1. SORE THROAT(rhinorrhea) Dr Eoghan O’Shea

2. NEJM 2011;34:648-55 STREPTOCOCCAL PHARYNGITIS DR MICHAEL R. WESSELS

3. 10 YEAR OLD GIRL C/O SORE THROAT AND FEVER X 1/7

4. HISTORY NKDA NO SURGERIES NO MEDICAL RX NIL FAMILY HISTORY NON CONTRIB

5. FINDINGS T= 39 TENDER BILAT ANT CERVICAL LYMPH GLANDS TONSILS RED,WHITE YELLOW EXUDATES NORMAL EARS CHEST CLEAR

6. NOW WHAT ? THINC VD VINDICATE

7. CAUSES INFECTIOUS NON INFECTIOUS e.g. allergic or chronic rhinitis.OTHER :TRAUMA,FOREIGN BODY,NEOPLASM

8. ORGANISMS VIRAL BACTERIAL OTHER

9. VIRUS RHINO INFLUENZA COXSACKIE hand foot and mouth HERPES SIMPLEX gingivostomatitis EBV mono CMV mono like HIV

10. BACTERIA GROUP A STREP pharyngitis, scarlet fever GROUP C,G pharyngitis MIXED ANEROBES vincents angina FUSOBACTERIUM lemierre’s syndrome septic thrombophlebitis of int jug vein STI g.c.,chlamydia,treponema pallidum

11. SCORING SYSTEM CRITERIA POINTS T > 38 1 ABSENCE OF COUGH 1 ANT CERVIC GLANDS 1 TONS SWELLING EXUDATE 1 AGE 3<15 1 AGE 15-45 0 AGE >45 -1

12. RISK POINTS % 0 1-2.5 1 5-10 2 11-17 3 28- 35 4 51-53

13. Mono ?? Rash with AMOXIL CBC,MONOSPOT SWAB RAPID ANTIGEN DETECTION TEST

14. ANTIBIOTICS DRUG DOSE,ROUTE,DURATION PEN V <27 KG 40mg/kg/day bid-tid AMOXIL 40 mg/kg/day bid-tid To prevent rheumatic fever 10 days

15. Penicillin allergy Clarithromycin Azithromycin Erythromycin Cephalexin Cefadroxil Clindamycin

16. Miscellaneous In India, rheumatic fever still an issue,use IM PEN G Know if you have access to rapid antigen- detection test.Positive test very useful.If neg in adults,no further rx,in children:SWAB