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  #1  
Old 02-07-2013
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Question female with fever and sore throat

healthy 24 yr old caucasian woman comes to office with complaint of fever n sore throat. she denies cough and shortness of breath. her temp:101F, BP:120/70, pulse:80/min, respiration:14/min.
examination shows tonsillar exudate.
lung fields are clear to auscultation.
tender bilateral cervical lymphadenopathy.
what is most appropriate next step?

A. rapid strep. antigen test
B. throat culture
C. empiric antibiotics
D. serum ASO titre
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  #2  
Old 02-07-2013
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I would go for A.
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Yup. Id go with option A. as well. Though I feel this is most probably a case of Mono. So if Monospot test (Heterophile Antibody test) would have been one of the options I would have probably picked that. My reasoning for picking A:

Option B: Too slow, DD's are probably Mono or strep throat.
Option C: If it's mono, never give antibiotics. Can induce generalized rash.
Option D: Maybe needed after option A to confirm if positive.

Any thoughts ? What's the answer ?
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Old 02-07-2013
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^^Mono does not present with tonsillar exudates.
Diagnosis is streptococcal sore throat, as Centor criteria is fulfilled. Before giving antibiotics, a rapid strep test to confirm diagnosis wont hurt, so A) seems to be the right answer
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Quote:
Originally Posted by theundead View Post
^^Mono does not present with tonsillar exudates.
Diagnosis is streptococcal sore throat, as Centor criteria is fulfilled. Before giving antibiotics, a rapid strep test to confirm diagnosis wont hurt, so A) seems to be the right answer
Hmm. I do believe Tonsilar exudates or any tonsilitis is a general sign indicative of any viral (influenza, rhino, ebv, etc) or bacterial (most commonly strep) infection.

But I did not know about the Centor Criteria. Thanks !
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Quote:
Originally Posted by qurat21 View Post
healthy 24 yr old caucasian woman comes to office with complaint of fever n sore throat. she denies cough and shortness of breath. her temp:101F, BP:120/70, pulse:80/min, respiration:14/min.
examination shows tonsillar exudate.
lung fields are clear to auscultation.
tender bilateral cervical lymphadenopathy.
what is most appropriate next step?

A. rapid strep. antigen test
B. throat culture
C. empiric antibiotics
D. serum ASO titre
Would you please give your answer & discussion for the benefit of all.
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Old 02-08-2013
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the ans is empiric antibiotic.

the Centor criteria is the guideline for the management of sore throat...
1.fever
2.tonsillar exudate
3.tender anterior cervical lymphadenopathy.
4.absence of cough.
if zero or one criteria: no further diagnostic test or treatment
if one or two criteria: rapid antigen test and if positive start antibiotic
if three or four criteria : empiric antibiotic
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Quote:
Originally Posted by qurat21 View Post
the ans is empiric antibiotic.

the Centor criteria is the guideline for the management of sore throat...
1.fever
2.tonsillar exudate
3.tender anterior cervical lymphadenopathy.
4.absence of cough.
if zero or one criteria: no further diagnostic test or treatment
if one or two criteria: rapid antigen test and if positive start antibiotic
if three or four criteria : empiric antibiotic
Interesting question. The answer is indeed Empiric antibiotics.

http://www.cdc.gov/getsmart/campaign...p-summary.html

Read the above link. Quite informative.
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Old 02-08-2013
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Thanks for this very useful question.
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Quote:
Originally Posted by qurat21 View Post
the ans is empiric antibiotic.

the Centor criteria is the guideline for the management of sore throat...
1.fever
2.tonsillar exudate
3.tender anterior cervical lymphadenopathy.
4.absence of cough.
if zero or one criteria: no further diagnostic test or treatment
if one or two criteria: rapid antigen test and if positive start antibiotic
if three or four criteria : empiric antibiotic
I reviewed the article of the CDC it is as follows " Do not test and do not treat patients with none or only one of these criteria. These patients are unlikely to have GABHS infection.
Test patients with 2 or more criteria using a rapid antigen test. Limit antibiotic therapy to patients with a positive test." No mention for the empiric antibiotic.

would you please give us your source.
Thanks.
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Quote:
Originally Posted by ag2011n View Post
I reviewed the article of the CDC it is as follows " Do not test and do not treat patients with none or only one of these criteria. These patients are unlikely to have GABHS infection.
Test patients with 2 or more criteria using a rapid antigen test. Limit antibiotic therapy to patients with a positive test." No mention for the empiric antibiotic.

would you please give us your source.
Thanks.
the question is from Uworld n my confusion is the same!!!
the explanation is also from Uworld.
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Old 02-09-2013
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Quote:
Originally Posted by qurat21 View Post
the question is from Uworld n my confusion is the same!!!
the explanation is also from Uworld.
Thanks for your response; as you say it is confusing.
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