Let’s talk URI and importance of hx

[GetMeOuttaThisMess]

Since I make my living with snot/cough daily I would like some input on whether others take this particular presentation into consideration?
 
It is my opinion that benign URI pts have a rollercoaster characteristic to their historical presentation over a 24 hour period. This is attributed to the variable nature of the degree of PND and its inherent acidic property. Conversely, people with primary tonsillitis/pharyngitis/pneumonia will have a less variable sx presentation and will in fact be somewhat constant, regardless of time of day.
 
This being said, I’m starting to employ this variable when using Centor to assist with odynophagia, especially during colder months.
 
Discuss.

[lkth487]

[citation needed]

 

Haven't noticed it myself, but then I haven't been looking for it. 

[thinkertdm]

2 hours ago, GetMeOuttaThisMess said:

 

Since I make my living with snot/cough daily I would like some input on whether others take this particular presentation into consideration?

 

It is my opinion that benign URI pt’s have a rollercoaster characteristic to their historical presentation over a 24 hour period. This is attributed to the variable nature of the degree of PND and its inherent acidic property. Conversely, people with primary tonsillitis/pharyngitis/pneumonia will have a less variable sx presentation and will in fact be somewhat constant, regardless of time of day.

 

This being said, I’m starting to employ this variable when using Centor to assist with odynophagia, especially during colder months.

 

Discuss.

 

Nice observation.  I think the centor could be more quantified for many variables, but for yours in particular, I have found most patients exaggerate their symptoms in the hopes of getting antibiotics that most, if not all of the history should be taken with a grain of salt.  Additionally, most people clump their symptoms as "all or none", and getting most to focus on the past 24 hours would difficult, even for skilled interrogators.

[GetMeOuttaThisMess]

The rationale for the observation is what is a variable that would account for variability of pt sx over a 24 hr period? I would argue that a primary process should be somewhat constant regardless of timing of the day. The two most prominent times of discomfort are early morning and late evening, both of which are dependent on patient positioning (supine and upright respectively). These pts I’ve observed are more likely to have either a cobblestone throat (see Google images) or a single linear midline erythematous streak consistent with drainage. Relief for these folks is nocturnal antacid elixir (2 swallows hs).

[thinkertdm]

Maybe it's due to the type of cells in each area and their response to infection; cells in the nasopharynx secrete mucous when inflamed, those in the throat don't.  Body position allows drainage and perhaps temporary relief.  

Can this be used to differentiate between viral and bacterial, though- I suppose if the onset is variable, suggesting my goofy scheme, then a nasopharyngeal source might be the focus.  I thought I read somewhere that pharyngitis with other uri symptoms- rhinosinusitis, etc- makes strep less likely.  Can't remember where.

Incidentally, how fast does cobblestoning develop?  I've always attributed it to chronic irritation, like reflux or post nasal drip from chronic rhinitis, not necessarily from an acute etiology.  I also had an excellent resident tell me that enlarged papillae on the posterior tongue indicates inflammation as well, mostly in smokers and gerd.

I'm not sure if this makes any sense, I'm just free thinking at Sam's now.

[DogLovingPA]

Agreed.  As soon as a patient tells me that their throat only hurts in the morning (or other specific time of day) I almost immediately discount strep as a possibility.