Case 23 - 5 yo with sore throat

Question 1

5 year old physical exam

Answer 1

• height weight, BMI, BP
• ophtho exam
• mouth exam
• neuro exam

Question 2

5 year old developmental exam

Answer 2

should be able to dress herself, name colors, draw a person with 6 body parts, copy a square and triangle, skip, hop and stand on one foot, talk in complete sentences

Question 3

Vaccinations required for school entrance

Answer 3

• hepatitis B, DTAP, polio, MMR, varicella

- not req’d but decrease mortality: Hib, pneumococcal, rotavirus, hep A, flu

Question 4

Screening for 5 year old

Answer 4

• CBC if low-iron diet or special health needs
• lead screening - if child lives in house before 1950
• TB screening if child is high risk (fam member with TB, birth in high risk country, travel to high-risk country, HIV, incarcerated adolescents)

Question 5

Anticipatory guidance for 5 year old

Answer 5

• nutrition - whole grains, cut down juice
• physical activity
• oral health
• safety: car seat, bike helmet, crossing street, swimming, sexual abuse
• other; routines, friends, bullying

Question 6

ADHD diagnosis

Answer 6

Child must be 6, have more frequent or severe sx than child the same age, present for six months in at least two settings

Question 7

Differential diagnosis for sore throat in 5 year old

Answer 7

1. Viral pharyngitis - most common cause of sore throat, sx often include fever and rash
2. Mononucelosis - EBV or CMV - low grade fever, pharyngitis, LAD, hepatosplenomegaly, often diagnosed in those with sore throat for >10 days
3. Group A Beta-hemolytic streptococcal (GABHS) pharyngitis - high fever, LAD, tonsillar exudates, palatal petechiae, strawberry tongue, scarlet fever
4. Peritonsilar abscess - fever, difficulty swallowing, neck or ear pain, muffled hot potato voice
   Less likely: epiglotitis, pertussis, viral croup, allergic rhinitis/pharyngitis (seasonal)

Question 8

Complications of GABHS pharyngitis

Answer 8

rheumatic fever, post-strep glomerulonephritis, peritonsillar abscess, bacteremia, endocarditis, otitis, pneumonia

Question 9

Centor score

Answer 9

Indicates whether to evaluate for GABHS, 1 point for:

• tonsilar exudate
• fever >38
• tender LAD
• absent cough

McIsaac Rule modifiers add a point for people 45

1 point: supportive treatment
2-3 points: rapid strep swab
4 points: strep swab + empiric treatment

Question 10

GABHS pharyngitis management

Answer 10

• penicillin VK is antibiotic of choice
• amoxicillin given to children instead of kids because of taste
• cephalexin and cefadroxil or erythromycin recommended for people with penicillin allergy
• pt should stay home until has had 24 hours of antibiotics