  • Lymphadenopathy: Tender anterior cervical nodes are consistent with streptococcal infection, whereas generalized adenopathy is consistent with infectious mononucleosis or the acute lymphoglandular syndrome of HIV infection.

  • Cardiovascular: Murmurs should be documented in an acute episode of pharyngitis to monitor for potential rheumatic fever.

  • Pulmonary: Pharyngitis and lower respiratory tract infections are more consistent with M pneumoniae or C pneumoniae, particularly when a persistent nonproductive cough is present.

  • Abdomen: Hepatosplenomegaly can be found in infectious mononucleosis infection.

  • Skin

    • A sandpapery scarlatiniform rash is seen in GAS infection (see Scarlet Fever). [17]

    • Maculopapular rashes are seen with various viral infections and with infectious mononucleosis empirically treated with penicillin.

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