Lily is a 20-year-old student who reported having a sore throat for the past three days and experiencing various related symptoms, including decreased appetite, headaches, and painful swallowing. In addition, it is possible to notice that the patient has a hoarse voice and a runny nose. It is possible to suggest that she suffers from a viral upper respiratory infection (URI), but several additional diagnoses should be suspected (Dains, Baumann, & Scheibel, 2012).
When assessing the patient’s health history, it is important to collect information about previous instances of bronchitis, allergies, immune incompetence, asthma, and inquire about the patient’s cigarette smoking habit because it is easier to develop lower respiratory infections and influenza with those predispositions (Seller & Symons, 2012). If the patient’s medical history also shows previous instances of sinusitis, it will more likely occur as a result of complications in viral infections (Seller & Symons, 2012).
Several examinations and tests should be implemented to test the patient’s condition to exclude several potential diagnoses. For example, with her symptoms, Lily could suffer from viral pharyngitis, inflammatory sore throat, mononucleosis, aphthous stomatis, and acute sinusitis. Aphthous stomasis is a possible diagnosis because the symptoms are present, but an inspection of the mouth is required to identify the presence of lesions with yellow membranes and red halos (LeBlond, Brown, & DeGowin, 2009).
Sinusitis should be tested because the postnasal drip indicates potential complications caused by URI. However, an inspection of the nasal mucosa should be performed because the presence of purulent discharge suggests the presence of sinusitis. The pharynx should also be inspected because it is mostly pale, boggy, and swollen in patients with viral infections. While mononucleosis generally has a slower onset of symptoms and a mild fever, it is still not possible to discard it, and Lily should undergo palpation of the abdomen and the cervicofascial lymph nodes.
A presence of splenomegaly and enlarged posterior cervical nodes indicates a presence of mononucleosis, and a complete blood cell count with differential is required because a presence of 10 percent atypical lymphocytes would confirm the diagnosis. A nasal cytology can be performed by obtaining a nasal smear, which should be included in the assessment to identify potential allergic reactions or inflammation processes (Dains et al., 2012).
References
Dains, J., Baumann, L., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (4th ed.). St. Louis, MO: Elsevier Mosby.
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin's diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.
Seller, R. H., & Symons, A. B. (2012). Differential diagnosis of common complaints (6th ed.). Philadelphia, PA: W. B. Saunders Company.
