case strudy question?At Children's Hospital( CHOP) the ER and Clinics are always busy. A 5-year old white male child in good general health and physical condition was presented at the Saturday walk-in clinic by his mother. He was brought in because he had a fever, was cranky and had complained of a sore throat for about 24 hours. On physical examination by the attending resident, the patient had a fever of 39 o C. He had considerable swelling and drainage of the pharynx and in the conjunctivae. His tonsils were enlarged and coated with a white patchy exudate. He had a red throat and swollen anterior cervical lymph nodes. His ears were clear. His chest sounded clear and he had no additional remarkable findings on routine examination. A rapid Strep test run ASAP by the lab was positive. Bacteria grown from a throat swab taken at the time of examination indicated gram positive Beta hemolytic bacteria.
These are the quesitions:
1.What would be your presumptive diagnosis for this child? Why?
2.What diagnostic testing would be indicated to follow this exam?
4.What factors of this case allowed you to make a presumptive diagnosis?
Isn't question 1 and 4 the same answer? and is rapid strep test the answer for question 2? Thanks
Blackcompe
1. Diagnosis is Streptococcal infection of the eyes and throat. Treatment consists of an oral antibiotic such as amoxicillin 500 mg 3x/day for 1 week.
2. Follow up with a rapid strep test in a week to see if the infection is eradicated.
3. Symptoms of a streptococcal infection are fever, swelling of the anterior cervical lymph nodes, enlarged tonsils with a white exudate, and a positive rapid strep test.
michellemilitza
4. refers to the S&S you saw when the patient was admitted. In this case it would be: pt is 5 y/o (usually pts that commonly get pharyngitis are between 5-15) fever, swelling and drainage of pharynx and conjuctivae, enlarged cervical nodes, patchy exudates, etc (basically what you see in the patient not what the patient tells you
Also, the first line agent for pharyngitis for caused by Strepococcus is Penicillin VK 250 mg BID for 10 days (since this is a child that's why it's only 250) also depending on the severity of the infection you can give it TID. Amoxicillin isn't recommended as first line agent because it has a broader spectrum of coverage and is less specific for this type of infection, therefore increasing the risk of resistance. If penicillin allergy give azithromycin. You don't want to give erythromycin because of risk of resistance to the AB.
Hope this helps.
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Links to information about tonsillitis , including tonsillectomy.
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