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Old 03-17-2012
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Question A 7 year old with Pharyngitis

A 7-year-old girl is brought to the physician in September because of fever and sore throat for 1 day. She is in the third week of second grade. Her temperature is 38.6 C (101.5 F). Examination shows an erythematous pharynx and slightly enlarged tonsils without exudate. There is no significant cervical lymphadenopathy. A rapid test for group A streptococcus is negative. Which of the following is the most appropriate next step in management?

A) Throat culture
B) Monospot test
C) Intramuscular penicillin therapy
D) Oral erythromycin therapy
E) Oral penicillin therapy
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Old 03-17-2012
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we have to give empirical antibiotic or serology first?
i will go with B. monospot first then D. erythromycin till results are back
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Old 03-17-2012
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Quote:
Originally Posted by confident View Post
we have to give empirical antibiotic or serology first?
i will go with B. monospot first then D. erythromycin till results are back
are u thinking in lines of IMN???

i would go with oral penicillin.

Q. what is the next dx test if rapid detection test comes negative?
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Old 03-17-2012
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its not IMN, if -ve rapid then go for throat culture if thers's any suspicious as in this case so before tx we have to dx first if therez any diagnostic test available in Qs.
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Old 03-17-2012
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yeah....but as far as appropiate management is concerned i would like to go with option (e)oral penicillin therapy but confused with IMN as patient devoid of cervical lymphadenopathy.......for the dx it would be throat culture better than other.
What's the answer??
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Old 03-18-2012
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Quote:
Originally Posted by tyagee View Post
are u thinking in lines of IMN???

i would go with oral penicillin.

Q. what is the next dx test if rapid detection test comes negative?
Yes I was thinking IMN or EBV. But not sure till monospot return so give erythromycin. But I think I was wrong we have to start penicillin . But I think in above q if initial test negative collect sample for another test and then start on rx.
So start with monospot.
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Old 03-18-2012
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they said the ans. is C. but i dont agree with that. this question is past exam question and some of the ans are collectively pulled togather by people that took the exam and those preparing. so i dont believe in some ans they give. my choice of ans. is THROAT CULTURE BEFORE GIVING ANTIBIOTIC.
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Old 03-19-2012
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FEVER present

History - very short -- rpr may be negative , Exudate not yet formed , Cervical LN wont develop so soon..

3rd week of second grade - possibily of contact... most common "strep"

IM - unlikely in this age group

So prob 'C' shub be correct
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