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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Identify the clinical signs and symptoms associated with streptococcal pharyngitis and acute otitis media (AOM)

  • List the treatment goals for streptococcal pharyngitis and AOM

  • Develop an appropriate treatment plan using patient-specific data

  • Create a monitoring plan for a patient with streptococcal pharyngitis and AOM using patient-specific data

  • Educate patients about upper respiratory tract infections and proper use of antibiotic therapy

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PATIENT PRESENTATION

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Chief Complaint

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"My daughter has a head cold and fever. She needs antibiotics so she can go back to school tomorrow."

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History of Present Illness

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Jasmine Henderson is a 5-year-old girl who presents with her mother to the pediatrician with complaints of fatigue, nasal congestion, reduced appetite, fever, and ear and throat pain on swallowing. The patient began feeling tired 4 days ago and developed mild nasal congestion 1 day later. Her mother reports that the patient's appetite has diminished over the past couple of days. She complained of ear and throat pain on swallowing water this morning and she was sent home from school this morning with a fever of 102.4°F (39.1°C). Her mother has been giving her a nonprescription cold medication for the past 2 days, but it has not helped alleviate her symptoms. She is requesting antibiotics so that the patient can return to school tomorrow, and she wants to know what other nonprescription medicines she can give to her to relieve her symptoms.

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Past Medical History

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Perennial allergic rhinitis (cat dander, dust mites) diagnosed last year

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Mild intermittent asthma diagnosed 2 years ago

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Atopic dermatitis diagnosed 6 months ago

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Iron-deficiency anemia diagnosed 6 months ago

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Prior episodes of otitis media (ages 14 months and 3 years)

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Upper respiratory tract infections three to five times each year

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Family History

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Father has atopic dermatitis, hypercholesterolemia, and seasonal allergies. Mother has perennial allergic rhinitis and exercise-induced asthma. She has a 7-year-old sister and a 2-year-old brother, who are healthy.

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Social History

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Lives with mother, father, sister, and brother. Both parents work outside of the home. Has 2 pets (cat, goldfish). Attends kindergarten at public elementary school. No recent travel.

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Allergies/Intolerances/Adverse Drug Events

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Erythromycin—abdominal pain and diarrhea

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Medications (Current)

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Loratadine 5 mg PO q 24 h PRN allergy symptoms

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Albuterol 2.5 mg solution for nebulization twice daily and q 6 h PRN wheezing

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Hydrocortisone 1% ointment once daily to affected area(s)

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Children's Tylenol Plus Cold (acetaminophen 160 mg/5 mL; chlorpheniramine 1 mg/5 mL; phenylephrine 2.5 mg/5 mL) 5 mL PO q 6 h PRN

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Ferrous sulfate 150 ...

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