Specific Examination

Palatal petechiae in GABHS infection (image courtesy of CDC)

Examination of the face and neck may identify suppurative complications of GABHS infection e.g. otitis media, mastoiditis, sinusitis.

Lymphadenopathy in the neck is common in both viral and GABHS infection but the presence of conjunctivitis is more specifically associated with adenoviral infection.

Examination of the mouth and pharynx should be undertaken with care; in particular, do not use a tongue depressor if there are any signs of potential airway obstruction as you may worsen the situation.

The image, right (reproduced with permission from CDC) shows palatal petechiae in GABHS infection.

Take care when examining the throat as over-vigorous examination or unnecessary painful procedures may worsen or precipitate airway obstruction.

The image below shows a peri-tonsillar abscess (Quinsy) with typical unilateral tonsillar swelling and uvula deviation.

Learning Bite

Take care when examining the throat as over-vigorous examination or unnecessary painful procedures may worsen or precipitate airway obstruction.

During Covid-19 pandemic, examination of the throat places the clinician at increased risk of viral exposure. The Royal College of Paediatrics and Child Health recommended that children should only have their throat examined when essential [23]. In many places this has been locally extended to adults. You should follow local guidance in this regard.

Any throat examination requires appropriate eye/respiratory personal protective equipment.

Table 1. specific findings and the corresponding diagnoses

Specific finding	Diagnosis
Tonsillopharyngeal or palatal petechiae	GABHS infection or infectious mononucleosis
Unilateral peritonsillar swelling	Peritonsillar abscess
Grey pseudo membrane on the pharynx	Diphtheria
Strawberry tongue	Scarlet fever or Kawasaki’s disease
Posterior pharyngeal swelling or oedema	Retropharyngeal abscess