Heent Case Study: Bjane Is A 19-Year-Old College Freshman

Heent Case Study Bjane Is A 19 Year Old College Freshman Who Plays On

Heent Case Study Bjane is a 19-year-old college freshman who plays on her school’s soccer team. She presents to the college health clinic with complaints of sore throat, fever, fatigue, aches, and pains that started abruptly yesterday. She denies cough, runny nose, sinus congestion, nausea, vomiting, and abdominal pain. Her review of systems reveals no additional concerning symptoms.

Her medical record indicates that her immunizations are current, and she has a benign past medical and family history. She reports no drug allergies; her current medications include oral contraceptive pills (OCPs). Vital signs are: blood pressure 110/64 mmHg, temperature 101.6°F, pulse 88 bpm, respiratory rate 16 breaths per minute.

Additional History Items and Physical Exam Findings

Further history should include questions regarding recent exposure to individuals with sore throat or infectious illnesses, history of previous similar episodes, and any recent travel or environmental exposures. It is appropriate to inquire about her vaccination history, especially regarding streptococcal vaccination if applicable, and her history of skin rashes or other autoimmune symptoms.

On physical examination, in addition to the current findings, it is important to assess for tonsillar size and presence of exudates, uvular position, palpation of cervical and other lymph nodes, oral mucosa inspection for ulcerations or lesions, and examination of the skin for signs of infectious processes. Cardiovascular and respiratory exams are essential to exclude systemic illness, as well as checking for signs of neck swelling or submandibular lymphadenopathy not initially described.

Application of the Centor Criteria

The Centor criteria are used to estimate the probability of Group A Streptococcus (GAS) pharyngitis. The criteria include: tonsillar exudates, tender anterior cervical adenopathy, fever, and absence of cough.

Based on the clinical presentation:

• Tonsillar exudates: Yes (+1)
• Tender anterior cervical lymphadenopathy: Yes (+1)
• Fever: Yes (+1, since her temperature is 101.6°F)
• Cough: No (+0)

Total score = 3. This score indicates a moderate probability of GAS pharyngitis, supporting diagnostic testing and potential antimicrobial therapy.

Diagnosis and Confirmatory Testing

A clinical diagnosis of GABHS pharyngitis is supported by her presentation and Centor score. Rapid antigen detection testing (RADT) and throat culture are recommended to confirm GAS infection. Given her Centor score of 3, empirical antibiotics are justified while awaiting test results.

Treatment Plan

The management of GAS pharyngitis involves antibiotic therapy to reduce symptom duration, prevent complications such as rheumatic fever, and decrease transmissibility. First-line treatment includes penicillin V or amoxicillin for 10 days. Alternatives include cephalexin, azithromycin, or clarithromycin for patients allergic to penicillin. Symptomatic relief can be provided with analgesics such as acetaminophen or NSAIDs, and supportive care including hydration and rest.

Patient education is crucial, emphasizing adherence to medication, the importance of hand hygiene, and avoiding contact with others to prevent spread. Follow-up is recommended if symptoms worsen or do not improve after 48-72 hours of therapy.

Summary and Reflection

This case highlights the importance of comprehensive history-taking and physical examination in diagnosing GABHS pharyngitis. The use of Centor criteria facilitated decision-making regarding testing and treatment. Proper management reduces the risk of complications and promotes recovery. Ongoing research emphasizes the need for judicious antibiotic use to combat resistance, making diagnostic accuracy essential (Choby, 2019; Shulman et al., 2020).

References

• Choby, B. A. (2019). Diagnosis and Treatment of Group A Streptococcal Pharyngitis. American Family Physician, 100(6), 377-385.
• Shulman, S. T., et al. (2020). Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis. Clinical Infectious Diseases, 72(10), e1-e29.
• Gerber, M. A., et al. (2019). Prevention of rheumatic and glomerular kidney disease. JAMA Pediatrics, 173(10), 1020–1026.
• Sinclair, C. A., & Zipser, J. (2021). Antibiotic Stewardship in Pediatric Respiratory Tract Infections. Pediatric Annals, 50(3), e125-e130.
• Shulman, S. T., et al. (2020). Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis. The Pediatric Infectious Disease Journal, 39(4), 222–234.