🦷 Sore Throat · Strep vs Viral · Pharyngitis · Peritonsillar abscess · Mononucleosis · Epiglottitis

Schwartz Clinical Handbook — Chapter 72 · Centor criteria · Fever · Exudate · Lymphadenopathy · Rapid strep · Throat culture · Rheumatic fever prevention

Select fever, exudate, cervical adenopathy, cough, hoarseness, drooling, muffled voice, and age → differentiate viral pharyngitis (URI symptoms) from Group A Strep (fever, exudate, anterior cervical nodes, no cough) and peritonsillar abscess (unilateral swelling, uvular deviation, trismus).
⚠️ Red flags: drooling, stridor, muffled voice, tripod position → epiglottitis (airway emergency).

📋 Step 1 — Pharyngeal exam & respiratory signs
📌 Diagnostic impressions
📖 Schwartz Ch 72

Select fever, pharyngeal exudate, tender anterior cervical adenopathy, cough, hoarseness, rhinorrhea, drooling, muffled voice, and age → system applies Centor criteria to estimate strep probability, and differentiates viral pharyngitis (cough, rhinorrhea), GAS pharyngitis (fever, exudate, no cough), infectious mononucleosis (posterior adenopathy, fatigue), peritonsillar abscess (unilateral swelling, uvular deviation, trismus), and epiglottitis (drooling, stridor, toxic).

✔️ Strep pharyngitis: fever, exudate, anterior cervical adenopathy, no cough.
✔️ Viral: rhinorrhea, cough, hoarseness.
✔️ Mononucleosis: posterior cervical nodes, fatigue, splenomegaly, atypical lymphs.
✔️ Peritonsillar abscess: unilateral bulge, uvular deviation, trismus, hot potato voice.
✔️ Epiglottitis: drooling, stridor, toxic appearance (airway emergency).
📘 Schwartz pearls (Chapter 72)
• Rapid strep test (70‑95% sensitive), culture if negative.
• Penicillin VK (250 mg BID‑TID ×10d) or amoxicillin for strep.
• Macrolides for penicillin allergy (if not contraindicated).
• Peritonsillar abscess: ENT drainage + IV clindamycin/penicillin.
• Epiglottitis: do NOT examine pharynx; immediate airway/OR.