Question

LL is a 12 year old female presenting to her pediatrician, complaining of sore throat and cough. She has had some hoarseness in her voice over the past few days and subjective sweats but no documented fever. She has a history of seasonal allergies in the fall, and takes loratidine only during that season. Upon review of systems, she complains of isolated throat pain, without any rhinorrhea, sinus pressure, or headache. Her mother has been taking her temperature at home, and they have fluctuated from 97.8^oF- 99.2^oF.

Vitals

Tcurr	99.0oF, 37.2oC
Heart Rate	115 bpm
Respiratory Rate	18 bpm
Blood Pressure	110/76
Oxygen Saturation	100% on room air

Physical Exam

General	Relatively comfortable healthy child
HEENT	Pupils equally round and reactive to light and accommodation, no sinus tenderness, enlarged tonsils
Neck	Supple, mildposterior cervical lymphadenopathy
Resp	Normal breath sounds
Card	Regular rate and rhythm, no murmurs, rubs, or gallops
Abd	Non-tender, non-distended
Ext	No edema
Skin	No rashes
Neuro	Normal for age

LabsNa: 1344
Creatinine: 0.6
K: 4.6
WBC: 8.6
Cl: 101
Hgb: 13.6
Bicarb: 25
Hct: 40.8
BUN: 18

Platelets: 333

Based on the information provided above and the clinical guidelines for diagnosis and management for sore throat answer the following questions

What is your primary diagnosis and how do you support it?

mention 3 differential diagnosis

Therapeutic plan

Answer 1

Streptococcal pharyngitis is the primary diagnosis. Because children with streptococcal pharyngitis do not have a cough, rhinorrhea. Streptococcal pharyngitis effectively ruled out on the basis of the presence of hoarseness.

Differential diagnosis is Rheumatic heart disease, Acute rheumatic fever, Staphylococcus aureus infection.

Therapeutic plan

Penicillin or Amoxicillin is recommended drug of choice. Primarily the therapeutic plan aimed at preventing the complications and decrease infectivity. A 10-day penicillin V 250mg twice daily or a single intramuscular injection of 1.2 million units of penicillin G benzathine can be administered(weight above 27kg). If weight less than 27 kg 600,000 units are used. Amoxicillin is much more tolerated in children. Azithromycin, clindamycin, first-generation cephalosporins are used when penicillin is resistant. Acetaminophen or NSAIDs to control high fever.