Browse categories and answer follow-up questions to refine your symptom profile.
History
HPI overview
Symptom profile
Sore throat onset context
Course
Progressive
Fluctuating
Improving
Prior episodes
Baseline voice and swallowing status
OPQRST
Onset
Sudden
Gradual
Duration
Provocation and palliation
Worse with swallowing
Worse with talking
Worse with neck movement
Relief with analgesics
Relief with cold fluids
Quality
Burning
Sharp
Scratchy
Globus sensation
Region and radiation
Unilateral throat pain
Bilateral throat pain
Otalgia referred
Jaw pain
Neck pain
Severity
Pain score 0 to 10
Oral intake limitation
Sleep disruption
Timing
Constant
Intermittent
Worse at night
Worse in morning
Associated symptoms
Symptom cluster
Fever or rigors
Coryza
Cough
Hoarseness
Drooling
Dysphagia
Odynophagia
Trismus
Neck swelling
Stridor
Shortness of breath
Chest pain
Rash
Conjunctivitis
Myalgias
Abdominal pain
Nausea
Vomiting
Exposure context
Epidemiology and exposures
Sick contacts
Daycare or school exposure
Recent travel
Recent oral sex exposure
Recent new partner
Recent antibiotic use
Tobacco or vaping exposure
Inhalational irritant exposure
Prior testing and treatment
Pre arrival care
Prior rapid strep test result
Prior throat culture result
Prior COVID test result
Analgesics used
Antibiotics started
Steroids taken
Alarm Features
Airway and breathing red flags
Immediate threats
Stridor at rest
Drooling with inability to swallow secretions
Muffled voice
Trismus with limited mouth opening
Respiratory distress
Tripod positioning
Inability to lie flat
Rapidly progressive neck swelling
Hemodynamic and systemic red flags
High risk physiology
Hypotension
Tachycardia out of proportion to fever
Toxic appearance
Altered mental status
Severe dehydration
Deep infection red flags
Cannot miss patterns
Neck stiffness with fever
Unilateral tonsillar swelling with uvular deviation
Neck swelling with pain along sternocleidomastoid
Pleuritic chest pain after recent pharyngitis
Persistent fever beyond 3 to 5 days
Immunocompromise and special populations
Higher risk host factors
Neutropenia
Solid organ transplant
HIV with low CD4
Active chemotherapy
Chronic high dose steroids
Pregnancy
Escalation triggers
Time critical actions
If airway compromise suspected, resuscitation bay
If drooling or stridor, avoid oral exam maneuvers that worsen obstruction
If suspected epiglottitis, early anesthesia and ENT involvement
Medications
Current medications
Medication list
Antibiotics in prior 30 days
Immunosuppressants
ACE inhibitor exposure
Anticoagulants
Antiplatelets
Inhaled steroids
Diabetes medications
OTC and symptomatic treatments
Recent OTC use
Acetaminophen dose and timing
Ibuprofen dose and timing
Decongestants
Antihistamines
Throat lozenges
Allergies and adverse reactions
Antibiotic allergy profile
Penicillin reaction type
Cephalosporin reaction type
Macrolide reaction type
Contraindications to common therapies
Therapy constraints
NSAID contraindication
Steroid caution
Uncontrolled diabetes
Active untreated bacterial infection concern
QT prolonging drug interactions with macrolides
Diet
Intake and hydration
PO tolerance
Able to swallow liquids
Able to swallow solids
Urine output reduction
Weight change
Dietary and irritant triggers
Exposures
Very hot beverages
Alcohol exposure
Smoking or vaping
Reflux triggering foods
Infectious exposure via ingestion
Food related risks
Unpasteurized dairy exposure
Shared drinks or utensils
Review of Systems
Infectious and inflammatory
Constitutional and infection
Fever
Chills
Night sweats
Fatigue
HEENT
Upper airway
Rhinorrhea
Nasal congestion
Sneezing
Ear pain
Hearing change
Dental pain
Facial swelling
Respiratory
Lower airway
Cough
Dyspnea
Wheeze
Hemoptysis
GI
Gastrointestinal
Dysphagia
Odynophagia
Reflux symptoms
Abdominal pain
Nausea
Vomiting
Skin and mucosa
Rash and mucosal findings
Diffuse rash
Palmar or plantar rash
Oral ulcers
Conjunctivitis
Collateral History and Family History
Collateral and reliability
Source context
Parent or caregiver report
EMS report
Prior records review
Household and contact history
Transmission context
Household sick contacts
School or daycare outbreak
Known strep exposure
Family history
Relevant inherited and household risks
Rheumatic fever history in family
Immunodeficiency history in family
Risk Factors
Infectious risk factors
Host and exposure risks
Close contact crowding
Poor vaccination access or uncertain status
Recent influenza like illness exposure
Recent COVID exposure
Bacterial pharyngitis risk factors
GAS and complications
Age 5 to 15 years
No cough with fever
Tender anterior cervical nodes
Tonsillar exudates
Deep neck infection risk factors
Predisposition
Recent dental infection
Diabetes mellitus (E11.9)
Immunocompromised state
Recent head and neck surgery
Lemierre risk factors
Fusobacterium risk
Adolescent or young adult
Recent worsening after initial improvement
Neck pain along jugular chain
Noninfectious risk factors
Irritant and inflammatory
Gastroesophageal reflux disease (K21.9)
Smoking
Allergic rhinitis exposure
Differential Diagnosis
Life threatening
Immediate threats
Epiglottitis (J05.1)
Drooling
Stridor
Tripod positioning
Deep neck space infection
Retropharyngeal abscess (J39.0)
Neck stiffness
Limited neck extension
Parapharyngeal abscess (J39.1)
Trismus
Neck swelling
Peritonsillar abscess (J36)
Unilateral tonsillar swelling
Uvular deviation
Hot potato voice
Ludwig angina (K12.2)
Submandibular swelling
Floor of mouth elevation
Diphtheria (A36.0) local protocol dependent
Pseudomembrane
Toxic appearance
Anaphylaxis or angioedema (T78.3)
Lip or tongue swelling
Wheeze
Hypotension
Common
High frequency etiologies
Viral pharyngitis (J02.9)
Cough
Coryza
Conjunctivitis
Group A streptococcal pharyngitis (J02.0)
Fever
Absence of cough
Tonsillar exudates
Tender anterior cervical nodes
Infectious mononucleosis (B27.90)
Posterior cervical lymphadenopathy
Fatigue
Hepatosplenomegaly
Influenza (J10.1)
Myalgias
Fever
COVID 19 (U07.1)
Exposure
Anosmia or ageusia
Less common
Additional considerations
Gonococcal pharyngitis (A54.5)
Recent oral sex exposure
Persistent symptoms
Chlamydial pharyngitis local protocol dependent
Oral exposure history
Minimal exam findings
Herpangina or HFMD (B08.5)
Vesicles
Hand or foot rash
HSV pharyngitis (B00.2)
Oral ulcers
Gingivostomatitis
Peritonsillar cellulitis
Trismus mild
No drainable collection
Mimics and pitfalls
Noninfectious or alternative diagnoses
GERD related throat irritation (K21.9)
Worse after meals
Heartburn
Post nasal drip
Chronic rhinorrhea
Allergic symptoms
Aphthous ulcers (K12.0)
Discrete painful ulcers
No systemic toxicity
Malignancy red flags (C32.9) local protocol dependent
Persistent beyond 3 to 4 weeks
Weight loss
Unilateral otalgia
Past Medical History
Relevant conditions
Baseline medical risks
Diabetes mellitus (E11.9)
Chronic kidney disease (N18.9)
Asthma (J45.909)
Immunocompromised condition
History of rheumatic fever (I00)
Prior ENT history
Airway and throat history
Recurrent tonsillitis
Prior peritonsillar abscess
Tonsillectomy history
Procedures and devices
Hardware and prior interventions
Recent intubation
Tracheostomy history
Recent dental procedures
Physical Exam
Initial appearance and vitals
Front door assessment
Work of breathing
Voice quality
Normal
Hoarse
Muffled
Hydration status
Vital sign patterns
Fever
Tachycardia
Hypoxia
Hypotension
HEENT and neck
Oropharynx and neck exam
Trismus measurement
Mouth opening limited
Mouth opening adequate
Tonsils
Exudates
Asymmetry
Swelling
Uvula
Midline
Deviation
Posterior pharynx
Erythema
Exudate
Ulcers
Soft palate
Bulge
Fluctuance
Neck range of motion
Pain with extension
Limited extension
Cervical lymph nodes
Anterior tenderness
Posterior enlargement
Airway focused exam
Airway risk findings
Drooling
Stridor
Tripod positioning
Tongue or floor of mouth swelling
Cardiopulmonary
Heart and lungs
Wheeze
Crackles
Murmur
Abdomen and skin
Systemic clues
Hepatosplenomegaly
Diffuse rash
Sandpaper rash
Palmar or plantar lesions
Neurologic and toxicity
Global status
Mental status change
Meningismus
Severe distress
Lab Studies
Infectious testing
Microbiology and virology
Rapid antigen detection test for GAS
Best fit for moderate pretest probability
Negative in children requires confirmatory throat culture local protocol dependent
Throat culture for GAS
Reference standard for GAS detection
Turnaround delay impacts ED decisions
NAAT for GAS local protocol dependent
High sensitivity strategy when available
Stewardship advantage over empiric antibiotics
COVID testing per local protocol
Transmission control implications
Isolation guidance local protocol dependent
Influenza testing per local protocol
Most useful early in course
Antiviral window considerations
Bloodwork when complicated
Systemic evaluation
CBC
Leukocytosis supports bacterial process
Atypical lymphocytes suggest EBV
CRP or ESR local protocol dependent
Supports inflammation
Nonspecific
BMP
Dehydration indicators
Renal function for medication dosing
Blood cultures
Suspected sepsis
Suspected Lemierre syndrome
EBV and complications
Mononucleosis testing
Heterophile antibody test
Lower sensitivity early in illness
Supportive not definitive
EBV serologies local protocol dependent
If high suspicion with negative heterophile
Interpretation depends on pattern
Pitfalls and limits
Interpretation cautions
GAS colonization
Positive test does not prove causation when viral features prominent
Clinical correlation required
Antibiotics after rash in EBV
Aminopenicillins associated with rash risk
Avoid amoxicillin if EBV likely
Imaging
Scoring Systems
Risk tools for GAS
Centor criteria
Tonsillar exudates
Tender anterior cervical lymphadenopathy
Fever history
Absence of cough
McIsaac modification
Age adjustment
Improves calibration in children and adults
FeverPAIN local protocol dependent
Fever
Purulence
Rapid attendance
Severely inflamed tonsils
No cough or coryza
MRI
MRI indications local protocol dependent
Suspected deep neck infection when CT contraindicated
Superior soft tissue delineation for complications
Limitations
Availability and time
Sedation needs in pediatrics
CT
CT neck with IV contrast
Suspected peritonsillar abscess with unclear exam
Suspected retropharyngeal or parapharyngeal abscess
Suspected Ludwig angina extension
Contrast cautions
Prior anaphylactoid reaction
Significant renal impairment local protocol dependent
Interpretation pearls
Differentiate cellulitis versus drainable collection
Evaluate airway caliber
Ultrasound
POCUS and targeted ultrasound
Peritonsillar abscess evaluation local protocol dependent
Identify drainable collection
Guide needle aspiration when trained
Neck ultrasound for lymphadenitis
Abscess versus reactive nodes
Pitfall with early phlegmon
Special Tests
Bedside maneuvers and procedural diagnostics
Focused tests
Trismus assessment
Mouth opening limitation supports PTA
Severity guides airway concern
Voice assessment
Muffled voice supports PTA or deep infection
Hoarseness supports laryngitis or irritant
Hydration bedside markers
Dry mucous membranes
Capillary refill delay
Fiberoptic evaluation and specialty tests
Airway visualization local protocol dependent
Flexible nasolaryngoscopy by ENT or anesthesia
Suspected epiglottitis
Suspected supraglottic edema
Limitations
Provokes distress in unstable airway
Requires airway ready environment
Procedure support
Peritonsillar abscess drainage local protocol dependent
Needle aspiration
Contraindicated if airway unstable
Bleeding risk higher with anticoagulation
Incision and drainage
Expertise dependent
Post procedure airway monitoring need
ECG
When relevant
Indications
Syncope
Chest pain
Tachycardia with systemic illness
Patterns that change management
High risk findings
New atrial fibrillation
Wide complex tachycardia
Ischemic changes
Assessment
Working diagnosis framework
Problem representation
Uncomplicated pharyngitis with low airway risk
Suspected GAS pharyngitis (J02.0) versus viral pharyngitis (J02.9)
Suspected infectious mononucleosis (B27.90)
Suspected peritonsillar abscess (J36)
Suspected epiglottitis (J05.1)
Suspected deep neck space infection (J39.0)
Severity and risk stratification
Airway risk tier
Low risk
Normal voice
No drooling
No stridor
Moderate risk
Muffled voice
Trismus
Neck swelling mild
High risk
Stridor
Drooling
Respiratory distress
Complications to rule out
Cannot miss complications
Dehydration requiring IV fluids
Peritonsillar abscess progression
Lemierre syndrome suspicion
Rheumatic fever risk context in GAS local protocol dependent
Plan
First 5 minutes for the critical patient
Airway first workflow
Continuous pulse oximetry
Cardiac monitoring if toxic or unstable
Two large bore IV if moderate or high airway risk
Supplemental oxygen if hypoxic
Airway backup readiness
Early anesthesia involvement if stridor or drooling
Early ENT involvement if suspected deep neck infection
Diagnostic plan
Testing sequence
GAS testing guided by Centor or McIsaac risk
Viral testing per local protocol and infection control needs
CBC and BMP if toxic, dehydrated, or deep infection concern
CT neck with IV contrast if deep neck space infection concern
Therapeutic plan for uncomplicated sore throat
Symptom control
Acetaminophen PO 1000 mg once
Maximum 3000 mg per day local protocol dependent
Lower maximum with chronic liver disease
Ibuprofen PO 400 mg once
Avoid with significant renal impairment
Avoid with active GI bleeding
Dexamethasone PO or IM 10 mg once local protocol dependent
Avoid if concern for untreated deep space infection with airway compromise without definitive plan
Hyperglycemia risk counseling
Topical anesthetic local protocol dependent
Viscous lidocaine caution with aspiration risk
Avoid excessive dosing
Antibiotics when indicated
GAS treatment options local protocol dependent
Penicillin V PO 500 mg twice daily for 10 days
Preferred when no allergy
Adherence importance
Amoxicillin PO 500 mg twice daily for 10 days
Avoid if EBV likely
Rash risk with EBV
Cephalexin PO 500 mg twice daily for 10 days
Avoid in immediate anaphylaxis type penicillin allergy
Alternative for non anaphylactic reactions
Azithromycin PO 500 mg day 1
Then 250 mg daily days 2 to 5
Macrolide resistance local protocol dependent
Peritonsillar abscess and deep infection
Escalation treatment local protocol dependent
IV antibiotics for deep infection concern
Ampicillin sulbactam IV 3 g every 6 hours
If penicillin anaphylaxis, clindamycin IV 600 mg every 8 hours
Drainage pathway for PTA when stable
Needle aspiration by trained clinician
ENT drainage if difficult anatomy or complications
IV fluids for dehydration
Balanced crystalloid 20 mL per kg bolus if hypotension
Reassess after bolus
Reassessment loop
Time based reassessment
Recheck airway and voice within 30 to 60 minutes after analgesia
Recheck PO tolerance after symptom control
Repeat vitals after fluids or antipyretics
Escalate imaging and consult if worsening
Disposition
ICU criteria
ICU needs
Impending airway compromise
Stridor at rest
Respiratory distress requiring high flow oxygen
Septic shock or persistent hypotension
Inpatient admission criteria
Admission indications
Deep neck space infection suspected or confirmed
Peritonsillar abscess with failed ED drainage or significant comorbidity
Severe dehydration with inability to tolerate PO
Immunocompromised with systemic illness
Observation pathway criteria
Observation fits
Moderate dehydration improving with IV fluids
Pain control requiring repeated parenteral dosing
Awaiting imaging or consultant reassessment
Discharge criteria
Safe discharge features
No airway red flags
Able to swallow liquids
Vitals stable
Reliable follow up and return ability
Clear plan for pending tests local protocol dependent
Follow up timing
Follow up plan
Primary care within 24 to 72 hours if persistent symptoms
ENT within 24 to 48 hours for PTA pathway local protocol dependent
Return for worsening within 12 to 24 hours if borderline
Discharge Instructions
Copy discharge instructions
Summary
Today you were seen for sore throat
Your exam and tests suggest a throat infection or irritation without dangerous airway swelling
Medications
Acetaminophen as directed on label
Ibuprofen as directed on label if safe for you
If antibiotics prescribed, take the full course
If you develop a rash after starting antibiotics, stop the medication and seek medical advice
Hydration and diet
Drink frequent small sips of fluid
Soft foods as tolerated
Activity
Rest until fever resolves
Avoid sharing drinks or utensils while symptomatic
Follow up
Follow up with your clinician in 1 to 3 days if not improving
Return to emergency care now if
Trouble breathing
Noisy breathing
Drooling or unable to swallow saliva
Worsening neck swelling
Severe worsening one sided throat pain
High fever with feeling very unwell
New rash with swelling of lips or tongue
Dehydration signs
Very low urine output
Dizziness
Fainting
References
Guidelines and key sources
Evidence base
Infectious Diseases Society of America guideline for group A streptococcal pharyngitis 2012
Centers for Disease Control and Prevention clinical guidance for group A strep pharyngitis updated regularly local protocol dependent
National Institute for Health and Care Excellence sore throat acute antimicrobial prescribing guideline 2018
American Academy of Pediatrics Red Book streptococcal pharyngitis section updated regularly local protocol dependent
American Academy of Otolaryngology Head and Neck Surgery guidance on peritonsillar abscess management local protocol dependent
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.