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An Understated Myth? Strep Throat & Rheumatic Fever

Sore throat (aka, pharyngitis) is the 3rd most common complaint for physician visits.  Although the overwhelming majority of these cases are viral in origin (rhinovirus ~20%), the major focus of our attention in the ED stems around the question of “strep (GAS) vs not strep” and who gets antibiotics…. does anyone need antibiotics? And what about rheumatic fever?

em@3am

EM@3AM: Back Pain

A 59-year-old man presents to the ED for acute onset low back pain that started immediately after he moved furniture. He states his lumbar pain has been unrelenting, with mild pain radiating to down both legs.  He appears in pain and has mild midline and bilateral paraspinal tenderness to palpation over his lumbosacral spine.  He has bilateral loss of strength in the distal lower extremities, notably in dorsiflexion.  What diagnoses should you consider?