March 2018

Introduction & Initial Assessment

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Nicolas C. -

Great review !!!,
Hi boys and girls, in Québec, we used to treat with antibiotics only the pharyngitis with microbiology confirmation of strep or when patients have extremely severe symptoms or scarlatina even if patients have 4 points on the half men/horse score. What do you think about that?

Jess Mason -

I think there's a lot of regional differences and also differences in the guidelines of who to treat and culture. Sounds like a reasonable approach to me! Especially if your incidence of rheumatic fever is low.

Adam N. PA-C MS -

I saw an interesting case recently in where a 18 y/o came in with CC of sore throat only. Looked fine. VSS. RN did strep test prior to my evaluation and came back positive. Went into room thinking slam dunk strep and thought I’d be in and out in 2 minutes. Patient had unimpressive exam including normal pharynx , but only thing abnormal on PE was that he had some discomfort on ROM of neck. I took lateral neck X-ray. What did it show? Free air in the retropharangeal space. Pt had huge pneumomediastinum tracking up into neck. Key to history was that ST started abruptly after blowing nose hard. No CP SOB at all. I had Lady Luck in my corner that day to not miss this one. So lesson learned... Pneumomediastinum can also cause a sore throat. Go figure.

Jess Mason -

That's an odd one! Coincidentally, we will cover pneumomediastinum in next month's episode on chest pain in young patients. Stay tuned!

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