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By B. Seruk. Barrington University. 2017.

SORE THROAT Antibiotic treatment should primarily target Bordetella species (Gilbert order omnicef 300mg with amex, Moellering and Sande, 2002). The Common infectious causes of acute pharyngitis include first line choice is erythromycin estolate (500 mg qid viral URIs, group A beta-hemolytic strep (GABHS), for 14 days). Second line choices include trimethoprim- infectious mononucleosis (IM), and enterovirus infec- sulfamethoxazole-DS (1 bid for 14 days) or clari- tions, like coxsackievirus, which have been linked to thromycin (500 mg bid for 7 days). These can trig- On examination look for tonsillar erythema and exu- ger bronchospasm and impede training. The clinician dates, asymmetric tonsillar swelling, ulcerations, palatal must provide considerable reassurance as complete petichiae, fever, cervical adenopathy, and splenomegaly. Management relies on avoiding irritant stimuli Symptomatic treatment with warm salt water gargles, and using bronchodilators such as albuterol (1–2 puffs humidified air, throat lozenges, and analgesics is often q 4–6 h). If negative, then a throat culture should be bid-qid) may be useful too (McDonald, 1997). Second line choices include Chest X-rays often show localized or diffuse infiltrates, azithromycin (500 mg qd for 1 day and then 250 mg but may not early in the course of disease. Sputum a day for 4 days) or erythromycin (250 mg qid for gram stain and culture may provide clues to the 10 days) (Perkins, 1997). Antibiotics hasten recovery, causative organism (Masters and Weitekemp, 1998). Proper rest, hydration, and IM, caused by Ebstein-Barr virus (EBV), occurs most nutrition are critical, as well as antibiotics to cover the commonly between ages 15 and 24 and affects 1–3% common bacterial pathogens (Streptococcus pneumo- of college students each year (Maki and Reich, 1982). One may also malaise are often present for longer, and can lengthen consider a flouroquinolone with increased S. There is no correlation Diagnostic studies include a lymphocytosis of >50%, between the severity of the illness and the susceptibil- >10% atypical lymphocytes on a peripheral smear, and ity to splenic rupture.

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Treatment: A combination of splinting and corticosteroid and anes- thetic injections is effective in more than 95% of patients discount omnicef 300 mg visa. Treatment: First-line treatment includes rest, NSAIDs, splinting, and physical therapy. Surgical release may be necessary in patients who do not respond to more conservative measures. Treatment: If the ganglion cyst is asymptomatic, then simple reas- surance may be all that is necessary. If the cyst becomes symptomatic or if it is aesthetically unacceptable to the patient, aspiration or surgi- cal excision may be performed. Additional diagnostic evaluation: X-rays, including AP, lateral, ulnar deviation, and oblique views (depending on the fracture sus- pected), should be obtained. Computed tomography and/or magnetic resonance imaging are also often necessary. Special consideration: Patients with snuffbox tenderness but nega- tive radiographs should be treated with 2 weeks of a thumb spica fol- lowed by repeat X-rays to rule out scaphoid fracture because of the risk of avascular necrosis. As in the cervical spine, because the diagnostic and therapeutic approach to radicular and nociceptive pain is very different, it is important to dis- tinguish them during the history and physical examination. Understanding the language of low back pain is as important as under- standing the language of neck pain. You may wish to briefly review the principles and terminologies discussed at the beginning of Chapter 1. In the lumbosacral spine, radicular symptoms are caused by an intervertebral disc bulge, protrusion, extrusion, or sequestration that compresses and inflames a nerve root in approximately 98% of all cases. Other causes of radicular symptoms emanating from the lumbo- sacral spine include disc osteophytes, a buckled ligamentum flavum, zygapophysial (Z)-joint hypertrophy, and other causes of lumbosacral spinal stenosis.