Acute Sore Throat

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Question 1 of 10

1. Question
When considering how to treat a patient with tonsillopharyngitis, which one of the following statements is correct?
- The standard antibiotic regime used for GABHS infection is a five day course of phenoxymethylpenicillin
- There is no evidence that either paracetamol or non-steroidal anti-inflammatory drugs have a positive effect on a sore throat illness
- Erythromycin is as effective as phenoxymethylpenicillin when treating GABHS infection in penicillin allergic individuals
- Patients with more than three episodes of tonsillopharyngitis should be referred to ENT for consideration of tonsillectomy
- Erythromycin is the antibiotic of choice for pregnant women with tonsillopharyngitis who are penicillin allergic
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Question 2 of 10

2. Question
There are a number of illnesses other than tonsillopharyngitis which may present as a sore throat. Which one of the following is true regarding these problems?
- Scarlet fever may be complicated by Lemierre’s syndrome
- Having made a diagnosis of epiglottitis, this mandates early intubation of the patient
- Incision and drainage is the only effective way of managing peritonsillar abscess
- Retropharyngeal abscess may be complicated by the development of mediastinitis
- The presence of stridor in epiglottitis is common and is not predictive of the development of airway obstruction
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Question 3 of 10

3. Question
When considering the presentation of patients with a sore throat to health care professionals, which one of the following statements is correct?
- Most patients going to their GP in the UK will be managed without an antibiotic prescription
- Group A β haemolytic streptococcus (GABHS) is the most common organism responsible
- Tonsillitis and pharyngitis are completely different disease processes
- Most patients seek medical care for their sore throat
- Patients with a sore throat account for approximately 2% of all visits to an emergency department (ED)
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Question 4 of 10

4. Question
GABHS infection is one of the causes of a sore throat. Which one of the following statements is true regarding this organism?
- Exotoxin release is the main pathological process responsible for the development of rheumatic fever
- Antistreptolysin O titre (ASOT) is a reliable method of identifying recent GABHS infection
- Up to 20% of adults are asymptomatic carriers of GABHS
- Peritonsillar abscess is a non-suppurative complication of GABHS infection
- Rheumatic fever is a far rarer problem in the developing world than in the western world
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Question 5 of 10

5. Question
You start to examine the boy and after ensuring his ABC assessment is normal, you begin by conducting a general examination. Which one of the following statements is true regarding this assessment?
- A general examination is usually not needed as positive findings are rare
- The presence of a macular rash with confluence in the skin folds is characteristic of rheumatic fever
- Hepatosplenomegaly may be found in infectious mononucleosis
- Erythema migrans is the characteristic rash found in rheumatic fever
- New heart murmurs may be found as a complication of scarlet fever
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Question 6 of 10

6. Question
An 11-year-old boy is brought to the ED by his parents. He is complaining of a sore throat. You start your assessment – which one of the following statements is correct with regards to the history?
- A reported inability to swallow should be assessed after adequate analgesia
- Abdominal symptoms are common in children and indicate a high chance of GABHS infection
- A history of a previous episode of post-streptococcal glomerulonephritis will not alter your management of this patient
- Stridor is common in tonsillopharyngitis in childhood
- Neck stiffness is a common complaint and is always due to enlarged lymph nodes in the neck
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Question 7 of 10

7. Question
You move on to examine the boy’s mouth and throat. Which one of the following statements is true regarding this examination?
- Unilateral peri-tonsillar swelling with uvular deviation is a classic finding in quinsy
- Diphtheria typically causes a petechial rash on the pharynx and palate
- A strawberry tongue is only found in scarlet fever
- Retropharyngeal abscess is diagnosed by finding a pseudomembrane on the posterior pharyngeal wall
- It is important to view the pharynx clearly, so use of a tongue depressor is mandatory
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Question 8 of 10

8. Question
To help in your decision whether to treat your patient with a course of antibiotics, you decide to calculate a FeverPAIN score. Which one of these statements is accurate regarding this calculation?
- The presence or absence of a cough has no bearing on the score
- The age of the patient has no bearing on the score
- The presence of exudate on the tonsils means that antibiotics should always be given
- A score of 3 or more means that antibiotics should always be given
- The use of a sore throat score may reduce unnecessary antibiotic prescriptions by 10%
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Question 9 of 10

9. Question
The parents are concerned that you are not going to do any tests to confirm your diagnosis. Which one of the following statements is correct?
- The rapid streptococcal antigen test is well validated and widely used in the UK
- Blood tests should be performed for all patients attending ED with a sore throat as they are more likely to represent severe disease
- A rapid streptococcal antigen test is highly specific and a negative test effectively rules out GABHS infection
- Throat swabs are of limited use due to operator-dependent technique and the presence of asymptomatic carriers of GABHS
- A lateral soft tissue neck x-ray shows characteristic abnormalities in peritonsillar abscess
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Question 10 of 10

10. Question
You diagnose tonsillopharyngitis in your patient. In making your decision how to treat him, you take a number of factors into consideration. Which one of these statements is true regarding this decision?
- A course of antibiotics is likely to significantly shorten the course of his illness
- Antibiotics should not be withheld if the person has very severe symptoms and there is concern about their clinical condition
- If you don’t prescribe antibiotics, it is likely that he and his parents will be very unhappy with his management
- Prescribing a course of antibiotics will have no effect on his decision to seek medical help for future sore throat illnesses
- If an expectant policy for antibiotic treatment is used, the risk of him developing complications is much greater
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Acute Sore Throat

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