Dr. Huntley's
Diagnosis
Checklist
Have a symptom?
See what questions
a doctor would ask.
See what questions
a doctor would ask.
❑ Rhinovirus
❑ Group A streptococci
❑ Ebstein-Barr virus
❑ Adenovirus
❑ Influenza
❑ Candida/thrush
❑ Herpes simplex virus
❑ Peritonsillar abscess
❑ Mycoplasma pneumoniae
❑ Coxsackievirus
❑ Primary HIV
❑ Neisseria gonorrhea
❑ Epiglottitis
❑ Corynebacterium diphtheriae
❑ Leukemia
The most important consideration is whether the patient has a group A strep infection because prompt treatment prevents rheumatic fever. The findings of fever, tender anterior cervical adenopathy, and tonsillar exudate can be combined to make the diagnosis more or less likely. Rapid antigen tests have a sensitivity of 80% to 90% and specificity of 95% to 100%, so give a reasonably accurate diagnosis. Because of limitations in sensitivity however, patients with a high suspicion on clinical grounds should have a backup culture taken.
Prior probability in an adult population with sore throat is 5% to 10%, and in a pediatric population 20% to 25%. A prominent sore throat out of proportion to the degree of pharyngeal inflammation should raise the possibility of acute epiglottitis and acutely impending airway compromise. Persistent unilateral tonsillar enlargement in a young adult without sore throat should raise the suspicion of lymphoma.
Rhinovirus The sore throat is mildly scratchy with nasal congestion, rhinorrhea, and nonproductive cough.
Group A streptococci There is acute onset of a bright red throat with a tonsillar exudate, fever, and tender anterior cervical adenopathy. Cough and rhinorrhea are usually absent.
Ebstein-Barr virus Infectious mononucleosis is a systemic illness with fever and prominent fatigue. The tonsils are usually quite large and covered with an exudate. Palatal petechiae, posterior cervical adenopathy, and splenomegaly are helpful clues although not always present. The pharyngitis will persist longer than with other agents.
Adenovirus Infection causes a febrile pharyngitis and conjunctivitis that occurs in the summer.
Influenza Sore throat is a relatively minor manifestation compared with fever and myalgias. This occurs in the context of a community outbreak.
Candida/thrush A cottage cheese-like exudate appears on the throat, tongue, and buccal mucosa with the underlying mucosa becoming bright red. Precipitating factors include immune compromise, such as HIV, diabetes, or use of inhaled steroids for asthma.
Herpes simplex virus Infection presents as a vesicular and ulcerative pharyngitis/stomatitis. Often a typical vesicular “cold sore” will be present on the lip.
Peritonsillar abscess Abscess is recognized by the severity of the sore throat, high fever, toxic appearance of the patient, and trismus with drooling (unable to open the mouth or swallow). A unilateral bulging of the anterior tonsillar pillar may be fluctuant and displace the uvula. The patient has a muffled “hot potato” voice. Common carotid infection can lead to rupture, heralded by bleeding in the nose, mouth, or ear.
Mycoplasma pneumoniae Associated symptoms include a prominent dry cough or a syndrome of atypical pneumonia. Bullous otitis media, when present, is diagnostically helpful.
Coxsackievirus Vesicles and ulcers on the tonsillar pillars and soft palate appear similar to herpes.
Primary HIV Sore throat occurs in 70%. Characteristic features include an acute monolike illness with fever, lymphadenopathy, diffuse maculopapular rash including involvement of the palms or soles, and mucocutaneous ulceration. Question about risk factors for HIV transmission.
Neisseria gonorrhea Many cases are asymptomatic. A history of oral-genital contact can be elicited.
Epiglottitis The patient has a severe sore throat without erythema, appears acutely anxious, sits forward, and has stridor. The edematous uvula may project over the base of the tongue.
Corynebacterium diphtheriae An adherent bluish-white to green-gray membrane covers the tonsils and causes bleeding if removed. The patient is severely lethargic often with stridor. There is a “bull’s neck” appearance due to submental and cervical adenopathy. The breath is said to smell like a “wet mouse.”
Leukemia A nonspecific sore throat, asthenia, lymphadenopathy, and gum infiltrates are indicators.
Review other book chapters online related to Flu:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
More About This Book:
Title: Field Guide to Bedside Diagnosis Authors: David S. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-78178-165-5 
|
|
What do you think about the features of this website? Take our user survey and have your say:
Next articles:
Tools & Services:
Medical Articles:
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2010 Health Grades Inc. All rights reserved. Last Update: 8 February, 2010 (23:19)
