November Week 3

Article: Throat Infections. Peds in Review. November 2011

Case #1:

An 8 y.o. boy comes to clinic with complaints of sore throat for the past 2 days. He has had fever at home to 101, but he denies URI symptoms or cough.  On exam, he has 2+ tonsillar hypertrophy, pharyngeal erythema, and whitish exudates.  A few tender cervical lymph nodes can be palpated. The rest of the exam is unremarkable.
1. What is the most likely diagnosis?
2. Describe the Centor criteria.
3. How would you confirm your diagnosis?  What is the gold standard test?
4. When discussing treatment, the patient’s mother says she has read that this disease is self-limited and wishes that her son not be placed on antibiotics. What would you tell her?
5. After educating the mother about the benefits of antibiotics, she agrees to start them. You then learn that he has a history of systemic rash with the use of Penicillin. What can you give instead? When is he no longer contagious?
6. That afternoon, the patient’s mother phones the clinic. She is very concerned because her son has now developed a rash which started on his chest but has spread to his entire body. He has not yet had his first dose of antibiotic that you prescribed. What is the most likely cause of this rash? What should they expect?
Case #2:
A 16 y.o. boy presents with fever, sore throat, dysphagia, and new right-sided ear pain. He has tried to look at his throat in the mirror, but reports that he is having difficulty opening his mouth wide enough to see.  Upon review of his past medical history, he reports that he has had at least 4 episodes of strep throat, all treated with a course of p.o. antibiotics.  You suspect peritonsillar abscess.
1. What are the distinguishing features you would expect to see on physical exam if your suspicion is correct?
2. How might a retropharyngeal abscess present differently?
3. What is the most common aerobic cause and anaerobic cause of peritonsillar abscess?
4. What can be done to help confirm your diagnosis?  What is the gold standard?
5. Effective treatment for a peritonsillar abscess includes the combination of which two things?  Given this patient’s history of recurrent tonsillitis, what else might he benefit from?  When should it be done?