Chapter 32: Sore Throat Assessment & Diagnosis

The text categorizes the condition based on the presence or absence of pharyngeal ulcers, a critical distinction for narrowing down the differential diagnosis between viral, bacterial, fungal, and non-infectious causes. It emphasizes the urgent recognition of life-threatening emergencies such as acute epiglottitis and peritonsillar or retropharyngeal abscesses, which are characterized by airway obstruction symptoms like stridor, drooling, and the inability to swallow. A significant focus is placed on differentiating Group A Beta-hemolytic Streptococcus (GAS) from viral etiologies like adenovirus, influenza, and Epstein-Barr virus (infectious mononucleosis), utilizing diagnostic reasoning that analyzes fever patterns, onset severity, and associated upper respiratory symptoms like cough and rhinorrhea. The physical examination guidelines are extensive, detailing how to inspect the oral mucosa for specific lesions—such as the vesicles of herpangina or the plaques of candidiasis—grade tonsillar hypertrophy, and palpate lymph nodes, noting that anterior cervical adenopathy often suggests bacterial infection while posterior involvement points to viral causes. The chapter also outlines the appropriate use of diagnostic studies, including rapid antigen detection tests, throat cultures as the gold standard, and serology for mononucleosis. Furthermore, it covers specific conditions affecting different populations, such as gonococcal pharyngitis in sexually active adults and risk factors like immunosuppression. Finally, the discussion includes evidence-based management strategies for complications like peritonsillar abscesses and highlights the importance of treating streptococcal pharyngitis to prevent sequelae such as rheumatic fever and glomerulonephritis.