Mr. Wong is presenting with a chief complaint of a sore throat. “The goals of assessment and diagnosis are to identify those patients with group A Î²-hemolytic streptococcus (GABHS) infection (because they are at risk for rheumatic fever and glomerulonephritis), to reduce the possibility of sequelae of peritonsillar and retropharyngeal abscess, and to identify epiglottitis” (Dains, Baumann, & Scheibel, 2007, p. 22). In order to reach a diagnosis for Mr. Wong, a history must be obtained. According to Dains et al (2007), the following questions should be examined to evaluate the patient:
Symptoms associated with epiglottitis, which is an emergency, include sore throat, difficulty swallowing, and respiratory distress. The respiratory distress is characterized by drooling, dyspnea, and inspiratory stridor. Peritonsillar abscess, another emergency, is associated with sore throat, odnyophagia, trismus, and deviation of the soft palate and peritonsillar fold (Dains et al, 2007).
Exposure to another individual with an illness increases the likelihood of an infection and can help identify a potential cause, bacterial or viral. A sudden onset of a sore throat with intense pain is related to GABHS. A gradual onset of a sore throat is related to infectious mononucleosis. A sore throat associated with viral pharyngitis typically begins one to two days after the onset of other symptoms. The pain associated with influenza and adenovirus is typically severe with edema of the throat. A sore throat due to noninfectious causes has an insidious onset and is associated with less severe pain described as scratchy or annoying. Peritonsillitis is associated with severe throat pain with trismus and the patient refuses to speak (Dains et al, 2007).
A fever associated with GABHS is sudden in onset and rises above 101.5oF with malaise, headache, and painful swallowing as additional symptoms. The temperature with influenza is abrupt in onset and ranges from 100oF to 104oF. A temperature greater than 104oF is associated with adenoviral infection. EBV is accompanied by a low-grade fever. A temperature that is not present for several days and then recurrent fever or a fever that continues for several days is due to peritonsillar abscess. A sore throat without fever is due to noninfectious cause. Influenza and GABHS is associated with systemic complaints (Dains et al, 2007).
Two or more of the above symptoms indicates a viral infection and rarely accompanies streptococcal pharyngitis. Influenza is associated with several days of fever, cough, and rhinorrhea. A sore, scratchy throat, nasal congestion, cough, and rhinorrhea is associated with viral pharyngitis. Symptoms of allergic pharyngitis is clear nasal discharge, a sore throat due to postnasal drip, watery or itchy eyes, sneezing, and hoarseness. Viral infections are associated with mild conjunctivitis, sneezing, and hoarseness (Dains et al, 2007).