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step2ck_form6/Block 2/Question#34 (4.1 difficulty score)
A 7-year-old girl is brought to the physician ...
Throat cultureπŸ”,πŸ“Ί

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submitted by szsnikaa(13),

This question is a rather interesting one. While pharyngitis with viral or bacterial etiologies have very similar clinical presentations, there are a few subtle hints that make Throat Culture the more likely answer regardless of the CENTOR score in this Vignette.

September. The seasonality of Group A Strep (GAS) pharyngitis is usually between winter & early spring. Viral pharyngitis, although all year round, is more common in the colder months.

The main objective of a primary care physician is distinguishing which patients have a higher likelihood of GAS infection vs. viral and because there is a significant overlap between the 2 etiologies, clinical judgment alone is not accurate in diagnosing GAS infections often leading to overtreatment with antimicrobial therapy.

Throat culture is the gold standard in diagnosing GAS. This is done in this scenario, despite the negative rapid test (Sensitivity 70% - 90%), because of the suspicion of viral etiology as well as the avoidance of overtreatment. Throat culture is the most appropriate next step in this case.

drdoom  😍😍😍 +  

submitted by welpdedelp(227),

She met the Centor criteria for empiric antibiotics, why was is culture?

tinylilron  I think that if you do a rapid test for group A strep if it is negative you have to follow it up with a throat culture... I remember this from my pediatric rotation... the culture is supposed to be more sensitive(?) than the rapid test. +