Case - You are a physician's assistant at a local pediatrician's office. Five-year-old Michael is brought to the office by his father. Michael is crying and complaining that his mouth hurts. His father has been at work and does not know whether the boy has had a fever during the day. Currently his temperature is 103o F. The physician notices that Michael's breath smells rotten. Lymph nodes in his neck are swollen, and visual examination of the throat reveals a white packet adhering to the left tonsil. Much of the soft palate is red.
1. What laboratory tests are called for?
2. What types of infections are in the differential diagnosis?
3. Your practice has recently been overrun by sore throats and now, late in the evening, there are no supplies for performing the proper test. Should the physician prescribe antibiotics or not?
4. In deciding whether to prescribe antibiotics, should the physician be extra careful not to prescribe an unnecessary antibiotic, or be extra- careful not to let bacterial infection go untreated.
5. What are the possible sequelae of untreated, sore throats?