Sore throat or pharyngitis is a frequent complaint, usually associated with an acute URI. However, sometimes a sore throat is the only symptom.
Centor's clinical prediction rules for streptococcal and Fusobacterium necrophorum pharyngitis have been used in the past to help guide diagnosis and treatment of bacterial infection: fever history, tonsillar exudates, swollen tender anterior cervical adenopathy, and absence of cough. However, the sensitivity and specificity of these rules are less than 90%, calling their validity into question due to a high rate of unnecessary antibiotic use. Guidelines now recommend rapid antigen testing or throat culture for diagnosis and treatment.
A sore tongue may result from local lesions as well as from systemic illness.
Bleeding from the gums, especially when brushing teeth, is a common symptom. Ask about local lesions and any tendency to bleed or bruise elsewhere.
Hoarseness refers to a change in voice quality, often described as husky, rough, harsh, or lower pitched than usual. Causes range from diseases of the larynx to extralaryngeal lesions that press on the laryngeal nerves. Ask the patient about environmental allergies, acid reflux, smoking, alcohol use, and inhalation of fumes or other irritants. Also ask if the patient talks a great deal at work.
Is the problem chronic, lasting more than 2 weeks? Is there prolonged tobacco or alcohol use, cough or hemoptysis, weight loss, or unilateral throat pain?
Ask "Have you noticed any swollen glands or lumps in your neck?" because patients are often more familiar with lay terms than with "lymph nodes."
Assess thyroid function and ask about any enlargement of the thyroid gland, or goiter. To evaluate thyroid function, ask about temperature intolerance and sweating. Opening questions include, "Do you prefer hot or cold weather?" "Do you dress more warmly or less warmly than other people?" "What about blankets … do you use more or fewer than others at home?" "Have you noticed any changes in the texture of your skin?" "Do you perspire more or less than others?" "Any new palpitations or change in weight?" Recall that as people grow older, they sweat less, have less tolerance for cold, and tend to prefer warmer environments.
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