Odynophagia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of pain with swallowing

Rated at ‍012345678910 / 10 ‍

Described as ‍scratchyburning

Radiation ‍none to ‍

Pattern ‍constantintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective

Contact with individual with strep throat: ‍YesNo



Associated symptoms: *Try using right-click for negatives*

‍swollen lymph nodes

‍hoarseness

‍redness in throat

‍white patches/pus on tonsils

‍swelling in throat

‍drooling

‍muffled voice

‍inability to open mouth fully

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍sputum, ‍clearwhiteyellowgreen

‍runny nose, ‍clearcolored

‍nasal congestion

‍difficulty breathing

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍rash

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍earache



Contributing factors:

‍smoking

‍allergies

‍similar symptoms in close contacts

‍daycare

‍risk factors for gonorrhea

no history of: ‍tonsillitis, ‍strep throat, ‍gastroesophageal reflux disease, ‍tonsillectomy, ‍immunodeficiency





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Pharyngitis ‍likelysuspectedpossible

DDx: strep pharyngitis, viral pharyngitis, tonsillitis, infectious mononucleosis, peritonsillar abscess, retropharyngeal abscess, esophagitis, glossopharyngeal neuralgia, foreign body in the throat, GERD, throat cancer, thyroiditis, epiglottitis, herpangina, diphtheria, HIV acute infection, thrush, allergic rhinitis, postnasal drip, acute sinusitis





PLAN:

Investigations:

- Rapid strep test

- Throat swab

- Chlamydia and gonorrhea throat swab

- Blood work: ‍CBC, ‍monospot test, ‍LFTs, ‍CRP

- CT scan of the neck

- Barium swallow

- Upper GI endoscopy

Treatments:

- NPO

- ‍Analgesics

- ‍Oral ntibiotics

- ‍IV antibiotics

- ‍Mycostatin

- ‍Dexamethasone

- Tantum lozenges

- Salt water gargles 4 times daily

- Rest and hydration

Further care:

- Referral to ENT specialist

- Referral to gastroenterologist

- Follow-up in ‍ ‍daysweeks

- Return if not better after 72 hrs or before if worsens