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Have sore throat, ear ache, sinus pressure, neck pain and fever. Done with test. Diagnosis?

DOCTOR OF THE MONTH - Feb 2013
Feb 2013
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Pediatrician
Practicing since : 2002
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A 36 y/o with complaints of sore throat x 3 days, ear ache,slight sinus pressure, pain in right side of neck with low grade fever. Assessment showed +2 lymphadenopathy, tragal tenderness Rt. side, right ear slight red, with dull gray TM, pharynx red- edematous with tonsils +2 with white patchy spots.

What is the diagnosis and why? differential diagnosis and why?
Posted Sat, 6 Jul 2013 in Ear, Nose and Throat Problems
 
 
Answered by Dr. E Venkata Ramana 2 hours later
Hi,

Thank you for your query on Healthcare Magic.

The symptoms and signs you have described are suggestive of an upper sore throat, fever, pharynx congestion, and white patches on tonsils, and with tender lymphadenopathy.

But as there is tragal tenderness associated with slight sinus pressure, there may be associated middle ear and sinus infection.

The differential diagnoses are :

Membranous and follicular tonsillitis

Streptococcal pharyngotonsillitis

Upper respiratory tract infections caused by viruses

Infectious mononucleosis (Epstein Barr Virus infection)

Sinusitis

Scarlet fever- here upper respiratory tract infection is associated with skin rash.

Diphtheria-It is rare in immunized people.

I thought this differential diagnoses because of association of upper respiratory tract infection with white patchy spots on tonsils.

But physical examination by the doctor and throat swab for culture and sensitivity is necessary to know the organism responsible for this infection.

Therefore I advise you to consult the physician for examination and for management.

Hope I have answered your query, if you have any clarification please let me know.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Have sore throat, ear ache, sinus pressure, neck pain and fever. Done with test. Diagnosis? 2 days later
Thank You for your response.

However, if someone presented to you with these symptoms what would be your plan of action {with prescription, diagnostic testing, patient education (meds, dx, etc.), and health promotion/maintenance needs}.
 
 
Answered by Dr. E Venkata Ramana 4 hours later
Hi,

Thank you for getting back.

With this type of presentation, my plan of action is :

I advise to rule out streptococcal throat infection first, followed by advising to go for throat swab for gram stain and special stain, culture and sensitivity, complete blood picture, and an X XXXXXXX paranasal sinuses.

I will advise antibiotic if it is suggestive of streptococcal or other bacterial infection depending on physical examination and investigations.

I advise to do gargling with salt water or betadine mouth gargles.

I advise other supportive medication like Tylenol for fever and slight pain.

As a preventive measures, I advise to use tissue or cloth while coughing or sneezing, frequent washing of hands to maintain hand hygiene, and to avoid the sharing of objects to prevent the spread of infection to others.

Hope I have answered your query, if you have any clarification please let me know.

Regards.
Above answer was peer-reviewed by
 
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