Case Presentation 1

00326480 ( F/18)
C.C.> sore throat onset) 1DA

P.I.> 1) 2 Hx. , .

 PMHx. DM / HTN / Tbc( - / - / - ) OPHx. ( - ) Drug Hx ( + ) SHx. Alcohol/smoking ( - / - )

Syetemic Review
Throat discomfort (-) sore throat (+) dyspnea (-) dysphagia (-) odynophagia (-) voice change (-) H/L (-/-) otalgia (-/-) otorrhea (-/-) vertigo (-) tinnitus (-/-) earfullness (-/-) Nasal obstruction (-/-) rhinorrhea (-/-) PND (-) sneezing (-) snoring (-) hyposmia (-) anosmia (-)

Physical Examination
N.C & nasopharynx ; DSN ( - ) Polyp (-) Discharge ( - ) Remaining adenoid O.C & oropharynx : PI (-) PTH (+++/++++) Exudate (+), dirty gray color tonsils Lx & hypophx. : TVC motility : both good Pyriform sinus : free Valleculae : free Neck : Palpable neck mass (-) -Tenderness (-)

 A> P>

r/o Peritonsillar abscess,both

-I&D and culture -Lab -Pharynx ECT -Antibiotics -Pain control -Hydration

Lab
WBC 15000 ESR 53, CRP 14.1 PBS :
RBC: Normocytic normochromic WBC: Slightly increased in number. Neutrophilia with toxic granules and cytoplasmic vacuole PLT: Normal in number

Heterophil Ab(-) Throat swap : Enterobacter cloacae Pus culture : throat normal flora

Adm#3
Sore throat persisted Swelling of the soft palate with a midline uvula pushed anteriorly.
Pharynx ECT Diffuse enlarged both palatine tonsil with peripheral rim enhanced cystic mass in both peritonsillar area (Rt: 2.5cm, Lt: 0.6cm) and multiple reactive LNs. --> R/O Acute tonsillitis with peritonsillar abscess I&D culture

Adm#7D
Sore throat(-), odynophagia(-+) WBC; 5570 CRP(QN) 7.1 ESR 25 Discharge

Discharge #7D
Sore throat(-) PTH(+++/+++)

Discharge #14D
PI(+), PTH(+++/+++) Rt ant pillar I&D site pus discharge Adm refuse -short term f/u -antibiotics( cefdinir, clindamycin)

Discharge #17
PTH(+++/+++) no pus discharge Mx 7days

Discharge #24
Sore throat(-) PTH(+++/+++) No pus discharge tonsillectomy

Case Presentation 2

00215194 ( F/17)
C.C.> sore throat onset) 1WA

P.I.> 1) 1 . 2)

 PMHx. DM / HTN / Tbc( - / - / - ) OPHx. ( + ) 2005 4 ASD direct suture clos ure Drug Hx ( + ) SHx. Alcohol/smoking ( + / + )

Syetemic Review
Throat discomfort (-) sore throat (+) dyspnea (-) dysphagia (-) odynophagia (-) voice change (-) H/L (-/-) otalgia (-/-) otorrhea (-/-) vertigo (-) tinnitus (-/-) earfullness (-/-) Nasal obstruction (-/-) rhinorrhea (-/-) PND (-) sneezing (-) snoring (-) hyposmia (-) anosmia (-)

Physical Examination
TM : Rt. : free Lt. : free Valsalva ( + / + ) Weber test : ( no ) lateralization

N.C & nasopharynx ; DSN ( - ) Polyp (-) Discharge ( - ) O.C & oropharynx : PI (-) PTH (++++/++++) Exudate (+) Lx & hypophx. : TVC motility : both good Pyriform sinus : free Valleculae : free Neck : Palpable neck mass (-) -Tenderness (-)

 A>

r/o Peritonsillar abscess,both menorrhagia

P>

-I&D -Lab -Pharynx ECT -Antibiotics -Pain control -Hydration

 4 Tiramox 1.2g 1via [IV side] i03 5 Fullgram 600mg/4ml 1amp [IntraVenous] i03

I&D
Rt peritonsillar abscess : anchovy like pus aspiration, I&D bloody discharge gush out Lt peritonsillar abscess : small bloody asp iration , I&D bloody discharge gush out

Lab
WBC 6900 Hb 7.6 PBS : Slightly microcytic hypochromic anemia with Anisopoikilocytosis Heterophil Ab(-)

Pus study
Gram stain : no bacteria seen Anaerobe : no growth bacteria Fungus : Candida albicans AFB stain (-) AFB culture : no growth of 6weeks