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+--- Thread: rapid strep:neg, next step? - sveta4 (/showthread.php?tid=235352)
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rapid strep:neg, next step? - sveta4 - ArchivalUser - 10-25-2007
An 8-year-old boy is brought to the health center by his parents because of a 2-day history of sore throat and fever. Temperature is 38.3°C (101.0°F) and pulse is 88/min; other vital signs are normal. Physical examination shows erythema of the posterior pharynx; the tonsils are enlarged and there are a few spots of whitish exudate on the left tonsil. A few small, nontender posterior cervical lymph nodes are palpable. There is no rash. Rapid streptococcal test is negative. Which of the following is the most appropriate next step?
A
) Administer intramuscular penicillin
B
) Obtain a throat culture
C
) Obtain acute-phase serum for antistreptolysin-O titer
D
) Prescribe azithromycin
E
) Reassure the patient's parents that he has a viral illness
0 - ArchivalUser - 10-25-2007
E.
0 - ArchivalUser - 10-25-2007
pt still has bacterial pharyngitis even though rapid/strep neg. can be staph, pneumococcal, ...etc. A--wont hurt patient. B--must do throat culture...but will take several days for results. C--usless if rapid strep is neg. D--zithrommax good coverage but 8 y/o will have hard time swallowing. E--reassuring patient in this case will cost you your porsche. I would answer D.
0 - ArchivalUser - 10-25-2007
well...i think it must be throat culture...even if the rapid strep is negative..there is still the possibility of bacterial infection.....anyone who disagrees???
0 - ArchivalUser - 10-25-2007
the answer is B. i stand corrected. just called my brother who is a pediatric attending. cant treat until culture results are back. if you empirically treat bac pharyngitis....and the patient has ebv mono....you make matters worse...pt will likely develop rash. exudates are rare and less effusive in viral cases.....except in ebv mono pharygitis....which often times looks worse than strep pharyngitis. so get a throat culture. if culture is positive....treat offending organism. if culture results are negative, treat supportively for viral pharyngitis.
0 - ArchivalUser - 10-25-2007
correct! many a times EBV is misdiagnosed as strep & given amox then develop rash---retrospectively diagnose EBV!
0 - ArchivalUser - 10-25-2007
The Centor criteria (fever, absence of cough, anterior cervical adenopathy, and tonsillar exudates) are commonly used to predict group A streptococcal (GAS) pharyngitis in adults
0 - ArchivalUser - 10-25-2007
But has serious flaws according some later reports..what should be done...I think Culture is a safe alternative..but takes 3 days min to return. Inputs anybody?
0 - ArchivalUser - 10-25-2007
Obtain a throat culture
0 - ArchivalUser - 10-25-2007
A)
u treat pt and take culture...
culture without treatment is wrong,