PEDIATRICS CASE Allison Rogers

King University
STUDY
SUBJECTIVE
Initials: R.P. Date of Birth: 07-28-2011 Age: 5 years
History provided by mother, which appears to be a reliable source.
Chief Complaint: Sore throat (rates moderate on pain scale) and fine itchy rash all over for
past two days. Temperature of 101F last night, resolved with Ibuprofen OTC. Denies
known sickness of any other family members or contacts.
Medical/ Surgical History: Term cesarean birth due to failure to progress with no
complications, APGAR 8/9. Birth weight 6 pounds 5.5 ounces/ newborn discharge weight
5 pounds 14 ounces; bottle feed without difficulty. No significant medical or surgical
history.
Family/ Social History: Lives at home with birth parents (mother age 36, dad age 33); no
siblings. No smokers living in home with the child, denies frequent exposure to cigarette
smoke. No pets. Attends Kindergarten in public school system.
Immunizations: Current and up-to-date
Allergies: Amoxil (rash)
Medications: Ibuprofen OTC PRN. No additional prescription or over-the-counter
medications
REVIEW OF SYSTEMS
General: Reports temperature of 101F last night, denies additional fever, skin
feeling hot to touch, or complaints of chills. States just dont feel good
HEENT: Reports sore throat x2 days, reports hurting when swallowing but denies
difficulty swallowing. Reports clear drainage from nose since yesterday. Denies
itching, burning, irritation, tenderness, or drainage of eyes, or ears.
Respiratory: Denies cough, congestion, shortness of breath at rest or with
activity.
Cardiac: Denies chest pain, tightness, burning or funny feeling in chest.
GI: No change in appetite. Reports diarrhea x1 yesterday. Denies nausea or
vomiting.
MS: Denies muscle aches, weakness, difficulty with movement or walking.
Skin: Reports fine, itchy rash all over body x2 days. Denies new or different
medications, foods/drinks, insect/animal bites, detergents, or exposure to
chemicals.
OBJECTIVE: PHYSICAL EXAM
Vital Signs: Temp: 99.2F; HR: 120; RR: 22; SpO2: 99%
Constitutional: Caucasian female, dressed appropriate for age and weather. Cooperative,
alert, active at times, sitting on mothers lap.
HEENT: Normocephallic, no drainage noted from bilateral eyes or ears. Clear secretions
noted from bilateral nares; nares intact. Bilateral tympanic membranes visualized, pearly
grey in color; no redness or bulging noted. Tonsils 2+, tonsils and pharynx erythematous
with white exudate noted to bilateral peritonsillar area. No lymphadenopathy noted.
Respiratory: Chest expansion symmetrical. Clear and equal bilaterally in all lobes.
Cardiac: RRR, S1, S2 present. No murmur noted.
GI: Normoactive bowel sounds. Denies tenderness upon palpation, no organomegally
noted.
Skin: Warm, dry, and intact. Fine papular rash noted on anterior and posterior trunk,
upper and lower extremities. Scattered fine papular rash noted to cheeks, cheeks appear
erythematous, not hot to touch. Circumoral pallor noted.
Other: Rapid strep test positive
ASSESSMENT
My Differential Diagnoses:

Acute viral pharyngitis

Bacterial pharyngitis
Candidiasis
Peritonsillar abcess
What would your diagnosis be?
DIAGNOSIS
Streptococcal pharyngitis
What would your plan for this diagnosis
be?
PLAN
Rx:
1. azithromycin 200mg/5ml 1 teaspoon once daily for ten days
2. Benadryl 12.5mg/5ml 1 teaspoon every six hours as needed for
itching

May return to school on Wednesday (school excuse was given for

today and tomorrow)
According to Blosser, OKeefe, and Sanderson (2017), children are
generally considered non-infectious 24 hours after the start of
appropriate antibiotic therapy (p. 535).
REFLECTION
What I wish I had done differently:
I wish that I had not been hesitant to touch the rash. (I visually inspect, but do
not always think to palpate.)
Difference of opinion with preceptor (yes/no). Explain your answer.
No. After reading in the textbook about this diagnosis, I feel that my preceptor did
everything that is recommended.
What I will do differently next time:
Not be afraid to touch the patient. I realize through palpation that you can pick
up on subtleties that sometimes cannot be easily visualized.
What I learned from this experience:
Scarlatina rash is common with group A beta-hemolytic streptococcus infection.
Finely papular (making the skin feel course, like sandpaper), blanches to pressure.
Onset: 1-5 days following onset of symptoms or may be presenting symptom.
(Blosser, OKeefe, & Sanderson, 2017)
REFERENCES
Blosser, C. G., OKeefe, C., & Sanderson, S. K. (2017). Infectious
diseases and immunizations. In C. E. Burns, A. M. Dunn, M. A.
Brady, N. B. Starr, C. G. Blosser, & D. L. Garzon (Eds.), Pediatric
Primary Care, 6th (ed.), (pp. 474-548). St.Louis, MO: Elsevier.