Skip to Main Content

++

Probability diagnosis

++

Viral pharyngitis

++

Epstein–Barr mononucleosis (glandular fever)

++

Streptococcal (GABHS) tonsillitis

++

Chronic sinusitis with postnasal drip

++

Oropharyngeal candidiasis

++

Serious disorders not to be missed

++

Cardiovascular:

++

  • angina

  • myocardial infarction

++

Neoplasia/cancer:

++

  • cancer of oropharynx, tongue

++

Blood dyscrasias (e.g. agranulocytosis, acute leukaemia)

++

Infection:

++

  • acute epiglottitis (children and adults)

  • peritonsillar abscess (quinsy)

  • pharyngeal abscess

  • diphtheria (very rare)

  • HIV/AIDS

++

Pitfalls (often missed)

++

Foreign body (e.g. fish bone)

++

Epstein—Barr mononucleosis (glandular fever)

++

Candida:

++

  • common in infants

  • steroid inhalers

++

STIs:

++

  • gonococcal pharyngitis

  • herpes simplex (type II)

  • syphilis

++

Irritants (e.g. cigarette smoke, chemicals)

++

Reflux oesophagitis → pharyngolaryngitis

++

Tonsilloliths

++

Cricopharyngeal spasm

++

Kawasaki disease

++

Chronic mouth breathing

++

Aphthous ulceration

++

Thyroiditis

++

Glossopharyngeal neuralgia

++

Rarities:

++

  • scleroderma

  • Behçet disease

  • sarcoidosis

  • malignant granuloma

  • tuberculosis

++

Masquerades checklist

++

Depression

++

Diabetes (Candida)

++

Drugs (e.g. NSAIDS, cytotoxics)

++

Anaemia (possible)

++

Thyroid disorder (thyroiditis)

++

Spinal dysfunction (cervical referred pain)

++

Is the patient trying to tell me something?

++

Unlikely, but the association with depression is significant.

++

Key history

++

First determine whether the patient has a sore throat, a deep pain in the throat or neck pain. Enquire about relevant associated symptoms such as a metallic taste in the mouth, fever, upper respiratory infection, postnasal drip, sinusitis, cough and other pain such as ear pain. Note whether the patient is an asthmatic and uses a steroid inhaler or is a smoker or exposed to environmental irritants.

++

Key examination

++

  • On inspection note the general appearance, look for toxicity, the anaemic pallor of leukaemia, the nasal stuffiness of infectious mononucleosis or the halitosis of a streptococcal throat

  • Palpate the neck for soreness and lymphadenopathy and check the sinus area

  • Then inspect the oral cavity and pharynx

++

Key investigations

++

Consider:

++

  • throat swab

  • FBE

  • mononucleosis test

  • blood sugar

  • biopsy of suspicious lesions.

++

Diagnostic tips

++

  • Tonsillitis with a covering membrane may be caused by Epstein–Barr mononucleosis.

  • Admit if any suspicion of epiglottitis—and do not examine the throat.

  • The triad-hoarseness, pain on swallowing and referred ear pain → pharyngeal cancer.

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.