Case Study: Pediatric Patient Althea - Diagnosis, Treatment, and Plan

This case study presents the case of Althea, a 5-year-old female, who presented with a fever, sore throat, and rash. The assignment includes an epidemiological profile, prioritized cues from history and physical examination, and a problem statement. The analysis focuses on the differential diagnosis, highlighting Group A Beta-hemolytic Streptococcus pharyngitis and viral pharyngitis, supported by specific history and physical exam findings. The diagnostic plan includes a rapid antigen detection test and culture, with treatment plans emphasizing penicillin, amoxicillin, and cephalosporin/macrolide options. The rationale behind each diagnostic test and treatment is clearly outlined, along with patient education considerations regarding medication adherence, infection transmission, and prevention.

Case Analysis Tool Worksheet
Student's Name:
I. Epidemiology/Patient Profile
Name: Althea
Age: 5 years old
Chronic dx: No history of any chronic disease
Smoking: No history of smoking either actively or passively.
II. Prioritized Cues from Hx and PE.(Do not include lab, x-‐ray, or other diagnostic test results here.)
• Tier 1: The cues (may be positive or negative) that contribute most to the diagnosis of the active problem.
• Tier 2: These are cues of intermediate importance (list only positive cues).
• Tier 3: Of least importance (list only positive cues).
Tier 1 Tier 2 Tier 3
Dry cough Otitis media Colic
Sore throat
Fever with temperature of 38.6
Mouth petechiae appears on soft
palate and oropharynx-
erythematous having patchy white
exudate on tonsils.
Enlarged anterior cervical
lympnodes bilaterally measuring
1cm by 1 cm. The uvula is also
inflammed but in the midline.
Rash on the patient’s chest and
abdomen and consists of
numerous rough feeling papule.
Mild tarchycardia but no murmur.
Her heart rythm is normal.
Negative symptoms she does not
have ear pain, nausea, rhinorrhea,
diarrhea, vomiting or any
breathing problems.
III. Problem Statement
Althea is a 5-year-old female who has been healthy until two days ago when she started complaining of
fever. She also has a history of a sore throat, mild abdominal pains, dry cough, headache and decreased
appetited. She arrived at thehospital accompanied by her mother mainly because of fever and a sore throat.
Athea’s friend at school is being treated for streptococcal throat infection. On performing a physical
examination on Althea, the nose was clear with no rhinorrhea, the soft palate mouth petechie, oropharynx
was erythematous having patchy white exudate on the tonsils. The tonsils were moderately swollen and

uvula appeared enlarged but still in the midline. On examination of the neck, the anterior cervical lympnodes
were tender and enlarged bilaterally measuring about 1 cm by 1 cm. On auscultation of the heart there was
no murmur and the rhythm was normal but she had mild tachycadia. The lungs were clear, no wheeze or
crackles noted on auscultation. The abdomen was soft, nontender and no organomegaly. The axillary and
inguinal lymph nodes had no enlargement. The patient had skin rash was which was observed on the chest
and abdomen. The rash comprises of many rough-feeling red papules. Negative symptoms were ear pain,
rhinorrhea, nausea, vomiting, diarrhea and no sign of breathing difficulty.
IV. Differential Diagnosis
Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patient’s complaint(s).
List your most likely diagnosis first, followed by two other reasonable possibilities. For some cases, fewer than 3 diagnoses will be appropriate.
Then, enter the positive or negative findings from the history and the physical examination that support each diagnosis.
Leading dx:
Group A Beta-hymolytic Streptococcus pharyngitis.
Viral pharyngitis
History Finding(s) Physical Exam Finding(s)
Sore throat for the past two days. Oropharynx is erythematous and have exudates
that appear patchy white on tonsils. The tonsils
are moderately swollen and symmetric. The
uvula is mildly inflammed but still in the midline.
Anterior cervical lympnodes are tender and
enlarged bilaterally with no posterior cervical
lympnode enlargement.
A cough which is dry. Nose is clear, no rhinnorhea and the nasal nares
are clear. Mouth petechie are present on the soft
palate.
Fever for the last two days. Temperature of 101.6 Fahrenheit or 38.6
Celsius.
Skin rash Rash on the skin of the chest and abdomen. The
rash consists of numerous rough-feeling red
papules.
Headache. Mild tachycardia with normal rythm and no
murmur.
A friend at school who is being treated for
streptococcal infection using antibiotics.
Alternative dx:
Viral pharyngitis
History Finding(s) Physical Exam Finding(s)
Sore throat for the past two days. Oropharynx is erythematous and have exudates
that appear patchy white on tonsils. The tonsils
are moderately swollen and symmetric. The
uvula is mildly inflammed but still in the midline.
The anterior cervical lympnodes are tender and
enlarged bilaterally woth no posterior cervical

enlargement.
Dry cough. Nose is clear, no rhinnorhea and the nasal nares
are clear. Mouth petechie are present on the soft
palate. Negative rhinnorhea and chest
congestion.
Fever for two days Temperature of 101.6 Fahrenheit or 38.6
Celsius.
Headache Mild tachycardia with normal heart rythm and no
murmur.
Skin rash Rash on the skin of the chest aabd abdomen.
The rash consists of rough-feeling red papules.
A friend at school who is being treated for
streptococcal infection using antibiotics.
V. Explanation of Diagnostic Plan (including tests, labs, imaging studies, etc.) and Treatment Plan in prioritized order:
Diagnostic Plan Rationale
Rapid antigen detection test for stretococcus To find out if the patient is positive for group A
Beta-hemolytic streptococcus.
Culture if the test is negative. To increase number of colonies which can be
detected easily.
Treatment Plan Rationale
Take penicillin This is the first line treatment of pharyngitis due
to low cost
Take amoxicillin Effective against strep and less likely to
contribute to antimicrobial resistance
Take a cephalosphorin or marolide Indicated for patient resistant to penicillin.
Get immunized once she recover This will boost her immunity and may prevent
her from getting infections.
Patient and family education Teach the patient on the importance of
completing the penicillin dose. Teach also about
the transmission and prevention of
streptococcus infection and complications that
may arise
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