Diagnosis of Gastroesophageal Reflux Disease
Diagnostic Test list for Gastroesophageal Reflux Disease:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Gastroesophageal Reflux Disease
includes:
Gastroesophageal Reflux Disease Diagnosis: Book Excerpts
Tests and diagnosis discussion for Gastroesophageal Reflux Disease:
If your heartburn does not improve with lifestyle changes or drugs, you
may need additional tests.
- A barium swallow radiograph uses x rays to help spot
abnormalities such as a hiatal hernia and severe inflammation of the
esophagus. With this test, you drink a solution and then x rays are
taken. Mild irritation will not appear on this test, although narrowing
of the esophagus--called strictures--ulcers, hiatal hernia, and other
problems will.
- Upper endoscopy is more accurate than a barium swallow
radiograph and may be performed in a hospital or a doctor's office. The
doctor will spray your throat to numb it and slide down a thin, flexible
plastic tube called an endoscope. A tiny camera in the endoscope allows
the doctor to see the surface of the esophagus and to search for
abnormalities. If you have had moderate to severe symptoms and this
procedure reveals injury to the esophagus, usually no other tests are
needed to confirm GERD.
The doctor may use tiny tweezers
(forceps) in the endoscope to remove a small piece of tissue for biopsy.
A biopsy viewed under a microscope can reveal damage caused by acid
reflux and rule out other problems if no infecting organisms or abnormal
growths are found.
- In an ambulatory pH monitoring examination, the doctor puts a
tiny tube into the esophagus that will stay there for 24 hours. While
you go about your normal activities, it measures the amount of and when
acid comes up into your esophagus. This test is useful in people with
GERD symptoms but no esophageal damage. The procedure is also helpful in
detecting whether respiratory symptoms, including wheezing and coughing,
are triggered by reflux.
(Source: excerpt from
Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD): NIDDK)
Diagnosis of Gastroesophageal Reflux Disease: medical news summaries:
The following medical news items
are relevant to diagnosis and misdiagnosis issues for Gastroesophageal Reflux Disease:
Diagnostic Tests for Gastroesophageal Reflux Disease: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about diagnostis of Gastroesophageal Reflux Disease.
SORE THROAT:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Are there exudates? This is a key question when evaluating a sore throat. Most cases of sore throat with exudates will be found to have streptococcal pharyngitis. Without exudates, one could still have a streptococcal sore throat, but it is less likely.
- Is there a temperature elevation? A significant elevation of the temperature, with or without exudates, is also characteristic of streptococcal pharyngitis.
- Are there enlarged lymph nodes? If the lymph nodes are enlarged in the peritonsillar area, this is often a sign of streptococcal sore throat, but it certainly is not diagnostic. Interestingly enough, 90% of patients with infectious mononucleosis have posterior cervical adenopathy.
- Are there systemic symptoms and signs? Patients who present with exudative tonsillitis and splenomegaly certainly should be considered to have infectious mononucleosis until proven otherwise. Also, an exudative tonsillitis along with a fever and heart murmur should make one consider rheumatic fever. Systemic symptoms such as dry cough, runny nose, and generalized malaise or fatigue should make one think of a viral URI.
DIAGNOSTIC WORKUP
In a sore throat with typical exudates very suggestive of streptococcal pharyngitis, a throat culture may be all one needs before starting definitive antibiotic therapy. In the more difficult cases, screening for streptococcal antigens (streptozyme test and ASO titer) might be indicated. An ASO titer is particularly important when one suspects rheumatic fever. If the patient's streptococcal sore throat persists, a Monospot test and a culture for gonorrhea should be done. Although there are hardly any false-negative Monospot tests, there are 10% false positives, and that should be kept in mind. A blood smear for atypical lymphocytes may be helpful, as well as a heterophile antibody titer in those cases.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Sore Throat:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Viral pharyngitis/laryngitis
–Most common cause of sore throat
–Associated with cough, low-grade fever,
nasal congestion, and sneezing
–Influenza occasionally causes sore throat
with high fever, cough, severe myalgias
–Rhino-, adeno-, coxsackie-, and herpesvirus
–Acute HIV infection
- Mononucleosis
–Associated with fever, headache, and
excessive fatigue
–Most common in teen and college ages
–May have associated lymphadenopathy,
splenomegaly, hepatitis, or encephalitis - Streptococcal pharyngitis
–May be associated with scarlatiniform rash, fever >101°F (>38.3°C), exudative pharyngitis, tender cervical lymphadenopathy, and absence of cough
–More common in winter months, ages 5–10, and with history of group A Streptococcus exposure
-
Allergic pharyngitis
-
Gonococcal pharyngitis
-
Fungal pharyngitis (e.g., Candida)
-
Foreign body in throat
–Most often occurs in smaller children
–Associated with sudden onset of audible
wheezing, stridor, drooling
-
GERD
-
Sore throat secondary to postnasal drip
-
Irritation secondary to inhalants (e.g., cigarette smoke), chemicals (e.g., alcohol), hot foods
-
Voice abuse (e.g., excessive screaming)
-
Deep neck space infections (e.g., retropharyngeal abscess, peritonsillar abscess, Ludwig's angina)
-
Epiglottitis/bacterial tracheitis
–Occurs in children ages 2–7 and
increasingly in adults
-
Diphtheria
-
Trauma
-
Lymphadenitis (cervical)
-
Cancer (e.g., tonsillar, tongue, laryngeal, esophageal)
-
Caustic ingestions
-
Thyroiditis
-
Angina/acute coronary syndrome
Workup and Diagnosis
- History and physical exam often make the diagnosis
–Consider exposure history, age, associated symptoms, past medical history (e.g. immunocompromise), use of inhaled steroids (e.g. with Candida pharyngitis), allergy history)
–Focus on head and neck, lung, and abdominal
examinations
- Streptococcal pharyngitis is often a clinical diagnosis
–Presence of three out of four of the following criteria suggests the diagnosis: Exudative pharyngitis (not just a red throat); tender anterior lymphadenopathy; presence or history of fever; and absence of a cough; whereas if none or one of the criteria exists, group A β-hemolytic streptococcus is unlikely
–Streptococcal culture is the gold standard (inexpensive; identifies group A and others; 1–2 days for results)
–Rapid strep testing is more expensive and identifies only group A strep, but gives immediate results; very specific (95%) but less sensitive (60–70%), so consider culture if negative
-
Monospot or CBC showing atypical lymphocytes is diagnostic for mononucleosis
-
X-ray for foreign body; laryngoscopy if unable to verify
-
Lateral neck X-ray may diagnose epiglottitis and retropharyngeal abscess
-
Gonococcal and diphtheria cultures if necessary
-
Barium swallow, upper GI series, or EGD for GERD
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Sore Throat:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
Infectious
–Viral
–Adenovirus
–Rhinovirus
–Parainfluenza
–Influenza
–Coronavirus
–Others: EBV RSV, CMV, HSV
–Bacterial
–Streptococcus
–Haemophilus
–Moraxella
–Staphylococcus
–Corynebacterium
–Fungal
–Candida
-
Inflammatory
–Allergy
–Gastroesophageal reflux disease
–Sinusitis resulting in postnasal drainage
-
Tumors
–Leukemia
–Rhabdosarcomas
–Squamous cell carcinoma secondary to oral
ulcerations
-
Trauma
–Foreign body ingestion
–Caustic ingestion
–Soft tissue injury from accidental and
nonaccidental trauma
-
Systemic/rheumatologic disorders
–Kawasaki disease: Mucocutaneous lymph node syndrome may have sore throat at presentation (other oral findings include strawberry tongue, fissured lips, mucosal erythema, fever, and lymphadenopathy)
–Behçet syndrome
–Reiter syndrome
- Others
–Cigarette smoke
–Environmental pollutants
–Pharyngeal drying: Mouth and pharynx can
be dry from mouth breathing, more common in the winter months
Workup and Diagnosis
History
–Duration, onset, severity, frequency, odynophagia, dysphagia, daycare, sick contacts, fever, malaise, headache
–Foreign body and caustic ingestion
–Days of school or work missed
–Immunization history
–Medical history: Systemic disease, connective tissue
disorder
-
Physical exam
–Nasal exam: Evidence of rhinosinusitis
–Mouth: Ulcerations, masses, tonsil size, erythema,
exudates
–Neck: Lymphadenopathy
–Skin: Rash
–Chest: Wheezes, asymmetry
-
Studies
–For pharyngitis: A major goal is to differentiate streptococcal pharyngitis from viral etiologies
–Throat culture: 92% sensitive; 100% specific; requires
24–48 hours
–Rapid strep test: 72–85% sensitive; 88–100% specific
–CBC with differential for suspected mononucleosis
–Chest X-ray (inspiratory and expiratory) for suspected
foreign body
–CT neck: When complication of infection is suspected such as abscess
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
SORE THROAT:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
In diagnosing the cause of sore throat, it has been traditional to do a throat culture and possibly a CBC and differential and start the patient on penicillin until the culture comes back. Now Abbott Laboratories (Abbott Park, IL, U.S.A.) has developed a rapid Streptococcus agglutination test on a throat swab. In resistant cases, repeated cultures (especially for diphtheria, gonorrhea, and Listeria organisms) and a monospot test will be useful. Because the titer for infectious mononucleosis may not be high initially, the differential test (Paul–Bunnell) or a repeated monospot test 1 to 3 weeks later may be necessary. Remember that subacute thyroiditis may present as a sore throat.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Dyspepsia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, a cough, or chest pain? Ask if he's taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed a change in the amount or color of his urine?
Ask the patient if he's experiencing an unusual or overwhelming amount of emotional stress. Determine the patient's coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate the patient's level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of the lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Gastroesophageal reflux:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
CONFIRMING DIAGNOSIS After a careful history and physical examination, tests to confirm GERD include barium swallow fluoroscopy, esophageal pH probe, esophageal manometry, and esophagoscopy. In children, barium esophagography under fluoroscopic control can show reflux.
Recurrent reflux after age 6 weeks is abnormal. An acid perfusion (Bernstein) test can show that reflux is the cause of symptoms. Finally, endoscopy and biopsy allow visualization and confirmation of any pathologic changes in the mucosa.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Dyspepsia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do any drugs or activities relieve or aggravate it? Has the patient had nausea, vomiting, melena, hematemesis, cough, or chest pain? Ask if he’s taking any prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed any change in the amount or color of his urine?
Ask the patient if he’s experiencing an unusual or overwhelming amount of emotional stress. Determine the patient’s coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect it for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate it for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting any tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Sore Throat:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Rhinovirus
❑ Group A streptococci
❑ Ebstein-Barr virus
❑ Adenovirus
❑ Influenza
❑ Candida/thrush
❑ Herpes simplex virus
❑ Peritonsillar abscess
❑ Mycoplasma pneumoniae
❑ Coxsackievirus
❑ Primary HIV
❑ Neisseria gonorrhea
❑ Epiglottitis
❑ Corynebacterium diphtheriae
❑ Leukemia
Diagnostic Approach
The most important consideration is whether the patient has a group A strep infection because prompt treatment prevents rheumatic fever. The findings of fever, tender anterior cervical adenopathy, and tonsillar exudate can be combined to make the diagnosis more or less likely. Rapid antigen tests have a sensitivity of 80% to 90% and specificity of 95% to 100%, so give a reasonably accurate diagnosis. Because of limitations in sensitivity however, patients with a high suspicion on clinical grounds should have a backup culture taken.
Prior probability in an adult population with sore throat is 5% to 10%, and in a pediatric population 20% to 25%. A prominent sore throat out of proportion to the degree of pharyngeal inflammation should raise the possibility of acute epiglottitis and acutely impending airway compromise. Persistent unilateral tonsillar enlargement in a young adult without sore throat should raise the suspicion of lymphoma.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Gastroesophageal reflux:
Diagnosis
(Handbook of Diseases)
After a careful history and physical examination, tests to confirm gastroesophageal reflux include barium swallow fluoroscopy, esophageal pH probe, endoscopy, and esophagoscopy. In children, barium esophagography under fluoroscopic control can show reflux. Recurrent reflux after age 6 weeks is abnormal.
An acid perfusion (Bernstein) test can show that reflux is the cause of symptoms. Degree of reflux may be determined with 12- to 36-hour esophageal pH monitoring. Finally, endoscopy and a biopsy allow visualization and confirmation of pathologic changes in the mucosa.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Dyspepsia:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do any drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, cough, or chest pain? Ask if he’s taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed any change in the amount or color of his urine?
Ask the patient if he’s experiencing an unusual or overwhelming amount of emotional stress. Determine the patient’s coping mechanisms and their effectiveness.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Sore Throat:
Clinical Features and Diagnosis
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Infection
Pharyngitis/Tonsillitis
Viral
Severalviruses may cause pharyngitis/tonsillitis, including parainfluenzaviruses, influenza viruses, rhinoviruses, coronaviruses, and respiratorysyncytial virus. Coryza and cough predominate, whereas fever isvariable finding. Nasal wash cultures are diagnostic but usuallyunnecessary for management.Enteroviruses also may cause sore throatand fever, especially in summer months, but tonsillar exudate isunusual.Herpanginais characterized by fever and painful vesicular lesions on pharynxand tonsils.Coxsackie A16 is major cause of hand-foot-mouthdisease, which is characterized by vesicular lesions in the mouthand on hands and feet.
Herpes simplex virus produces acutegingivostomatitis with fever and painful vesicles usually confinedto anterior mouth. However, lesions may extend to anterior tonsillarpillars.Epstein-Barr virus is common causeof sore throat in adolescents. Other characteristic findings ofinfectious mononucleosis include fever, malaise, fatigue, cervicalor generalized lymphadenopathy, and hepatosplenomegaly. >10% atypicallymphocytes are usually seen on blood smear. Positive mono spottest, which identifies immunoglobulin M (IgM) heterophile antibody,is diagnostic. When this test is negative, IgG and IgM antibodyagainst viral capsid antigen (VCA) should be determined. Presenceof IgM-VCA is associated with recent or current illness and confirmsdiagnosis, whereas IgG-VCA is present continuously after acute infection.Adenovirus may cause pharyngoconjunctivalfever. Follicular hyperplasia of tonsils and exudate may be seen. Bacterial
Group A Streptococcus
Most commonbacterial cause of pharyngitis/tonsillitis is group A Streptococcus.Classic clinical presentation is school-agedchild with acute onset of fever and sore throat. Headache, abdominalpain, and vomiting also may occur. Rhinorrhea, cough, conjunctivitis,hoarseness, and diarrhea are unusual. Tonsils are enlarged and inflamed,with patches of exudate. Petechiae may sometimes be seen on palate.Anterior cervical lymph nodes may beenlarged on 1 or both sides and are often tender.Usual clinical dilemma is to distinguishbetween viral infection or group A streptococcal infection. Difficultto distinguish them clinically, except when typical erythematoussandpaper-like rash of scarlet fever occurs, which signifies infectionwith group A Streptococcus.Rapid techniques are now availablefor detection of streptococcal antigen. Either rapid antigen testor throat culture should be performed if streptococcal pharyngitisis suspected. If antigen assay is negative, throat culture shouldbe obtained. Other Bacteria
Pharyngitiscaused by group C or G Streptococcus is indistinguishable from that causedby group A Streptococcus.A. hemolyticum produces illness similarto group A Streptococcus. Scarlet fever–like rash occursmost often in adolescents, but strawberry tongue and palatal petechiaehave not been described.N. gonorrhoeae pharyngitis can occurin sexually active adolescents as consequence of oral-genital contact.Ulceration of pharynx and tonsils along with exudate may be seen.Its presence in younger children suggests sexual abuse.M. pneumoniae is uncommon cause ofpharyngitis, whereas C. diphtheriae is rare cause of pharyngitis.With the latter infection, acute onset of fever and sore throatis followed in 1–2 days by grayish membrane over pharynxand tonsils, which may extend into larynx and trachea.Positive throat culture confirms diagnosisof these pathogens. Peritonsillar, Retropharyngeal, and Lateral Pharyngeal Abscesses
Generallydue to spread of infection from local sites.Most common pathogens are aerobes (groupA Streptococcus, S. aureus, H. influenzae) and anaerobes (Peptostreptococcus,Fusobacterium, Prevotella, Porphyromonas species), although manyinfections are polymicrobial.Peritonsillar abscess generally occursas complication of acute bacterial tonsillitis in older childrenand adolescents. Sore throat, fever, pain on swallowing, drooling,and trismus characterize this infection. Ipsilateral otalgia alsomay occur. Swollen inflamed tonsil has fluctuant quality and oftenpushes uvula across midline of oral cavity. Diagnosis is clinical,although specific pathogen can be cultured from infected tonsilor abscess drainage.Although retropharyngeal abscess/cellulitisis uncommon cause of sore throat, it usually occurs in children <4yrs. Most children appear toxic and are in respiratory distress,but some complain of sore throat and painful swallowing early incourse. Often direct visualization is impossible and lateral neck radiographyshows bulge of posterior pharyngeal wall. If diagnosis is uncertain,CT can be performed.Lateral pharyngeal abscess usuallypresents with fever and trismus as well as swelling and tendernessbelow mandible. CT is helpful in determining extent of abscess. Irritants
Upon awakeningin morning, otherwise well child may have scratchy sore throat, whichusually improves over several hours. This sensation is usually dueto dryness of pharynx and frequently occurs with rhinitis, especiallyduring winter months when humidity is low and mouth breathing islikely because of nasal congestion.Exposure to dust or smoke also maycause irritation of pharynx.Postnasal drip secondary to allergicrhinitis or sinusitis also may cause pharyngeal irritation and mildsore throat. Trauma
Excessiveuse of voice due to prolonged shouting or singing may cause sore throat.Burn secondary to exposure of hot gasesor liquid also may cause pharyngeal pain. Foreign Body
Foreignbody lodged in pharynx causes acute onset of choking, dysphagia,and sometimes upper airway obstruction.Commonly, fish bone or chicken bonecan be seen in pharynx. Otherwise, neck radiography may be diagnostic.Only symptom of retained foreign bodyin upper airway may be persistent stridor. In this circumstance,laryngoscopy is usually diagnostic. Caustic Substances
Ingestionof caustic substances may cause inflammation of pharynx.History and physical exam are diagnostic.For suspected esophageal injury, esophagoscopyshould be performed. Psychogenic
Sometimes there does not seem to be explanationfor sore throat after history, physical exam, negative throat culture,and normal neck radiographs. In this case, psychosocial historyis most valuable clinical tool.
Diagnostic Approach
Historyand physical exam provide important clues for proper diagnosis ofsore throat.Most common clinical dilemma in childwith pharyngitis is whether pathogen is virus or group A Streptococcus.Tests to detect streptococcal antigen may be diagnostic, but ifresults of such tests are negative, throat culture should be performed.Because many cases of pharyngitis aredue to viruses, antibiotic use should be guided by antigen detectiontests or culture. Presence of conjunctivitis, cough, rhinitis, andhoarseness suggests viral etiology. Infectious mononucleosis isalso a consideration, especially in older children and adolescents.Neck radiography, flexible laryngoscopy,and CT are useful with suspected foreign body or retropharyngeal/lateralpharyngeal abscess. >
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Dyspepsia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, a cough, or chest pain? Ask if he's taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed a change in the amount or color of his urine?
Ask the patient if he's experiencing an unusual or overwhelming amount of emotional stress. Determine the patient's coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate the patient's level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of the lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
SORE THROAT:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
In diagnosing the cause of sore throat, it has been traditional to do a
throat culture and possibly a CBC and differential and to start the patient
on penicillin until the culture comes back. Now Abbott Laboratories (Abbott
Park, IL) has developed a rapid Streptococcus agglutination test on a throat swab. In
resistant cases, repeated cultures (especially for diphtheria, gonorrhea,
and Listeria organisms) and a monospot test will be useful. Because the titer for
infectious mononucleosis may not be high initially, the differential test
(Paul–Bunnell) or a repeated monospot test 1 to 3 weeks later may be
necessary. Remember that subacute thyroiditis may present as a sore throat.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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