Physical Exam

Posterior Pharynx Inspection

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Video coming September 2026

How to Perform

With the patient's mouth wide open and the tongue relaxed, press a tongue depressor on the middle of the tongue and shine a light into the mouth. Inspect the soft palate, uvula, anterior and posterior pillars, tonsils, and posterior pharyngeal wall, noting color, swelling, exudate, asymmetry, or lesions. Ask the patient to say "ah" and watch the soft palate and uvula rise.

How to Interpret

Peritonsillar Abscess

Uvular deviation away from the swollen side

Rule in

InconclusiveWide CI

Rule out

Minimally helpful

Evidence:Limited

Streptococcal Pharyngitis

Petechiae — pinpoint red or purple spots — on the soft palate

Rule in

Somewhat helpful

Rule out

Not helpful

Evidence:Strong

Whitish-yellow exudate on the tonsils or pharyngeal wall

Rule in

Minimally helpful

Rule out

Not helpful

Evidence:Strong

Tonsillar Malignancy

Persistent unilateral tonsillar enlargement (marked asymmetry) in the absence of acute infection

Rule in

Very helpfulDerived CI

Rule out

Somewhat helpfulDerived CI

Evidence:Strong

References

Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical examination. Does this patient have strep throat? JAMA. 2000;284(22):2912-2918. PMID: 11147989.
Shaikh N, Swaminathan N, Hooper EG. Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. J Pediatr. 2012;160(3):487-493.e3. doi:10.1016/j.jpeds.2011.09.011. PMID: 22048053.
Gao EY, See ASY, Tan BKJ, Chan SWD, Zhou Y, See A, Kiong KL, Chan CY, Koh LH, Tan HKK, Abhilash B, Lim CM. Tonsillar Asymmetry and Malignancy: A Meta-analysis of Diagnostic Accuracy. Otolaryngol Head Neck Surg. 2026;174(3):643-654. doi:10.1002/ohn.70132. PMID 41614350.
Voruz F, Revol R, Combescure C, Monnier Y, Becker M, Dulguerov N. Diagnosis of peritonsillar abscess—a prospective study comparing clinical with CT findings in 133 consecutive patients. Diagnostics (Basel). 2025;15(2):228. PMID: 39857112.
Kenny BJ, Bordoni B. Neuroanatomy, Cranial Nerve 10 (Vagus Nerve). [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Bookshelf ID NBK537171.
Truelove SA, Keegan LT, Moss WJ, et al. Clinical and Epidemiological Aspects of Diphtheria: A Systematic Review and Pooled Analysis. Clin Infect Dis. 2020;71(1):89-97. doi:10.1093/cid/ciz808. PMID: 31425581. PMCID: PMC7312233.
Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical examination. Does this patient have strep throat? JAMA. 2000;284(22):2912-8. PMID: 11147989.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.