05-04-2007, 05:42 PM
A 13-year-old boy comes to the office because of an 8-day history of a fever, sore throat, and extreme "tiredness". He also complains of a "red rash" that he noticed 5 days ago. He had been seen at a 24-hour clinic 6 days ago for a sore throat, and even though no diagnostic test was performed, he was treated with a 5-day course of ampicillin. He is usually very healthy and has never had "strep throat" before. His temperature is 37.8 C (100.0 F). Physical examination shows cervical adenopathy, tonsillar enlargement with a pharyngeal exudate, and a macular rash on his trunk. Laboratory studies show an elevated white blood cell count with 40% atypical lymphocytes. The most appropriate next step is to
A. obtain a rapid strep test
B. obtain a throat culture
C. order a heterophile test
D. order a Tzanck smear of a scraping from the rash
E. prescribe a 7-day course of prednisone
A. obtain a rapid strep test
B. obtain a throat culture
C. order a heterophile test
D. order a Tzanck smear of a scraping from the rash
E. prescribe a 7-day course of prednisone