When is a "simple" pharyngitis just not a simple pharyngitis?

Sore throat is probably one of the most common chief complaints that we encounter during our daily practice. What historical and clinical clues do you use to distinguish the patient with a simple pharyngitis from those with more serious disease (ie epiglottis, abscess, bacterial tracheitis, etc...)?

To start ....

• toxic appearing


• tripod sitting position


• drooling


• "hot potato" voice


• trismus


• decreased neck mobility


• neck swelling

In patients with these symptoms I would consider going beyond the usual pharyngitis workup (+/- rapid strep/mono spot/pcn vk) to consider imaging and ENT consultation.

Agree?