CHIEF COMPLAINT: "I have an earache." History of Present Illness:
Johnny B. is a 15-year-old high school student who comes to the office complaining of an earache that has persisted for the last 3 days. His mother says Johnny's forehead felt hot at home, but she did not have a thermometer to check his temperature. He has a decreased appetite and a runny nose with clear to yellow drainage. He has been sneezing but not coughing. Some of his classmates are sick with similar symptoms.
Johnny is healthy. He has never had surgery, and he does not smoke.
What parts of the exam would you like to perform? (Circle the appropriate areas.
General Survey Breasts and Axillae
Vital Signs Female Genitalia
Skin Male Genitalia
Thorax and Lungs Peripheral Vascular/ Extremities
Abdomen Nervous System
What physical findings are you looking for to help determine the diagnosis?
These are the actual findings on physical examination:
Thorax and Lungs
Alert, interactive, well-nourished adolescent; appears mildly ill
BP 100/60 mm Hg; HR 80 bpm and regular; respiratory rate 24 breaths/min; temperature 100.5°F
Pupils equal, round, and reactive to light and accommodation; constrict from 4 mm to 2 mm Disc margins sharp; fundi without hemorrhages or exudates
External ear canals patent, with small amount of cerumen bilaterally
Right tympanic membrane red and bulging; left tympanic membrane dull
Nasal mucosa pink
Oral mucosa pink without enlarged tonsils; pharynx is without exudates
Supple, with spotty anterior cervical adenopathy; no thyromegaly
Thorax symmetric, with good expansion Lungs resonant; breath sounds vesicular
JVP 7 cm above the right atrium; carotid arteries brisk, without bruits
PMI tapping and nondisplaced
Good Sj, S2; no S3 , S4; no murmurs, rubs, or clicks
Based on this information, what is your differential diagnosis?
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