“Big tonsils” means nothing to the next clinician, and one gentle pass with a tongue blade separates a yeast infection from a precancerous lesion. Grade a live drawing 1+ to 4+, count Centor criteria, run the scrape test, work a nosebleed — and learn the single mouth you must never put a tongue blade into.
Tonsil grade — 1+
Uvula and soft palate on phonation
Centor criteria — tap what is present
These four raise the probability of group A streptococcus. Nurses do not prescribe from them — nurses decide who is seen this afternoon.
What do you see in the mouth?
Gloves on, tongue blade and a good light. Then do the part students skip: wrap the tip of the tongue in gauze, pull it gently forward and to each side, and inspect the lateral borders and the floor of the mouth — then palpate the floor bimanually.
Now run the scrape test
One gentle pass with the tongue blade. This is the highest-yield ten seconds in the entire oral exam.
Nasal findings
Otoscope with a wide short speculum, or a nasal speculum and penlight, head tilted back slightly. Expect a midline septum, pink moist mucosa, and the inferior and middle turbinates as smooth reddish-pink ridges on the lateral wall.
Epistaxis — tap every correct action
Some of these will make it worse. Choose carefully, then check.
A patient with a sore throat is in front of you
Tap every finding that is present, then decide whether you inspect the pharynx.
Technique, when it is safe to look. Depress the middle third of the tongue — pressing too far back only triggers gagging. Inspect tonsils, anterior and posterior pillars, uvula and posterior pharyngeal wall. The soft palate should rise symmetrically with the uvula staying midline (cranial nerves IX and X), and the protruded tongue should come out midline (cranial nerve XII).
Grade it, do not eyeball itMove the grade slider and the drawing and the interpretation follow.