A 30-year-old male patient complains of fever and sore throat for several days. The patient presents to you today with additional complaints of hoarseness, difficulty breathing, and drooling. On examination, the patient is febrile and has inspiratory stridor.
Which of the following is the best course of action?
a. Begin outpatient treatment with ampicillin.
b. Culture throat for β-hemolytic streptococci.
c. Admit to intensive care unit and obtain otolaryngology consultation.
d. Schedule for chest x-ray.
e. Obtain Epstein-Barr serology.
Answer And Discussion:
The answer is c. (Admit to intensive care unit and obtain otolaryngology consultation..)
This patient, with the development of hoarseness, breathing difficulty, and stridor, is likely to have acute epiglottitis. Because of the possibility of impending airway obstruction, the patient should
be admitted to an intensive care unit for close monitoring. The diagnosis can be confirmed by indirect laryngoscopy or soft tissue x-rays of the neck, which may show an enlarged epiglottis. Otolaryngology consult should be obtained. The most likely organism causing this infection is H influenzae. Many of these organisms are β-lactamase producing and would be resistant to ampicillin.
Streptococcal pharyngitis can cause severe pain on swallowing but the infection does not descend to the hypopharynx and larynx. Lateral neck films would be more useful than a chest x-ray. Classic finding on lateral neck films would be the thumbprint sign.
Infectious mononucleosis often causes exudative pharyngitis and cervical lymphadenopathy but not stridor.
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