Case (35)

[Mustafa]

A 13-year-old male presents to the emergency department with a chief complaint of sore throat and fever for the past 2 days. He reports that his younger sister has been ill for the past week with “the same thing.” The patient has no other medical problems, takes no medications, and has no allergies. He denies any recent history of cough, rash, nausea, vomiting, or diarrhea. He denies any recent travel and has completed the full series of childhood immunizations.
On examination, the patient has a temperature of 38.5ºC (101.3ºF), a heart rate of 104 bpm, blood pressure 118/64 mmHg, a respiratory rate of 18 breaths per minute, and an oxygen saturation of 99% on room air. HEENT (head, ears, eyes, nose, throat) exam reveals erythema of the posterior oropharynx with tonsillar exudates, but no uvular deviation or significant tonsillar swelling. Neck exam reveals mild tenderness of anterior lymph nodes. His neck is supple. The chest and cardiovascular exams are unremarkable, and his abdomen is nontender with normal bowel sounds and no hepatosplenomegaly. His skin is without rash.


Questions:

1. What is the most likely diagnosis?

2. What is your next step?

3. What are potential complications?

[Diagnostic]

The most likely diagnosis is Streptococcal pharyngitis, other differential diagnosis include glandular fever and diphtheria.

Give single injection of penicillin or with a 10 day course of antibiotics taken by mouth.

The two major complications of streptococcal pharyngitis are rheumatic fever and post-streptococcal glomerulonephritis.

I hope this is the answer

[Mustafa]

salam.

well done. all the three answers are correct.