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) of oral cavity (especially oropharynx/mouth) [acute tonsillitis: inflammation limited to palatine tonsils].
- Skin and mucous membranes
- Examination of the nasopharynx by epipharyngoscopy (nasopharyngoscopy).
- [acute tonsillitis:
- Recurrent (acute) tonsillitis (RAT): lack of luxation of the tonsil (due toScarring trains with the peritonsillar tissue).
- Peritonsillar abscess:
- Unilateral (unilateral) markedly swollen tonsil + surrounding redness and swelling of the soft palate.
- Tonsillar exudate
- Deviation of the uvula (uvula) to the opposite side]
- Examination of the ears by otoscope / otoscopy [due topossible secondary disease: otitis media (otitis media)].
- Palpation (palpation) of the cervical and nuchal (“belonging to the neck and neck”) lymph nodes [pronounced lymph node enlargement of the cervical lymph nodes].
- Auscultation (listening) of the heart [due topossible secondary diseases: Endocarditis (meningitis, usually the heart valves are affected), myocarditis (myocarditis), pericarditis (pericardial inflammation)]
- Inspection (viewing) of oral cavity (especially oropharynx/mouth) [acute tonsillitis: inflammation limited to palatine tonsils].
- If necessary, ENT medical examination
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.
