Sore throat

With odynophagia—painful swallowing.

Some differential diagnoses and typical outline evidence

Viral pharyngitis	Suggested by: sore throat, pain on swallowing, fever, cervical lymphadenopathy and injected fauces. ↑ lymphocytes, leucocytes normal in WBC.
	Confirmed by: negative throat swab for bacterial culture, self-limiting: resolution within days.
Acute follicular tonsillitis (streptococcal)	Suggested by: severe sore throat, pain on swallowing, fever, enlarged tonsils with white patches (like strawberries and cream). Cervical lymphadenopathy especially in angle of jaw. Fever, ↑ leucocytes in WBC.
	Confirmed by: throat swab for culture and sensitivities of organisms.
	Management: OHCS p564.
Infectious mononucleosis (glandular fever) due to Epstein–Barr virus	Suggested by: very severe throat pain with enlarged tonsils covered with creamy membrane. Petechiae on palate. Profound malaise. Generalised lymphadenopathy, splenomegaly.
	Confirmed by: ↑ atypical lymphocytes in WBC. Paul–Bunnel test positive. Viral titres.
	Management: OHCM p570.
Candidiasis of buccal or oesophageal mucosa	Suggested by: painful dysphagia, white plaque, history of immunosuppression/diabetes/recent antibiotics.
	Confirmed by: oesophagoscopy showing erythema and plaques, brush cytology ± biopsy shows spores and hyphae.
	Management: OHCM p210.
Agranulocytosis	Suggested by: sore throat, background history of taking a drug or contact with noxious substance.
	Confirmed by: low or absent neutrophil count.
	Management: OHCM p662.
Meningococcal meningitits	Suggested by: headache, photophobia, vomiting, sore throat, red fauces without purulent patches, neck stiffness. High blood neutrophil count.
	Confirmed by: lumbar puncture showing pus or neutrophil count and organisms on microscopy or culture.
	Management: OHCM p370.