FNP 591 Week 2 Aquifer Case Study: Family Medicine

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Family Medicine 23: 5-year-old female with sore throat

Student name

United States University

FNP-591

Prof Name

Submission Date

Introduction of the Case 

This case involves Althea Newman, a five-year-old girl presenting with a two-day history of fever, sore throat, headache, dry cough, mild abdominal pain, and decreased appetite. Key epidemiological factors include potential strep exposure, no known COVID-19 contacts, and second-hand smoke exposure from her father. The physical examination reveals red, enlarged tonsils with exudates, anterior cervical lymphadenopathy, palatal petechiae, and a red, fine papular rash on the neck, face, and trunk. This paper will focus on the main diagnosis, ruling out alternative differentials, and proposing a diagnostic and treatment plan for Althea.

Main Diagnosis with Rationale

Althea’s symptoms are most consistent with strep throat (Group A Streptococcal pharyngitis). The presence of red, enlarged tonsils with exudates, palatal petechiae, and anterior cervical lymphadenopathy are suggestive of a bacterial etiology. The two-day history, exposure to a school friend with strep throat, and the absence of dysphagia further support this diagnosis (Sykes et al., 2020).

Differential Diagnosis 

Non-specific viral pharyngitis

While viral infections can present with sore throat and fever, the specific findings of enlarged tonsils with exudates, palatal petechiae, and anterior cervical lymphadenopathy make strep throat a more likely diagnosis (Sykes et al., 2020).

Scarlet fever

The presence of a red, fine papular rash on the neck, face, and trunk raises the possibility of scarlet fever, which is a complication of Group A Streptococcal infection. This aligns with the strep throat diagnosis (Alotaibi et al., 2022).

Diagnostic Plan

Rapid Antigen Detection Test (RADT) for Group A Streptococcus

Perform a RADT to confirm the presence of Group A Streptococcus in the throat. A positive result would support the diagnosis of strep throat (Alotaibi et al., 2022).

Throat culture

If the RADT is negative but clinical suspicion remains high, a throat culture should be obtained for definitive confirmation (Alotaibi et al., 2022).

Treatment Plan

Antibiotic therapy

Initiate antibiotic treatment with penicillin or amoxicillin as first-line agents for 10 days. In cases of penicillin allergy, alternative antibiotics such as cephalosporins or macrolides can be considered (Mustafa & Ghaffari, 2020).

Symptomatic relief

Provide supportive care, including analgesics (e.g., acetaminophen) for pain and fever, and encourage fluid intake to prevent dehydration (Mustafa & Ghaffari, 2020).

Follow-up

Schedule a follow-up appointment to monitor Althea’s response to treatment and assess for resolution of symptoms (Mustafa & Ghaffari, 2020).

Conclusion

This case underscores the importance of considering strep throat in pediatric patients with sore throat and associated symptoms. The diagnostic plan involves RADT and throat culture for confirmation, and the treatment plan includes appropriate antibiotic therapy and supportive care. Close follow-up will ensure adequate response to treatment and prevent potential complications associated with Group A Streptococcal pharyngitis.

References for FNP 591 Week 2 Aquifer Case Study

Alotaibi, A., Binsaqr, M. A., Mutlaq, M. R., Khojah, A. A., Khojah, S. A., & Mohamed, H. A. (2022). Atypical presentation of scarlet fever. Cureus, 14(12). https://doi.org/10.7759/cureus.33142

Mustafa, Z., & Ghaffari, M. (2020). Diagnostic methods, clinical guidelines, and antibiotic treatment for group A streptococcal pharyngitis: A narrative review. Frontiers in Cellular and Infection Microbiology, 10. https://doi.org/10.3389/fcimb.2020.563627

Sykes, E. A., Wu, V., Beyea, M. M., Simpson, M. T. W., & Beyea, J. A. (2020). Pharyngitis. Canadian Family Physician, 66(4), 251–257. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145142/

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