Exam of the throat reveals the tonsils to be hypertrophic and kissing in the midline. The uvula is somewhat deviated to the left. There is erythema of the tonsils bilaterally with a peritonsillar abscess present on the right. The soft palate is bulging somewhat. Nose: The nares are patent with some clear nasal discharge. Ears: There is slight erythema of the tympanic membranes bilaterally. There is a blue collar button tube present in the right tympanic membrane; no tube is present on the left.
He apparently had bilateral myringotomies with insertion of collar button tubes about a year and a half ago. Neck: The neck is supple with no motion tenderness. There are shotty nodes present. Rapid strep was performed and was positive. DIAGNOSES 1. Acute streptococcal pharyngitis. 2. Otitis media. 3. Lymphadenopathy. PLAN A throat culture was obtained. Checking the chart, this boy did have a positive culture about 4 months ago with heavy growth of group A beta hemolytic strep. Mother states he had several episodes like this when he lived in Missouri.
A throat swab was done for C&S. He is allergic to Amoxicillin so will give a course of cephalexin. The mother requested a liquid, and cephalexin oral suspension 12. 5 mg/kg 3 times daily was ordered, this should also help the otitis media. The mom asked about tonsillectomy, and we spent several minutes discussing the criteria for a tonsillectomy. She is to bring the patient in for a re-check on Thursday, or call sooner if there is no improvement. _________________________ Doug Brown, MD DB:as d: 27/05/2013 t: 28/05/2013
The first character we are presented to within the Waste Land is Marie, whose privileged lifestyle and nationality, German, indicated by Eliot’s use of different settings, “Starnbergersee” is used to demonstrate that all of society is negative and his presentation of a society full of despair and isolation is a universal issue. Marie has travelled much of the world and spends her time “in the ...