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WHO/DAP/94.

11 Distr: General Original: English

Guide to Good
Prescribing
A practical
manual

Patients complaints are


mostly linked to
symptoms. A symptom is
not a diagnosis, although
it will usually lead to it.
The following five patients
all have the same
complaint, a sore throat.
But do they all have the
same diagnosis?
Let's look at them in more

Patient 1:
Man, 54 years.
Complains of a severe
sore throat. No general
symptoms, no fever,
slight redness in the
throat; no other
findings.

Patient 2:
Woman, 23 years.
Complains of a sore throat
but is also very tired and
has enlarged lymph nodes
in her neck. Slight fever.
She has come for the
results of last week's
laboratory tests.

Patient 3:
Woman student, 19 years.
Complains of a sore
throat. Slight redness of
the throat; but no fever
and no other findings.
She is a little shy and has
never consulted you
before for such a minor
complaint.

Patient 4:
Man 43 years. Complains
of a sore throat. Slight
redness of the throat; no
fever and no other
findings. Medical record
mentions that he suffers
from chronic diarrhoea.

Patient 5:
Woman, 32 years. Very
sore throat, caused by
a severe bacterial
infection, despite
penicillin prescribed
last week.

Patient 1
The sore throat of patient 1
probably results from a
minor viral infection.
Perhaps he is afraid of a
more serious disease (throat
cancer?). He needs
reassurance and advice, not
drugs. He does not need
antibiotics, because they
will not cure a viral
infection.

What Are Lymph Nodes?


Your lymph nodes are small, round, or beanshaped masses of tissue. They are part of the
lymphatic system that helps your body fight
infection and disease. As lymphatic fluid
travels through the body, immune cells (called
lymphocytes) in the lymph nodes trap
bacteria, viruses, and other potentially
harmful substances and destroy them to help
prevent their spread. They also keep fluid
balance in check.

Patient 2
Her blood test confirms
your clinical diagnosis of
AIDS. Her problem is
completely different from
the previous case, as the
sore throat is a symptom
of underlying disease.

Patient 3
You noticed that she was
rather shy and remembered
that she had never consulted
you before for such a minor
complaint. You ask her gently
what the real trouble is, and
after some hesitation she
tells you that she is 3 months
overdue. Her real concern
had nothing to do with her
throat.

Treat a Sore Throat Naturally


Natural sore throat treatments are the safest option
during pregnancy. An expectant mother can try
gargling saltwater to soothe a sore throat. Water
mixed with honey and lemon and heated until warm
can be help alleviate some of the pain associated
with a sore throat. A spoonful of straight honey can
offer instant, temporary relief for a sore throat and
can also help treat a cough if it is present at the
same time. Orange juice provides plenty of vitamin
C to help an expectant mother get over a sore
throat faster and can also offer temporary relief
from the pain of a sore throat.

Can sore throat be associated with


pregnancy?

Answer:
To be blunt, yes it can be. But don't rely
on a sign. Use multiple pregnancy
tests, up to 2 or 3, just to be sure

In this case, information from the


patients medical record is
essential for a correct
understanding of the problem. His
sore throat is probably caused by
the loperamide he takes for his
chronic diarrhoea. This drug may
produce reduced salivation and
dry mouth as a side effect. Routine
treatment of a sore throat would
not have solved his problem. You
may have to investigate the
reason for his chronic diarrhoea,

Patient 5
A careful history of patient 5,
whose bacterial infection
persists despite the penicillin,
reveals that she stopped
taking the drugs after three
days because she felt much
better. She should, of course,
have completed the course.
Her problem has come back
because of inadequate

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