A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
- Inspection (viewing).
- Skin and mucous membranes
- Mouth and oropharynx (areas from the soft part of the palate, the tonsils and the base of the tongue) [acute pharyngitis: inflammation of the pharyngeal mucosa without involvement of the palatine tonsils; possibly also stipples and viscous mucus deposits].
- Palpation (palpation) of the regional lymph nodes [pressure painful swollen?]
- Examination of the ears by otoscope / otoscopy [due topossible sequelae: otitis media (otitis media)].
- Auscultation (listening) of the heart [due topossible sequelae: Endocarditis (meningitis, usually the heart valves are affected), myocarditis (myocarditis), pericarditis (pericardial inflammation)]
- Inspection (viewing).
- ENT medical examination – including endoscopy of the oral cavity and pharynx.
Square brackets [ ] indicate possible pathological (pathological) physical findings.
McIsaac score (modified Centor score): predictor of GABHS tonsillopharyngitis for patients aged 3 to 14 years.
Symptom | Points |
Body temperature (in the medical history) > 38 °C | 1 |
no cough | 1 |
cervical (“belonging to the neck”) lymph node enlargement | 1 |
Tonsil enlargement or exudate. | 1 |
Age: 3-14 years | 1 |
15-44 years of life | 0 |
≥ 45 years of life | -1 |
McIsaac score (modified Centor score) point total | Probability of GABHS detection in throat swab. |
-1 or 0 | 1 % |
1 | 10 % |
2 | ∼ 17 % |
3 | ∼ 35 % |
4 or 5 | ∼ 50 % |
Centor score: predictor of GABHS tonsillopharyngitis for patients ≥ 15 years of age.
Symptom | Points |
Body temperature (in the medical history) > 38 °C | 1 |
No cough | 1 |
Cervical lymph node enlargement | 1 |
Tonsil enlargement or exudate. | 1 |
Centor scoreSum of points | Probability of GABHS detection in throat swab. |
0 | ∼ 2,5 % |
1 | ∼ 6-7 % |
2 | ∼ 15 % |
3 | ∼ 30-35 % |
4 | ∼ 50-60 % |
Legend: GABHS = group A beta-hemolytic streptococci.