Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Pharyngitis Pheochromocytoma 1165

■Culture for gonorrhea and test for acute HIV if epidemiologic suspi-

cion

differential diagnosis

■Diphtheria (membrane present), parapharyngeal and retropharyn-

geal abscesses (bulging of posterior or lateral pharyngeal wall),

epiglottitis (severe sore throat, hoarseness, stridor, drooling with

minimal findings on exam-exclude by direct visualization of epiglot-

tis) and foreign body (especially infants and children)

management

■Supportive care – rest, analgesics (ibuprofen, acetaminophen), fluids

specific therapy

■For group A streptococcus, penicillin or amoxicillin for 10 days (ery-

thromycin for the penicillin allergic patient) or benzathine penicillin

(single dose)

■See gonorrhea for therapy of GC pharyngitis

follow-up

■Symptoms resolve in 2–3 days

■Follow-up cultures NOT recommended for test of cure

complications and prognosis

■Pyogenic complications include peritonsillar, retropharyngeal and

parapharyngeal abscesses

■Nonpyogenic complications include rheumatic fever (preventable

if infection treated within 10 days of onset) and glomerulonephritis

(not prevented with therapy)

■Penicillin prophylaxis indicated for patients with rheumatic fever

PHEOCHROMOCYTOMA

RICHARD I. DORIN, MD

history & physical

History

■Headaches, paroxysms

■Adrenergic excess: tachycardia, excessive sweating

■Hypermetabolism: fever, weight loss

■Hypertension, stable or paroxysmal

■Chest or abdominal pain