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- Page navigation anchor for RE: Respiratory presentations during a Covid-19 pandemicRE: Respiratory presentations during a Covid-19 pandemic
The January 4th 2021 CMAJ report of a fatal respiratory diphtheria case in a 69 year-old visitor to Canada, is a sobering reminder of unusual diseases that one needs to consider in primary care medicine. The Key Points included with this article are important, but is there one missing?
A "telemedicine clinic" review advised the patient to present to the Emergency Department immediately; was this the Covid-19 hot-line? If so, the assessing nurse is to be congratulated in recognizing the urgent nature of the patient's symptoms.
A relative presenting to the 811 phone line with a cough, was told to phone her GP, who in turn recommended that she make an appointment with the local hospital Covid clinic for appraisal and get a naso-pharyngeal swab taken; there, the physician's recommendation was to presume a diagnosis of corona virus and to isolate oneself for 14 days.
Over the next few months of persistent cough, this sequence was repeated 3 times (in addition to chest imaging and bloodwork). Eventually, resolution of the coughing bouts occurred within a few hours of prescription of a broncho-dilator.
Like the old adage "all that glitters is not gold", during the pandemic all coughs are not caused by Covid-19, a key point.Competing Interests: None declared.References
- Scott Cholewa, Fareen Karachiwalla, Sarah E. Wilson, et al. Fatal respiratory diphtheria in a visitor to Canada. CMAJ 2021;193:E19-E22.
- Page navigation anchor for RE: oropharyngeal examinationRE: oropharyngeal examination
The complaint of 'something' in the throat hopefully elicited a proper oropharyngeal examination including endoscopy of the upper airway. The physical findings as they are for 'mono' are often quite characteristic. There is no substitute for carefully listening to the patient and a complete physical examination and of course an open and curious mind. J.G. Young, MD FRCS(C) ret'd
Competing Interests: None declared.References
- Scott Cholewa, Fareen Karachiwalla, Sarah E. Wilson, et al. Fatal respiratory diphtheria in a visitor to Canada. CMAJ 2021;193:E19-E22.