Abstract

Name: Charles Whitcomb1 Birth date: May 3, 19762 Drug allergies: Hives with sulfonamides3 Immunizations: 5 DTP injections recorded4 Monday, September 24, 1990 CHIEF COMPLAINT: Sore throat. HISTORY: Throat started to hurt late Friday and has worsened gradually over the weekend. Hurts to swallow. Took temperature once: 100°F last night. Nose stuffy. Thinks he has swollen glands. PHYSICAL EXAMINATION: Fairly comfortable; complaining of throat pain. Temperature: 101°F orally. Tympanic membranes: clear. Nose: No discharge but sounds stuffy. Pharynx: Small tonsils; mildly erythematous; no exudate. Posterior soft palate and uvula mildly swollen; no petechiae. Neck: 1.0 cm mildly tender lymph node at each mandibular angle. A few smaller anterior and a number of 0.5 cm posterior cervical nodes. Neck fully supple.

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