Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care

 Introduction to the Patient’s Case

            The healthcare workers are expected to have an in-depth understanding of most clinical presentations so as to effectively manage the patient. They need to understand the underlying pathophysiology and how such pathologies lead to patient presentation. This week’s case study is about the 32-year-old Callie who presented with a three-day history of hoarse voice, and fever. Odynophagia, and tender cervical lymphadenopathy. She also had an erythematous tympanic membrane that appeared full. The objective of this presentation is to describe how the patient was managed including the questions, physical examinations and further testing that would be necessary in her diagnosis and treatment. The differential diagnoses and her treatment plan are also discussed.

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Relevant Questions

            Questions that are directed to the patient usually seek to identify the risk factors for a disease that is suspected. It can also help to diagnose a different condition with similar presentation as the suspected condition. Where the patient has sore throat, odynophagia and fever, the patient should be asked on whether she has other symptoms such as coryza, rhinorrhea, and cough which are suggestive of viral pharyngitis (Arnold & Nizet, 2018). Presence of other symptoms such as anosmia, dyspnea, and chest pain can also be inquired to help in ruling out possibility of coronavirus disease (Lovato et al., 2020). Further questions that would elicit the risk factors include history of travel to areas affected with coronavirus, or history of immunosuppression, cigarette smoking, and overcrowding that would predispose the patient to streptococcal pharyngitis (Arnold & Nizet, 2018). Other questions would include patient involvement in receptive oral sex that can lead to deposition of the pathogen in to the throat thus predispose to development of pharyngitis (Yoshida et al., 2021).

Essential Elements of Physical Examination

            Physical examination that are essential for assessment of the patient include temperature assessment and examination of the skin. Individuals with sore throat due to streptococcus may have low grade or high-grade fever or even a scarlatiniform rash that can be recognized during examination of the skin (Mustafa & Ghaffari, 2020). Where coronavirus disease is suspected, it would be appropriate to assess respiratory rate, respiratory system examination and the blood oxygen saturation levels (Lovato et al., 2020). Another physical examination that would be relevant for the patient is the Weber’s and Rinne’s hearing test to determine the impact of the condition on her hearing (Mustafa & Ghaffari, 2020). Oropharynx would also be examined to assess for tonsillitis or oral ulcers that may contribute to the patient presentation (Yoshida et al., 2021).

Further Testing

            The need for additional testing is determined by the findings during the physical examination. The further tests help in diagnosing the disease and ruling out its differential diagnosis that may have been suspected from patient’s history and physical examination. Some of the testing include nasopharyngeal swab for Covid-19 testing, throat culture to help in identifying a bacterial cause of the patient’s presentation (Arnold & Nizet, 2018). Throat culture which is the gold standard diagnostic test for streptococcal pharyngitis is indicated in this patient. Other laboratory tests would include complete blood count, erythrocyte sedimentation rate, and C-reactive protein assessment to determine an inflammatory picture (Yoshida et al., 2021). A chest x-ray can also help ruling out pneumonia and echocardiography would help assess the cardiac involvement especially in rheumatic fever (Alqanatish et al., 2019). The choice of these tests is determined by the suspected disease and the patient’s socioeconomic factors.

Diagnosis and Differential Diagnoses

            The patient’s diagnosis is acute pharyngitis with acute otitis media. The most probable cause of the presentation is the Streptococcal bacterium as opposed to viral because the patient denies a contact with sick individual (Mustafa & Ghaffari, 2020). The other possible causes of the patient’s presentation include infectious mononucleosis, epiglottitis, Coronavirus infections, and head and neck neoplasia. Infectious mononucleosis was less likely because the patient denies contact with infected individual, epiglottitis is unlikely because there is no history of drooling whereas coronavirus is ruled out because of there is no history of shortness of breath, headache, and anosmia (Lovato et al., 2020). Given the patient presentation was acute, it was also unlikely to be a neoplasia which is usually chronic in presentation (Arnold & Nizet, 2018). A thorough history taking and relevant diagnostic procedures helps in ruling out the possible diagnoses.

Treatment Plan

            Treatment of Callie would seek to address the patient’s symptoms as well as treating the underlying cause of presentation. The supportive therapy would include rehydration therapy, nutritional care, and then administration of 500mg of Tylenol or Advil to address the pain and pyrexia (Arnold & Nizet, 2018). Antibiotic therapy should then be advised to clear the pathogen with azithromycin, cephalosporin, and clindamycin being the antibiotic options (Mustafa & Ghaffari, 2020). In patient care, other team members who would be involved include the nutritionists, nurses, and even physicians. Further, the infectious disease specialists and otolaryngologists can be consulted to provide further specialized care especially when the disease persists or there is immunosuppression reported (Arnold & Nizet, 2018).

Conclusion

            In conclusion, patient who presents with sore throat should be worked up by asking relevant questions and requesting for appropriate diagnostic tests which would include throat culture. The questions and tests would help in ruling out other possible diagnoses such as infectious mononucleosis, epiglottitis, and Coronavirus infections. During patient care, supportive therapy and antibiotic therapy are indicated and different healthcare workers and specialists consulted. The aim of care is to address the patient’s signs and symptoms as well as clear the underlying pathogens.

References

Alqanatish, J., Alfadhel, A., Albelali, A., & Alqahtani, D. (2019). Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia. Journal of the Saudi Heart Association, 31(4), 273–281. https://doi.org/10.1016/j.jsha.2019.07.002

Arnold, J. C., & Nizet, V. (2018). Pharyngitis. In Principles and Practice of Pediatric Infectious Diseases (pp. 202-208.e2). Elsevier.

Lovato, A., Rossettini, G., & de Filippis, C. (2020). Sore throat in COVID-19: Comment on “Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: A single arm meta-analysis.” Journal of Medical Virology, 92(7), 714–715. https://doi.org/10.1002/jmv.25815

Mustafa, Z., & Ghaffari, M. (2020). Diagnostic methods, clinical guidelines, and antibiotic treatment for Group A streptococcal pharyngitis: A narrative review. Frontiers in Cellular and Infection Microbiology, 10, 563627. https://doi.org/10.3389/fcimb.2020.563627

Yoshida, H., Kanamori, M., & Sakemi, H. (2021). Sore throat with normal oropharyngeal examination. The American Journal of Medicine, 134(1), e49–e50. https://doi.org/10.1016/j.amjmed.2020.06.034

 

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Callie is a 32-year-old female with complaints of a hoarse voice for the past three days, painful swallowing without drooling, fever with a Temperature of 103 yesterday with chills, and occasional body aches. She presents to the clinic with a temperature of 99, while other vital signs are within normal limits. Cervical lymph nodes are mildly enlarged and tender. Both tympanic membranes (TM) are full and erythematous without bulging or drainage and no facial pain. Pharynx is erythematous and swollen without exudate. She has no other complaints and no significant past history; she has no sick contacts.