A 7-year-old girl is complaining of sore throat for the last 2 days. Today, she has developed fever of 38.7 °C, which has been relieved by acetaminophen. On examination, she was fo... A 7-year-old girl is complaining of sore throat for the last 2 days. Today, she has developed fever of 38.7 °C, which has been relieved by acetaminophen. On examination, she was found to have tender anterior cervical adenopathy and pharyngeal and tonsillar exudate. Which of the following is best next step toward diagnosis?
Understand the Problem
The question describes a 7-year-old girl presenting with symptoms suggestive of a possible infection (sore throat, fever, cervical adenopathy, tonsillar exudate). We need to determine the most appropriate next diagnostic step. The options include: a throat culture, echocardiography, a rapid antigen detection test, and fine needle aspiration for cervical adenopathy.
Answer
Perform a rapid streptococcal antigen test or throat culture.
Given the patient's symptoms (sore throat, fever, tender anterior cervical adenopathy, and pharyngeal and tonsillar exudate), the most likely diagnosis is acute streptococcal pharyngitis (strep throat). The best next step toward diagnosis is to perform a rapid streptococcal antigen test or throat culture to confirm the diagnosis.
Answer for screen readers
Given the patient's symptoms (sore throat, fever, tender anterior cervical adenopathy, and pharyngeal and tonsillar exudate), the most likely diagnosis is acute streptococcal pharyngitis (strep throat). The best next step toward diagnosis is to perform a rapid streptococcal antigen test or throat culture to confirm the diagnosis.
More Information
Rapid strep tests are very specific, meaning a positive result is highly accurate. However, they are less sensitive than throat cultures, resulting in a higher false-negative rate. If suspicion for strep throat remains high despite a negative rapid test, a throat culture should be performed, especially in children and adolescents, to avoid complications of untreated strep throat such as acute rheumatic fever.
Tips
A common mistake is to immediately prescribe antibiotics without confirming the diagnosis of strep throat. This can lead to antibiotic resistance and unnecessary side effects. Always confirm with a rapid strep test or throat culture.
Sources
- Sore Throat - Seattle Children's - seattlechildrens.org
- Pharyngitis - PMC - PubMed Central - pmc.ncbi.nlm.nih.gov
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