26 Jun Describe how DNA replication is initiated, including how
Question
What further questions do you have for Mary on this visit?
O – : When did you first notice the soreness in your throat? Has this occurred in the past? If so, how
many times?
L – Throat involvement
D – How long have you had the sore throat?
C – Since onset, have you noticed a change when you swallow? Have you noticed any drainage or
mucous from throat If so, how would you describe the drainage? Have you noticed any redness, swelling,
or white spots?
A – Does eating or drinking affect the pain? Does swallowing and or talking affect your throat?
R – Are you experiencing pain? If so, on a scale 0-10 what would you rate your pain? Have you taken
anything that helps alleviate the pain?
T – Have you taken anything that helps alleviate the pain? Have you tried pain medication or throat
lozenges?
Differential Diagnoses:
Pharyngitis/Sore Throat
Strep throat – Patients can experience a severe and sudden sore throat without coughing, sneezing, or
other cold symptoms. Pain or difficulty with swallowing. Fever over 101°F (38.3°C). Swollen lymph nodes
in the neck, and white or yellow spots or coating on the throat and tonsils. Strep throat is caused by a
bacterium known as Streptococcus pyogenes, or group A streptococcus (Nakhoul & Hickner, 2013).
Rationale: Mary presents in clinic with complaints of a sore throat and hurts worse when she swallows.
Tumors – Cancerous tumors of the throat, tongue or larynx can cause a sore throat. Other signs or
symptoms may include hoarseness, difficulty swallowing, noisy breathing, a lump in the neck, and blood
in saliva or phlegm (Waldman et al., 2013).
Rationale: Mary presents with a sore throat.
Viral infections- Viral illnesses that cause a sore throat include a common cold, Flu (influenza),
mononucleosis (mono), measles, chickenpox, and croup (Falsey et al., 2014).
Rationale: Mary presents to clinic with a sore throat that is worse when she swallows. She has a
daughter at home that is getting over a cold.
Based on your differential diagnoses list, what focused PE would you perform? What labs or diagnostic
tests, if any, would you order?
Vital signs. Complete physical assessment of the head, ears, eyes, nasal, looking down throat, palpating
the neck to check for swollen glands, and listening to heart and lungs. I would order a throat swab for a
rapid strep test as well.
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