Sunday, April 1, 2012

Case #1 and #2: Strep Pharyngitis

A sister and brother, aged 7 and 14, respectively present with pharyngitis.  The 7F has sore throat, cough, fever, and post-tussive vomiting for 1 day.  She has posterior pharyngeal erythema, no lymphadenopathy, no exudate, no petechiae, and looks like a viral URI.

The 14M had culture confirmed GAS pharyngitis 3 weeks ago, was treated with PCN-VK and symptoms resolved.  Now, he's in the ED with signs and symptoms of pharyngitis again, including dysphagia, fever, cough, posterior pharyngeal erythema, swollen tonsils, LAD, and petechiae on his hard palate.

Resources used:

I ordered cultures on each of them and then I opened up MDCalc (I have shortcuts saved to all my devices' desktops) to the Modified Centor Score for Strep Pharyngitis.  The easy-to-use calculator tells me that I won't treat the 7F unless positive cultures come back, and the 14M will get empirically covered.