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.
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.
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.