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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #29

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Have a child with nausea, vomiting and/or a “stomach ache?”

Examine their pharynx and order a rapid strep. These are atypical symptoms in pediatric patients who have strep, especially under the age of 5.

I couldn’t tell you how many times a mother has brought their child into the urgent care complaining of nausea and vomiting and when I looked at the pharynx, there was erythema, exudate, and tonsillar swelling which resulted in a positive rapid strep test.

The same thing goes with “stomach ache.” I have seen the complaint of “stomach ache” result in a strep diagnosis countless times. As long as the child does not exhibit significant abdominal findings on exam, then strep can cause a “stomach ache” in pediatric patients.

So, always look at the pharynx when you have a pediatric patient complaining of N+V and abdominal pain. Sometimes you will find your diagnosis!

As always, use your clinical judgement.

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