Physical Diagnosis, M2 Course
Devin Nickol, M.D.
Following today's lecture, students should understand the following:
1. The reasons why accurate and timely diagnosis of streptococcal pharyngitis is important.
2. The challenges involved in diagnosing streptococcal pharyngitis clinically.
3. A rational approach to the diagnosis and treatment of patients with pharyngitis.
A 19-year-old female presents to clinic with a two day history of sore throat with difficulty swallowing. She has also noted fevers (~ 101 F) and states "the glands in my neck are swollen." She has not noted a cough. On exam she is febrile (101.8 F), and you note white tonsillar exudates as well as anterior cervical lymphadenopathy. She does not have conjunctival injection.
What do you do?
- What is it?
- How common is it?
- How much money do we spend diagnosing and treating it?
- What causes it?
Most common etiology:
Most common bacterial cause:
Other bacterial causes:
- How do we diagnose the underlying cause of pharyngitis?
- Why do we care what the underlying cause is?
- Why not just treat everyone?
- How often is a sore throat caused by Group A streptococci?
- How accurate is the history and physical at diagnosing streptococcal pharyngitis?
- How accurate are individual physical exam findings?
- How can patients be stratified into risk groups using the physical exam?
- How should these different risk groups be treated?
- How should the patient in the case presentation be treated?