RepliesInstructions-Week1.docx

Case Scenario:

 A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.

Instructions:

Please read the Case Scenario (see above) and respond to two of your colleagues and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not.
**minimum of three (3) scholarly references are required for each reply cited within the body of the reply & at the end**

Reply # 1

Daivonna Graves 
Top of Form
There are a number of factors that attempt to explain how or why some children are more susceptible to strep throat. Although strep throat is very common and most times easily treatable, it has been discovered anatomy plays a significant role in the genetics of the disease. Tonsils are the two lymph nodes at the rear of the mouth that serve as defense mechanisms to prevent infections. Swelling is one of the first indicators of potential bacteria invasion such as the patient presenting with 3+ enlargement. In addition to adenopathy, white exudate on tonsils and soreness for 3 days is familiar presentation of a streptococcus infection. “Tonsils vary widely in size and swell in response to infection” (Hoffman, 2020). The smaller the pockets covering the tonsils, the more likely an infection will occur.   “Genetic testing revealed two specific genetic variants in the HLA region, which determines how pathogens interact with the immune system, that were associated with increased susceptibility to recurrent tonsillitis and one that protected against the disease” (Jolla, 2019). The primary physician wrote for amoxicillin resulting in an allergic reaction necessitating emergency interventions. The cells involved in anaphylactic reaction are IgE antibodies. Characteristics impacting diagnosis approach would be age. “Group A strep pharyngitis can occur in people of all ages. It is most common among children 5 through 15 years of age. It is rare in children younger than 3 years of age” (CDC, 2018).

References

CDC. (2018, November 1). Pharyngitis (Strep Throat). Retrieved from Centers for Disease Control: https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html#:~:text=to%205%20days.-,Risk%20Factors,than%203%20years%20of%20age.
Hoffman, M. (2020, June 28). Picture of the Tonsils. Retrieved from WebMD: https://www.webmd.com/oral-health/picture-of-the-tonsils
Jolla, L. (2019, February 6). Why Your Kid’s Strep Throat Keeps Coming Back. Retrieved from Science Daily: https://www.sciencedaily.com/releases/2019/02/190206144503.htm

Reply # 2

Erica Elder 

Top of Form
The patient is presenting with signs and symptoms of an anaphylactic reaction to the antibiotics.  This immediate reaction to the amoxicillin is an IgE mediated response with an incidence of occurring 0.02%-0.04% of the time (Patterson, 2020).  The incidence of anaphylaxis overall is estimated to range from 2-50 per 100,000 persons with a lifetime prevalence of less than 2% (Maker, 2019).  Anaphylaxis is considered a type I reaction where IgE antibodies bind to mast cells and trigger the release of mediators such as histamine, tryptase, carboxypeptidase A, proteoglycans, and leukotrienes to cause vasodilation and increased capillary permeability.  This IgE mediated reaction occurs from the result of IgE binding to Fc-epsilon-RI IgE receptors on mast cells and basophils (Maker, 2019).  This binding leads to mast cell degranulation and the release of various mediators, enzymes, and cytokines that cascade to trigger the signs and symptoms of anaphylaxis (Maker, 2019).  Histamine and tryptase are preformed mediators that are stored in the secretory granules of mast cells that are released during mast cell degranulation (Maker, 2019).  When histamine is released it can bind to four types of receptor sites: H1, H2, H3, and H4 (Maker, 2019).  The H1 and H2 receptors signal the following systemic effects: bronchoconstriction, tachycardia, hypotension, and flushing. Platelet activating factor is also released by the degranulation of mast cells, which directly increases bronchial epithelial inflammation, bronchoconstriction, and bronchial hyper-reactivity (Maker, 2019).  Prostaglandin D2 is also released during mast cell degranulation; and is a bronchoconstrictor, pulmonary and coronary vasoconstrictor, and a peripheral vasodilator (Peavy, 2008).  Leukotrienes also produce bronchoconstriction, increase vascular permeability, and promote airway remodeling (Peavy, 2008).  The inflammatory cytokine, tumor necrosis factor-a, is released as a performed mediator; it activates neutrophils, recruits other effector cells, and enhances chemokine synthesis (Peavy, 2008).  All of these overlapping and synergistic physiological effects contribute to the overall pathophysiology of anaphylaxis (Peavy, 2008).
 
References
Maker, J. H., Stroup, C. M., Huang, V., & James, S. F. (2019). Antibiotic Hypersensitivity Mechanisms. Pharmacy (Basel, Switzerland), 7(3), 122. https://doi.org/10.3390/pharmacy7030122
Patterson, R. A. (2020, August 14). Penicillin Allergy. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK459320/#:~:text=Approximately%2010%25%20of%20patients%20report,the%20most%20commonly%20reported%20reaction.
Peavy, R. D., & Metcalfe, D. D. (2008). Understanding the mechanisms of anaphylaxis. Current opinion in allergy and clinical immunology, 8(4), 310–315. https://doi.org/10.1097/ACI.0b013e3283036a90
Bottom of Form
Bottom of Form

Case

Scenario

:

A

16

–

year

–

old

boy

comes

to

clinic

with

chief

complaint

of

sore

throat

for

3

days.

Denies

fever

or

chills.

PMH

negative

for

recurrent

colds,

influenza,

ear

infections

or

pneumonias.

NKDA

or

food

allergies.

Physical

exam

reveals

temp

of

99.6

F,

pulse

78

and

regular

with

respirations

of

18.

HEENT

normal

with

exception

of

reddened

posterior

pharynx

with

white

exudate

on

tonsils

that

are

enlarged

to

3+.

Positive

anterior

and

posterior

cervical

adenopathy.

Rapid

strep

test

performed

in

office

was

positive.

His

H

CP

wrote

a

prescription

for

amoxicillin

500

mg

po

q

12

hours

x

10

days

disp

#20.

He

took

the

first

capsule

when

he

got

home

and

immediately

complained

of

swelling

of

his

tongue

and

lips,

difficulty

breathing

with

audible

wheezing.

911

was

called

and

he

was

taken

to

the

hospital,

where

he

received

emergency

treatment

for

his

allergic

reaction.

Instructions:

Please read the Case Scenario (see above) and r

espond

to two

of your

colleagues

and respectfully

agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation,

include why their explanations make physiological sense or why they do not

.

**minimum of three

(3)

scholarly references are required for each reply

cited

within the body of the reply & at the end

**

Reply

#

1

Daivonna

Graves

There are a number of factors that attempt to explain how or why some children are more susceptible to strep throat.

Although strep throat is very common and most times easily treatable, it has been discovered anatomy plays a significant role

in the

geneti

cs of the disease. Tonsils are the two lymph nodes at the rear of the mouth that serve as defense mechanisms to prevent

infections. Swelling is one of the first indicators of potential bacteria invasion such as the patient presenting with 3+ enl

argement. I

n

addition to adenopathy, white exudate on tonsils and soreness for 3 days is familiar presentation of a streptococcus infectio

n. “Tonsils

vary widely in size and swell in response to infection”

(Hoffman, 2020). The smaller the pockets covering the tonsils

, the more likely

an infection will occur.

“Genetic testing revealed two specific genetic variants in the HLA region, which determines how pathogens

interact with the immune system, that were associated with increased susceptibility to recurrent tonsilli

tis and one that protected

against the disease”

(Jolla, 2019). The primary physician wrote for amoxicillin resulting in an allergic reaction necessitating

emergency interventions. The cells involved in anaphylactic reaction are IgE antibodies. Characterist

ics impacting diagnosis approach

would be age. “Group A strep pharyngitis can occur in people of all ages. It is most common among children 5 through 15 years

of

age. It is rare in children younger than 3 years of age”

(CDC, 2018).

References

CDC. (2018, N

ovember 1).

Pharyngitis (Strep Throat)

. Retrieved from Centers for Disease Control:

https://www.cdc.gov/groupastrep/diseases

–

hcp/strep

–

throat.html#:~:text=to%205%20days.

–

,Risk%20Factors,than%203%20years%20of%20age.

Case Scenario:

A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever
or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or
food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of
18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils
that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. Rapid strep test
performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12
hours x 10 days disp #20. He took the first capsule when he got home and immediately
complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911
was called and he was taken to the hospital, where he received emergency treatment for his
allergic reaction.

Instructions:
Please read the Case Scenario (see above) and respond to two of your colleagues and respectfully
agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation,
include why their explanations make physiological sense or why they do not.
**minimum of three (3) scholarly references are required for each reply cited
within the body of the reply & at the end**

Reply # 1
Daivonna Graves
There are a number of factors that attempt to explain how or why some children are more susceptible to strep throat.
Although strep throat is very common and most times easily treatable, it has been discovered anatomy plays a significant role in the
genetics of the disease. Tonsils are the two lymph nodes at the rear of the mouth that serve as defense mechanisms to prevent
infections. Swelling is one of the first indicators of potential bacteria invasion such as the patient presenting with 3+ enlargement. In
addition to adenopathy, white exudate on tonsils and soreness for 3 days is familiar presentation of a streptococcus infection. “Tonsils
vary widely in size and swell in response to infection” (Hoffman, 2020). The smaller the pockets covering the tonsils, the more likely
an infection will occur. “Genetic testing revealed two specific genetic variants in the HLA region, which determines how pathogens
interact with the immune system, that were associated with increased susceptibility to recurrent tonsillitis and one that protected
against the disease” (Jolla, 2019). The primary physician wrote for amoxicillin resulting in an allergic reaction necessitating
emergency interventions. The cells involved in anaphylactic reaction are IgE antibodies. Characteristics impacting diagnosis approach
would be age. “Group A strep pharyngitis can occur in people of all ages. It is most common among children 5 through 15 years of
age. It is rare in children younger than 3 years of age” (CDC, 2018).
References
CDC. (2018, November 1). Pharyngitis (Strep Throat). Retrieved from Centers for Disease Control:
https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html#:~:text=to%205%20days.-
,Risk%20Factors,than%203%20years%20of%20age.