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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Evaluate the need for antibiotic therapy in a patient with pharyngitis based on signs and symptoms as well as microbiological and immunological diagnostic studies.

  • Identify the most common organisms responsible for causing pharyngitis.

  • Select an appropriate pharmacologic regimen for a patient with acute pharyngitis, including route, frequency, and duration.

  • List the suppurative and nonsuppurative complications of acute pharyngitis, as well as the prevalence of these complications, and the measures to prevent occurrence.

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PATIENT PRESENTATION

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Chief Complaint

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“It hurts to swallow.”

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HPI

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David Jacobs is a 5-year-old boy who presents to his pediatrician complaining of sore throat. His mother states he has had fever of 102°F on and off for the past 24 hours and was treated with acetaminophen. He has also been sleeping more than usual over the past 2 days. He has refused to eat anything solid since this time but has been drinking liquids. His mother states he does not have a cough, shortness of breath, or difficulty breathing. The patient mentions that both his stomach and head aches, but his mother states he has not vomited. Mother notes no recent illness in the family.

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PMH

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The patient has had prior cases of otitis media, his last over a year ago. Otherwise he is healthy. His mother states that he is up-to-date on all vaccinations.

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FH

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Noncontributory

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SH

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David lives with his parents and infant sister. He attends a local day care and preschool.

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Meds

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None

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All

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Amoxicillin: rash, hives

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ROS

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Negative except for complaints noted in the HPI

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Physical Examination

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Gen
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WDWN 5-year-old male, clearly fatigued

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VS
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BP 104/70, P 92, RR 22, T 38.8°C, Wt 21 kg, Ht 45″

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Skin
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Pale, warm, faint scarlatiniform rash on arms and trunk

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HEENT
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PERRLA; tonsils erythematous with associated white exudates; uvula edematous; soft palate with notable petechiae, TM normal

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Neck/Lymph Nodes
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Multiple enlarged anterior cervical lymph nodes, greater than 2 cm in size

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Lungs/Thorax
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CTA bilaterally, (–) shortness of breath, (–) cough

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CV
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RRR, normal S1 and S2

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Abd
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Soft, nontender, nondistended, (+) BS

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Genit/Rect
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Deferred

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Neuro
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CN I–XII intact

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