Discussion - HEENT/Immunization Case Study
Pharyngitis Case Study: John is a 4-year old boy who presents to the pediatric clinic complaining
of a sore throat. His mother states he has had a fever of 102F on and off for the past 24 hours and
was treated with acetaminophen. He has also been sleeping more than usual over the past 2 days.
He has refused to eat anything solid since this time but has been drinking liquids. His mother
states he does not have a cough, shortness of breath, or difficulty breathing. the patient mentions
that both his stomach and head aches, but his mother states he has not vomited. Mother notes no
recent illness in the family. John was full-term gestation, NSVD, 4 kg healthy infant at birth,
breastfed X 6 months. Immunizations are up to date. PMH: John has had prior cases of otitis
media, his last over a year age. Otherwise he is healthy. FH: noncontributory. SH: John lives
with his parents and infant sister. He attends a local day care and
preschool. Meds: None. Allergies: Amoxicillin: rash, hives. REVIEW OF SYMSTEMS
ROS: negative except for complaints noted in the HPI.
On Exam: well, developed, well nourished male child clearly fatigued. Wt. 21 kg. Ht. 45", BP
104/70, P 92, RR 22, T 101.7F. Skin: pale, warm, faint scarlatini-form rash on arms and
trunk. HEENT: PERRLA; tonsils, erythematous with associated white exudates; uvula
edematous; soft palate with notable petechiae, tympanic membrane TM normal. Neck/Lymph
Nodes: multiple-enlarged anterior cervical lymph nodes, greater than 2 cm in
size. Lungs/Thorax: CTA bilaterally, (-) shortness of breath, (-) cough. CV: RRR, normal S1 and
S2. ABD: soft, nontender, nondistended, (+) BS. Neuro: CN I-XII intact. Labs: a rapid antigen
detection RAD: negative, Throat C/S: results pending. Assessment: 4-year old male presents to
clinic with suspected group A beta-hemolytic streptococcus (GABHS) pharyngitis. Based on the
case study:
1. Provide 3 differential diagnoses along with rationale and ICD codes
2. What are the signs and symptoms in this patient that are indicative of possible
GABHS infection in comparison with symptoms of viral pharyngitis?
3. List the goals of therapy for both treatment and the prevention of clinical and
pharmacologic complications ?
4. If antibiotics are indicated, which of the alternative antibiotic would you
recommend to treat this child? Include the dose, duration, and rationale for
selection.
5. Discuss how you would manage a parent who demands an antibiotic when the
results of the throat culture are negative?
6. What information should be shared with John's parent regarding his clinical
condition as well as his drug therapy?
7. John's mother asks if antibiotics are prescribed and he has an allergic reaction,
what should she do?
8. Discuss anticipated immunizations that may be needed for this patient. In addition,
would you immunize now yes, or no and why?
Pharyngitis Case Study: John is a 4-year old boy who presents to the pediatric clinic complaining
of a sore throat. His mother states he has had a fever of 102F on and off for the past 24 hours and
was treated with acetaminophen. He has also been sleeping more than usual over the past 2 days.
He has refused to eat anything solid since this time but has been drinking liquids. His mother
states he does not have a cough, shortness of breath, or difficulty breathing. the patient mentions
that both his stomach and head aches, but his mother states he has not vomited. Mother notes no
recent illness in the family. John was full-term gestation, NSVD, 4 kg healthy infant at birth,
breastfed X 6 months. Immunizations are up to date. PMH: John has had prior cases of otitis
media, his last over a year age. Otherwise he is healthy. FH: noncontributory. SH: John lives
with his parents and infant sister. He attends a local day care and
preschool. Meds: None. Allergies: Amoxicillin: rash, hives. REVIEW OF SYMSTEMS
ROS: negative except for complaints noted in the HPI.
On Exam: well, developed, well nourished male child clearly fatigued. Wt. 21 kg. Ht. 45", BP
104/70, P 92, RR 22, T 101.7F. Skin: pale, warm, faint scarlatini-form rash on arms and
trunk. HEENT: PERRLA; tonsils, erythematous with associated white exudates; uvula
edematous; soft palate with notable petechiae, tympanic membrane TM normal. Neck/Lymph
Nodes: multiple-enlarged anterior cervical lymph nodes, greater than 2 cm in
size. Lungs/Thorax: CTA bilaterally, (-) shortness of breath, (-) cough. CV: RRR, normal S1 and
S2. ABD: soft, nontender, nondistended, (+) BS. Neuro: CN I-XII intact. Labs: a rapid antigen
detection RAD: negative, Throat C/S: results pending. Assessment: 4-year old male presents to
clinic with suspected group A beta-hemolytic streptococcus (GABHS) pharyngitis. Based on the
case study:
1. Provide 3 differential diagnoses along with rationale and ICD codes
2. What are the signs and symptoms in this patient that are indicative of possible
GABHS infection in comparison with symptoms of viral pharyngitis?
3. List the goals of therapy for both treatment and the prevention of clinical and
pharmacologic complications ?
4. If antibiotics are indicated, which of the alternative antibiotic would you
recommend to treat this child? Include the dose, duration, and rationale for
selection.
5. Discuss how you would manage a parent who demands an antibiotic when the
results of the throat culture are negative?
6. What information should be shared with John's parent regarding his clinical
condition as well as his drug therapy?
7. John's mother asks if antibiotics are prescribed and he has an allergic reaction,
what should she do?
8. Discuss anticipated immunizations that may be needed for this patient. In addition,
would you immunize now yes, or no and why?
