Case study 1

Case 1 

REVIEW THE PHARYNGITIS SCENARIOS AND DETERMINE THE MOST LIKELY CAUSE, INCLUDING PATHOGEN AND MODE OF TRANSMISSION. DISCUSS DATA THAT SUPPORT YOUR DECISION AND TREATMENT STRATEGIES. 

Scenario 1:  Susan is a 16-year-old with sudden onset of severe sore throat for the past day. She feels like she had a fever but did not check her temperature (i.e., subjective fever). She states it is very painful to swallow, and she thinks she sees white spots on her throat. She denies cough, rhinorrhea, nausea, otalgia, shortness of breath, or headache. She reports no exposure to sick individuals. 

Medications: none.

Allergies: none.

• Social history: nonsmoker and drinks alcohol (two to three beers) one to two times a month.
• Physical examination: vital signs – temperature 101.0°F; pulse 100 beats per minute; respirations 18 per minute; blood pressure 110/66 mmHg.
• General: ill and tired appearance.
• Head, Eyes, Ears, Nose, and Throat: unremarkable except for erythematous oropharynx with small petechiae and white tonsillar exudates.
• Neck: anterior cervical lymphadenopathy; two on right, three on left; all small (< 0.5 cm) and tender.
• Cardiovascular, Lungs, and Abdomen: unremarkable. 
• Answer the following questions or provide responses based on this scenario. 
• What is the most likely diagnosis and pathogen causing this disorder and mode of transmission? 

Discuss data that supports your decision. 

What diagnostic test, if any, should be done? 

1. Develop a treatment plan for this patient. 
2. Scenario 2: Mr. Jones is a 54-year-old man with complaints of a scratchy, raw sore throat and painful swallowing, mild productive cough, and runny nose for the past 2 days. He says his sputum is whitish-yellow. His ears feel full, and he feels like he is getting achy. He reports taking throat lozenges and denies nausea, fever, shortness of breath, chest pain, or headache. He states he teaches in a high school and a lot of his students have had colds. 
3. Medications: none.
4. Allergies: none.

Social history: nonsmoker and does not drink alcohol. 

Physical examination: vital signs – temperature 99.0°F; pulse 84 beats per minute; respirations 18 per minute; blood pressure 120/70 mmHg. 

• General: cough during exam. 
• HEENT: unremarkable except for mild erythematous oropharynx with no exudates; nares with mild erythema and scant yellowish discharge. 
• Neck, CV, Lungs, Abdomen: unremarkable. 
• Answer the following questions or provide responses based on this scenario. 
• What is the most likely diagnosis and pathogen causing this disorder and mode of transmission? 
• Discuss data that support your decision. 
• What diagnostic test, if any, should be done? 

Develop a treatment plan for this patient. 

Compare the causes, clinical manifestations, diagnosis, and treatment of pharyngitis in these two cases.

1. CASE 2
   Jamie is a 1-year-old girl who is coughing and has had rhinorrhea with yellowish discharge for the past day. Her father says today he felt like she had a fever and has not been eating or playing; she has been mostly sleeping. Her 5-year-old sibling has had a cold for a week. 
2. Medications: none. 
3. Allergies: no known drug allergies. 
4. Vaccinations: up to date for age. 
5. Social history: in day care; lives with mother, father, and 5-year-old sibling.

Physical examination: vital signs – temperature 101.5°F; pulse 120 beats per minute; respirations 34 per minute; blood pressure 100/60 mmHg; pulse oximeter 92%. 

1. General: sitting in father’s lap; ill, lethargic appearance, and coughing. 

HEENT: nasal flaring, nasal mucus yellowish bilaterally; oropharynx with mild erythema. 

Neck: small anterior and posterior cervical nodes. 

CV: unremarkable. 

• Lungs: intercostal retractions, expiratory wheezing. 
• Abdomen: unremarkable. 
• Answer the following questions or provide responses based on this scenario. 
• What is the most likely diagnosis and pathogen causing this disorder? Discuss the mode of transmission and discuss data that supports your decision. 
• What diagnostic test, if any, should be done? 

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