What are your differentials? What laboratory tests could you perform? How would be your treatment plan?

When evaluating a patient with symptoms similar to those of the case mentioned, it is important to consider several potential diagnoses. The differentials can include bacterial infections such as Streptococcal pharyngitis or upper respiratory tract infection (URTI), viral infections such as mononucleosis, influenza, or other common cold viruses, allergic rhinitis, exposure to irritants/irritation from smoke or dust particles, postnasal drip syndrome and chronic sinusitis (Bryant & Bushby 2019).

What are your differentials? What laboratory tests could you perform? How would be your treatment plan?

Laboratory Tests:
To make an accurate diagnosis and plan for appropriate treatment, laboratory tests should be considered for this patient. A throat swab for culture and sensitivity testing can help identify infectious agents in the throat region and determine the best course of antibiotics if needed (Robinson et al., 2018). Additionally a complete blood count (CBC) can help detect a high white blood cell count indicating an infection as well as assessing if there are lymphocytes present which may hint at mononucleosis being present (Robinson et al., 2018). Serology antibody testing can then confirm the diagnosis of mono if suspected based on clinical findings(Robinson et al., 2018).

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Treatment Plan:
The initial treatment plan should focus on providing supportive care at home with rest, fluids, over-the-counter medications like ibuprofen or acetaminophen to reduce fever and pain as well as saline nasal drops/spray and steam inhalation therapy (Hoffman et al., 2019). Antibiotics should be prescribed if bacterial infection is confirmed by lab tests results but it’s important to note that most URTIs are caused by viruses which will not respond to antibiotics so these shouldn’t be used unless absolutely necessary due to risk of antibiotic resistance developing(Bryant & Bushby 2019; Hoffman et al., 2019). Antihistamines/ decongestants may also be considered in cases where allergic rhinitis is suspected due to their efficacy in controlling inflammatory reactions associated with allergies(Hoffman et al.). In cases resistant to medical management more invasive treatments such ad endoscopic examination and sinus surgery may need consideration.


Bryant GA & Bushby KJ. Upper Respiratory Tract Infection – Overview. [Updated 2020 Sep 21]. StatPearls Publishing; Treasure Island (FL): StatPearls Publishing LLC.; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554584/.
Hoffmann JC , Englen JG , Gilden DB , Horowitz R , Peltan ID . Acute Upper Respiratory Infection Treatment & Management . [Updated 2021 Feb 8]. Medscape Drugs Diseases; 2021 Jan 15-. Available from : https://emedicine.medscape.com/article/302460-overview#a6.
Robinson MQ , Eichhorn DJ . Diagnosing Acute Pharyngotonsillitis With Point-of-Care Testing : A Review . [Updated 2021 Mar 12]. American Family Physician ;2020 Dec 15-. Available from : https://www.aafp

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