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

Streptococcal Pharyngitis

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

Rule in

Somewhat helpful

Rule out

—

Evidence:Strong

Whitish-yellow exudate (a pus-like coating) on the tonsils or the pharyngeal wall, seen on tongue-depressor and penlight inspection

Rule in

Minimally helpful

Rule out

—

Evidence:Strong

Tonsillar Malignancy

Persistent enlargement of one tonsil, with a clearly larger tonsil on one side (marked tonsillar asymmetry), in the absence of acute infection

Rule in

Very helpful

Rule out

Somewhat helpful

Evidence:Strong

References

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.
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.