Directions
All students should complete two (2) of the case study below (your choice). Note: All case studies are provided as a learning tool for students who wish to have them.
Case 1
Review the pharyngitis scenarios and determine the most likely cause, including pathogen and mode of transmission. Discuss data that support your decision and treatment strategies.
Scenario 1: Susan is a 16-year-old with sudden onset of severe sore throat for the past day. She feels like she had a fever but did not check her temperature (i.e., subjective fever). She states it is very painful to swallow, and she thinks she sees white spots on her throat. She denies cough, rhinorrhea, nausea, otalgia, shortness of breath, or headache. She reports no exposure to sick individuals.
- Medications: none.
- Allergies: none.
- Social history: nonsmoker and drinks alcohol (two to three beers) one to two times a month.
- Physical examination: vital signs – temperature 101.0°F; pulse 100 beats per minute; respirations 18 per minute; blood pressure 110/66 mmHg.
- General: ill and tired appearance.
- Head, Eyes, Ears, Nose, and Throat: unremarkable except for erythematous oropharynx with small petechiae and white tonsillar exudates.
- Neck: anterior cervical lymphadenopathy; two on right, three on left; all small (< 0.5 cm) and tender.
- Cardiovascular, Lungs, and Abdomen: unremarkable.
Answer the following questions or provide responses based on this scenario.
- What is the most likely diagnosis and pathogen causing this disorder and mode of transmission?
- Discuss data that supports your decision.
- What diagnostic test, if any, should be done?
- Develop a treatment plan for this patient.
Scenario 2: Mr. Jones is a 54-year-old man with complaints of a scratchy, raw sore throat and painful swallowing, mild productive cough, and runny nose for the past 2 days. He says his sputum is whitish-yellow. His ears feel full, and he feels like he is getting achy. He reports taking throat lozenges and denies nausea, fever, shortness of breath, chest pain, or headache. He states he teaches in a high school and a lot of his students have had colds.
- Medications: none.
- Allergies: none.
- Social history: nonsmoker and does not drink alcohol.
- Physical examination: vital signs – temperature 99.0°F; pulse 84 beats per minute; respirations 18 per minute; blood pressure 120/70 mmHg.
- General: cough during exam.
- HEENT: unremarkable except for mild erythematous oropharynx with no exudates; nares with mild erythema and scant yellowish discharge.
- Neck, CV, Lungs, Abdomen: unremarkable.
Answer the following questions or provide responses based on this scenario.
- What is the most likely diagnosis and pathogen causing this disorder and mode of transmission?
- Discuss data that support your decision.
- What diagnostic test, if any, should be done?
- Develop a treatment plan for this patient.
- Compare the causes, clinical manifestations, diagnosis, and treatment of pharyngitis in these two cases.
Case 2
Review the pulmonary infection scenarios and discuss whether the diagnosis is infectious rhinitis, influenza, acute bronchitis, acute bronchiolitis, or pneumonia. Discuss the most common pathogen and mode of transmission Discuss data that support your decision and treatment strategies.
Scenarios 1: Jack is a 21-year-old complaining of a sudden onset of myalgia with his body aching all over and headache for the past day. He feels tired and has the chills, and his temperature was 100°F. He has a mild nonproductive cough. He denies rhinorrhea, sinus pain, nausea, otalgia, or shortness of breath. He reports exposure to sick contacts in his dorm, stating, “Everyone seems to be coughing and catching a cold or the flu.”
- Medications: none.
- Allergies: penicillin.
- Past medical history: healthy.
- Social history: college student, lives in a dormitory. Nonsmoker and drinks alcohol once a week, about two or three beers.
- Physical examination: vital signs – temperature 100°F; pulse 98 beats per minute; respiratorations18 per minute; blood pressure 110/70 mmHg; pulse oximeter 98%.
- General: ill and tired appearance.
- Head, Eyes, Ears, Neck, Throat: unremarkable.
- Neck: no lymphadenopathy; negative Kernig sign, negative Brudzinski sign.
- Cardiovascular lungs, abdomen: unremarkable.
Answer the following questions or provide responses based on this scenario.
- What is the most likely diagnosis and pathogen causing this disorder?
- Discuss the mode of transmission and discuss the data that supports your decision.
- What diagnostic test, if any, should be done?
- Develop a treatment plan for this patient.
Scenarios 2: Mr. Menendez is a 65-year-old man presenting with 2–3 days of coughing up thick yellow sputum, shortness of , and fever (he did not check the actual temperature), and chills. He states his chest hurts when he breathes. He denies headache, rhinorrhea, sinus pain, and nausea. He reports no exposure to sick individuals.
- Medications: lisinopril 10 mg a day by mouth.
- Allergies: no known drug allergy.
- Social history: smokes 1 pack of cigarettes per day (has done so for 30 years); denies alcohol use; works as a landscaper.
- Physical examination: vital signs – temperature 101°F; pulse 98 beats per minute; respirations 22 per minute; blood pressure 140/86 mmHg; pulse oximeter 93%.
- General: ill and tired appearance, coughing during visit with thick yellow sputum noted.
- HEENT: unremarkable.
- Neck: small anterior and posterior cervical nodes.
- CV: unremarkable.
- Lungs: right basilar crackles with dullness to percussion in right lower lobe.
- Abdomen: unremarkable.
Answer the following questions or provide responses based on this scenario.
- What is the most likely diagnosis and pathogen causing this disorder?
- Discuss the mode of transmission. Discuss the data that support your decision.
- What diagnostic test, if any, should be done?
- Develop a treatment plan for this patient.
Case 3
Jamie is a 1-year-old girl who is coughing and has had rhinorrhea with yellowish discharge for the past day. Her father says today he felt like she had a fever and has not been eating or playing; she has been mostly sleeping. Her 5-year-old sibling has had a cold for a week.
- Medications: none.
- Allergies: no known drug allergies.
- Vaccinations: up to date for age.
- Social history: in day care; lives with mother, father, and 5-year-old sibling.
- Physical examination: vital signs – temperature 101.5°F; pulse 120 beats per minute; respirations 34 per minute; blood pressure 100/60 mmHg; pulse oximeter 92%.
- General: sitting in father’s lap; ill, lethargic appearance, and coughing.
- HEENT: nasal flaring, nasal mucus yellowish bilaterally; oropharynx with mild erythema.
- Neck: small anterior and posterior cervical nodes.
- CV: unremarkable.
- Lungs: intercostal retractions, expiratory wheezing.
- Abdomen: unremarkable.
Answer the following questions or provide responses based on this scenario.
- What is the most likely diagnosis and pathogen causing this disorder? Discuss the mode of transmission and discuss data that supports your decision.
- What diagnostic test, if any, should be done?
- Develop a treatment plan for this patient.
Expert Solution Preview
Introduction:
The case study provided focuses on two different scenarios of patients presenting with symptoms related to respiratory infections. The students are required to analyze each case, identify the most likely diagnosis and pathogen causing the disorder, discuss the mode of transmission, and develop appropriate treatment plans. In addition, they are also asked to compare the causes, clinical manifestations, diagnosis, and treatment of pharyngitis in the two cases.
Answers:
Case 1:
1. The most likely diagnosis for Scenario 1 is acute streptococcal pharyngitis, commonly known as strep throat. The pathogen causing this disorder is Group A Streptococcus (GAS). The mode of transmission is primarily through respiratory droplets.
2. The data supporting this diagnosis include the sudden onset of severe sore throat, presence of white spots on the throat, subjective fever, absence of cough or rhinorrhea, and the physical examination findings of erythematous oropharynx with small petechiae and white tonsillar exudates.
3. In this case, a rapid antigen detection test (RADT) or throat culture can be performed to confirm the diagnosis and confirm the presence of GAS.
4. The treatment plan for acute streptococcal pharyngitis involves prescribing antibiotics such as penicillin or amoxicillin to eradicate the infection, relieve symptoms, prevent complications, and minimize the risk of transmission.
Case 2:
1. The most likely diagnosis for Scenario 2 is viral pharyngitis or common cold. The pathogen causing this disorder is usually a respiratory virus, such as rhinovirus or coronavirus. The mode of transmission is through respiratory droplets or direct contact with infected individuals.
2. The data supporting this diagnosis include the presence of sore throat, mild productive cough, runny nose, exposure to sick individuals, absence of fever or significant constitutional symptoms, and the physical examination findings of mild erythematous oropharynx with no exudates and mild nasal erythema with scant yellowish discharge.
3. No specific diagnostic test is necessary for viral pharyngitis diagnosis. However, in some cases, a throat swab can be done for viral testing if necessary (e.g., outbreak investigation).
4. The treatment plan for viral pharyngitis involves symptomatic management, which includes rest, adequate fluid intake, throat lozenges, and over-the-counter pain relievers to alleviate symptoms. Antibiotics should not be prescribed as they are ineffective against viral infections.
Comparison:
In both cases, the patients presented with symptoms of a sore throat. However, Scenario 1 had more severe symptoms, including subjective fever, white spots on the throat, and tender lymphadenopathy, indicating a bacterial etiology like strep throat. On the other hand, Scenario 2 had milder symptoms and identified exposure to sick individuals, suggesting a viral cause. The treatment plan for bacterial pharyngitis involves antibiotics, while viral pharyngitis is managed symptomatically.
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