Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues' differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition and justify your reasoning.
Colleague's Post
Patient Information: Case 2
LL 20yo F
S.
CC Sore throat for 3 days. Also complaining of decreased appetite, headaches, and pain with swallowing. Flu going around campus. Decided she better make sure she does not have the flu.
HPI: 20-year-old Caucasian female presents with a sore throat for three days. Patient states her throat is scratchy and a little sharp pain when she swallows. Associated signs and symptoms are decreased appetite, headaches, runny nose and slightly hoarse throat with no congestion. Swallowing is an aggravating factor. She has not taken any medications for the pain. Patients states her pain is a 4/10. Patient is a student at the community college.
Current Medications: None
Allergies: None
PMHx: None. Patient has not had a flu vaccine for this year. No pneumonia vaccine. Last tetanus vaccine was 08/2017.
Soc Hx: Patient is a full-time student and enjoys hiking and surfing when not in school. She is a heterosexual female and is currently not in a relationship. Patient states that she does not smoke and only drinks alcohol socially with friends on the weekends. Patient also stated she does not like taking medications unless it is really necessary. She stated that she always wears a seat belt and is very conscientious about not using her cell phone when driving. When not in school she lives with her Mom and Dad and younger brother and sister. She feels her neighborhood is safe and feels safe at home. She feels she has a good support system with her parents and friends.
Fam Hx: Her mother is healthy with no chronic illnesses and occasionally will get upper respiratory infections. She believes her mother has seasonal allergies but is not sure. Her father is also healthy and per patient does not get sick very often. She is not aware of any chronic illnesses he may have. Her paternal grandparents are still living and her paternal grandmother has a history of heart disease and COPD due to being a 30-year smoker. Her paternal grandfather is healthy and does not have any chronic illnesses. Her maternal grandmother is deceased due to breast cancer. Patient states that until her breast cancer she was healthy. Her maternal grandfather is still alive and has a history of heart disease. She thinks he has something wrong with his rhythm but is not sure. Her brother and sister have always been healthy and only get occasional upper respiratory illnesses and the occasional stomach virus.
ROS:
GENERAL: No weight loss, fever, chills, weakness but has been feeling tired the last few days.
HEENT: Head: Complaining of headache in temporal area bilaterally. Pain is 4/10. Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears: No tinnitus or hearing loss. No pain or drainage from ears. Nose: Sense of smell is slightly decreased. Nasal mucosa has erythema and slight edema bilaterally with some clear discharge. No history of epitaxies. No history of polyps or recent sinus infections. No seasonal allergies. Mouth: Buccal mucosa is pink without any lesions. Last dental exam was 1/2019. No difficulty chewing. Throat: Posterior oropharynx is beefy red with no exudate. Frontal and maxillary sinuses are non-tender. Neck: No pain or lumps noted in neck.
SKIN: No rash or itching or lesions noted
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: Decreased appetite but no nausea, vomiting or diarrhea. No abdominal pain or blood.
GENITOURINARY: No burning on urination. Last menstrual period, 03/10/2019.
NEUROLOGICAL: Headache for three days in the temporal region bilaterally for 3 days. Pain feels like a dull ache. No dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain or stiffness.
HEMATOLOGIC: No anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
O.
Physical exam: Vital signs: B/P: 117/ 75, right arm, regular cuff; P 65 and regular, T 98.9 orally; RR15, non-labored, Wt.: 120 Ht: 5’4; BMI: 20.6. AAOX3 appears to be in slight distress from sore throat. HEENT: PERRLA, ornasopharynx is beefy red with no exudate and tonsils are not enlarged. Neck: No palpable nodes or tenderness noted. Skin/Lymph nodes: No edema, clubbing or cyanosis: no palpable nodes.
Diagnostic results: CBC with differential to check for WBC and decreased HCT and platelet which would help rule out Epstein Barr and an infection March and Karakashian (2018). Throat culture to rule out strep throat (Shepherd, 2013)
A.
Differential Diagnoses:
1) Viral Pharyngitis- According to Dains, Baumann, and Scheibel (2016) symptoms of viral pharyngitis are malaise, fever, headache, cough and fatigue. The pharynx can be erythematous, or it may be pale, boggy, and swollen. I believe the patient has viral pharyngitis due to the patient having a sore throat with erythematous and a headache with no swollen tonsils or exudate.
2) Epiglottitis- According to Ames, Ward, Tranter, and Street (2000) epiglottitis is an inflammation of the supraglottic structures than can occur at any age. Epiglottitis ha a higher incidence in adults. Symptoms of epiglottitis in adults is a sore throat and painful dysphagia. Drooling ad stridor are less common presenting signs. I don’t believe this patient has this disorder due to her presenting symptoms.
3) Group A streptococci bacteria- symptoms are acute sore throat with excessive erythema or exudate (Shepherd, 2013). The patient is not complaining of acute sore throat and does not have a fever.
4) Epstein-Barr Virus-March and Karakashian (2018) explain the signs and symptoms of Epstein Barr include a fever, sore throat, swollen lymph nodes, appetite loss, fatigue and enlargement of liver and spleen. Patient is not presenting with all of these symptoms. The authors go on to say that a clinical diagnosis is usually made by the patient’s clinical presentation. Laboratory tests would be performed for confirmation.
5) Viral tonsillitis- a patient with viral tonsillitis will present with general erythema and swelling to the tonsil bed. Patients will also have other symptoms of upper respiratory tract infection including dysphagia, blocked nose, malaise, headache and cough symptoms (Shepherd, 2013). This patient does not have a swollen tonsil bed. She also does not have a cough. Although she has a runny nose it does not say she has a blocked nose.
P.
If patient gets worse or does not improve within 7 days advise her to come back for further evaluation.