Physical Diagnosis, M2 Course


Devin Nickol, M.D.


Following today's lecture, students should understand the following:

     1. The reasons why accurate and timely diagnosis of streptococcal pharyngitis is important.

     2. The challenges involved in diagnosing streptococcal pharyngitis clinically.

     3. A rational approach to the diagnosis and treatment of patients with pharyngitis.



A 19-year-old female presents to clinic with a two day history of sore throat with difficulty swallowing. She has also noted fevers (~ 101 F) and states "the glands in my neck are swollen." She has not noted a cough. On exam she is febrile (101.8 F), and you note white tonsillar exudates as well as anterior cervical lymphadenopathy. She does not have conjunctival injection.

What do you do?



- What is it?


- How common is it?


- How much money do we spend diagnosing and treating it?


- What causes it?

     Most common etiology:

     Most common bacterial cause:

     Other bacterial causes:



- How do we diagnose the underlying cause of pharyngitis?


- Why do we care what the underlying cause is?




- Why not just treat everyone?




- How often is a sore throat caused by Group A streptococci?




- How accurate is the history and physical at diagnosing streptococcal pharyngitis?






- How accurate are individual physical exam findings?





- How can patients be stratified into risk groups using the physical exam?





- How should these different risk groups be treated?





- How should the patient in the case presentation be treated?