Question

Please Write Succinct: on URI

• Review of Systems: Associated symptoms and Risk Factors
• Findings on Focused Physical Exa
• Five Differential Diagnosis.

See example below for question #1:

1. Sore Throat

ROS:

Associated symptoms: fever, redness or eye discomfort, sneezing, wheezing, cough, runny nose, postnasal drip, GERD like symptoms, fatigue, muscle ache, n/v, and diarrhea.

Risk Factors:

Smoking, new sexual partners, irritant exposure, medications, and chronic health problems.

Red flags:

drooling, unable to swallow, unable to lie down, restless, unable to stay still, and unable to talk.

PE findings:

Epiglottis- severe illness with signs of upper airway obstruction such as restlessness, stridor, difficulty breathing, drooling, inability to swallow and high fever signals epiglottis and requires immediate referral. Further examination with a tongue blade could trigger laryngospasms and lead to airway obstruction.

Peritonsillar retropharyngeal abscess- orthopnea, dyspnea, symmetrical swelling, abscess, trismus.

Viral pharyngitis: Erythema, edema of throat, tender posterior cervical nodes.

GAS: temp more than 101.5, exudate anterior cervical lymphadenopathy.

Mononucleosis: presence or absence of pharyngeal exudate, posterior cervical lymphadenopathy, splenomegaly.

Gonococcal pharyngitis: pharyngeal exudate bilateral cervical lymphadenopathy

Inflammation: sinus tenderness, pale or swollen pharynx, postnasal drainage visible, no fever or lymphadenopathy.

Aphthous Stomatitis: shallow ulcers, no vesicles; indurated papules that progress to 1 cm ulcers; ulcer has yellow membrane and red halo; no fever or nodes.

Herpes simplex Lesions: perioral lesions; lymph adenitis; vesicles on palate, pharynx gingiva.

Herpetic pharyngitis: vesicles, ulcers, or exudate of the oral and pharyngeal mucosa.

Candidiasis: curd like white plaques that bleed when scraped off.

Differential diagnosis:

Viral Pharyngitis, Streptococcal Pharyngitis, peritonsillar or retropharyngeal abscess, Mononucleosis, Epiglottis, gonococcal pharyngitis, Herpangina, Vincent angina, Aphthous stomatitis, HSV type 1, Candidiasis, GERD.

Answer 1

UPPER RESPIRATORY INFECTION

URI

ASSOCIATED SYMPTOM: Cough,sneezing, nasal discharge ,nasal congestion,runny nose,fever,sratchy or sore throat,nasal breathing.

RISK FACTORS: Physical contact,poor handwashing,close contact in school seetings and by travel,smoking and second hand smoking,health care facilities and nursing homes,immunocompromised state,anatomical abnormalities like facial trauma,upper airway,nasal polyps.

RED FLAGS: Cough,sore throat,unable to sleep,having cold, feeling chesty,chest pain.

PE FINDINGS:

Otitis media- tympanic membrane bulging with limited mobility ,hearing loss

pneumonia/bronchitis- rales,decreased breath sounds,deep cough,fever,dysphagia,stridor ,drooling.

Epiglotititis- voice altered,stridor ,severe dysphagia and sore throat.

whooping cough- vomitimg with cough,no fever,rhinorrhrea.

influenza- general malaise ,myalgia,fever,cough,hoarseness,decreased appetite,headache.

Bronchiolitis- runny nose ,stuffy nose,cough,slight fever,wheezing.

streptococcal Pharyngitis - fever temp 104 F,pharyngeal or tonsillar exudate,absence if cough.

infectious mononucleosis- f ever, sore throat,diffuse adenopathy.

sinusitis -pain,nasl congestion,runny or sneexing nose,fatigue,fever ,facial tenderness,sleeping difficulty,throat irritation.

DIFFERENTIAL DIAGNOSIS:

Viral infections,seasonsl allergies,influenza, Strep Throat, mono (epstein barr virus),Asthma exacerbation,bacterial sinusitis,pneumonia,HIV