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LEARNING OBJECTIVES

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

  • List the subjective and objective information that a healthcare professional must gather from a patient with pharyngitis.

  • Assess the need for antibiotic therapy in a patient with pharyngitis based on signs and symptoms and the results from microbiological and immunologic diagnostic studies.

  • Prepare an evidence-based care plan for a patient with acute pharyngitis that is individualized to the patient’s current presentation, past medical history and concurrent medications.

  • Identify the key educational and counseling points needed by the patient and/or caregivers to safely and effectively implement the therapeutic plan and to prevent disease transmission.

  • List the parameters monitored by the healthcare professional to ensure clinical resolution and the prevention of suppurative and nonsuppurative complications of acute pharyngitis.

PATIENT PRESENTATION

Chief Complaint

“It hurts to swallow.”

HPI

Elizabeth Grant is a 14-year-old girl who presents to her family medicine provider complaining of sore throat. Her mother measured a fever of 102°F (38.9°C) on and off for the past 24 hours that was treated with acetaminophen. She has been more tired in school than usual over the past 2 days and has been drinking only liquids since this time. She denies cough, shortness of breath, or difficulty breathing. The patient complains of nausea and headaches but denies vomiting. Mother notes no recent illness in the family.

PMH

The patient has had prior cases of otitis media as a young child. Six months ago she was diagnosed with primary dysmenorrhea. Otherwise she is healthy. Immunization records indicate receipt of the following immunizations:

  • HepB: four doses (last dose age 12 months)

  • DTaP: five doses (last dose age 4 years)

  • Tdap: one dose given at age 11

  • Hib: four doses (last dose age 12 months)

  • PCV: four doses (last dose age 12 months)

  • IPV: four doses (last dose age 4 years)

  • MMR: two doses (last dose age 12 months)

  • Varicella two doses (last dose age 12 months)

  • HPV: one dose given at age 11

  • MenACWY-D: one dose given at age 11

  • Influenza IIV/LAIV: last received at age 11

FH

Noncontributory

SH

Elizabeth lives with her parents and 5-year old twin brothers. She started high school 2 months ago and is on the junior varsity soccer team. She denies the use of tobacco, alcohol, marijuana, or other substances.

Meds

Ethinyl estradiol 20 mcg/levonorgestrel 0.1 mg (21 days active-7 days placebo): one tablet by mouth daily

Naproxen 500 mg by mouth twice daily for 5 days (begin 2 days before menses)

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