Outpatient Clinic

Outpatient clinic

• • • • •

History. Examination. Investigations. Prescription. Communication skills.

History • • • • • •

Full Concise Most probably affected system Most probable disease Complications of this disease Drug intake

Examination • • • •

Thorough Suitable place Suitable equipments Targeted

Investigations • Consult!!!

Prescriptions

Communication skills • Attitude • Terminology – Localities – Common concept

• Pharyngitis is an inflammatory illness of the mucus membrane and underlying structures of the throat. • It includes: – – –

Tonsillitis Tonsillopharyngitis Nasopharyngitis usually viral

Nasopharyngitis Clinical Manifestations: • Chilliness on exposure to cold • Dryness and irritation in the nose and scratchy throat • Nasal obstruction, sneezing, watery discharge, eye irritation, cough • Low grade fever! ! • Infants ! ! !

Nasopharyngitis Physical Examination • • • •

Mostly healthy!! Colour and thickness of discharge In allergic rhinitis → edematous turbinates? colour Pharynx: 3 patterns of viral nasopharyngitrs: 1. Erythema alone

- Rhino viruses - R.S.V - Rotavirus

- Parainfluenza - Influenza

1. Cobblestone or follicular

- Adenovirus

- Some enterovirses

1. vesicular or ulcerative

- Enteroviruses

- Herpes simplex

Nasopharyngitis Treatment • The best : no pharmacologic ttt . – Not working

-Cost

-side effects

• Explanation and assurance • Therapy against the most annoying symptom – Fever and malaise – Rhinorrehea or nasal congestion. – Persistent cough.

Tonsillopharyngitis Bacterial Common Sterptococuus pyogenes

Uncommon Corynebacterium diphtheriae Haemophilus influenza

Tonsillopharyngitis Clinical Manifestations • Onset: usually sudden with fever, sore throat and anorexia. • Headache, nausea, vomiting, abdominal pain !! • Cervical L.N. are enlarged and tender. • May be follicles, ulcers, petechiae and generalized exudate.

Tonsillopharyngitis Viral or Bacterial • • • • •

Nasal infection Ulceration viral Conjunctivitis Child under 4 Y, no exudate Child older than 4 Y, pharyngitis with exudate or fever is most likely caused by S. Pyogenes.

Tonsillopharyngitis Treatment • Symptomatic relief – Drinking warm fluids – Saltwater gargle – Analgesic if discomfort is troublesome •

Paracetamol 10mg/kg/dose 4-6 hourly.

– Decongestants and antihistamines, no place. • Antibiotics – Penicillin

-Erythromycine - Cephalosporines.

The only reason that anyone would ever hate you, Is because they want to be just like you.

Infantile crying