Physical Diagnosis, M2 Course

ENT

Devin Nickol, M.D.

OBJECTIVES

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.

 

CASE PRESENTATION

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?

 

PHARYNGITIS

- 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?

 

 

STREPTOCOCCAL PHARYNGITIS

- 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?