Below is a series of management options for patients who present to you with a sore throat. From the list of patients below select the single most appropriate management option. Each option may be used once, more than once, or not at all.
1. A 50 year old woman recently commenced on carbimazole for thyrotoxicosis presents with a sore throat and headache for one day. On examination her pharynx is red, her temperature 37.0 and she looks well.
A. Amoxycillin for five days
B. Amoxycillin for 10 days
C. Delayed antibiotic prescription
D. No antibiotics
E. Penicillin V for five days
F. Penicillin V for 10 days
Answer: D
This patient needs a full blood count the same day to exclude a carbimazole induced blood dyscrasia. If this is normal the decision on antibiotics can be made later.
2. A four year old child with a sore throat of two days duration. The family are due to go on holiday in three days. His throat looks red (but there are no exudates), he has mild cervical lymphadenopathy but there is no fever.
A. Amoxycillin for five days
B. Amoxycillin for 10 days
C. Delayed antibiotic prescription
D. No antibiotics
E. Penicillin V for five days
F. Penicillin V for 10 days
Answer: C
3. A 19 year old female student who presents with sore throat, fever, anterior and posterior cervical lymphadenopathy and who has a foul tonsillar exudate on examination.
A. Amoxycillin for five days
B. Amoxycillin for 10 days
C. Delayed antibiotic prescription
D. No antibiotics
E. Penicillin V for five days
F. Penicillin V for 10 days
Answer: F
She also needs a FBC and glandular fever screen since she could well have glandular fever. Amoxycillin is undesirable in this patient for two reasons:
1. She may develop a rash if she has glandular fever
2. It will interfere with the OCP if she is on it - which Penicillin V will not.
4. A 10 year old boy presents with his third attack of "tonsillitis". He has no cough. On examination he looks unwell, has tonsillar exudates, cervical lymphadenopathy and a temperature of 38.7 degrees centigrade.
A. Amoxycillin for five days
B. Amoxycillin for 10 days
C. Delayed antibiotic prescription
D. No antibiotics
E. Penicillin V for five days
F. Penicillin V for 10 days
Answer: F
see NICE guidance. He has four centor criteria. The recommended duration of antibiotics (if given) is 10 days
5. A two year old travelling person attends as an emergency. On examination she is snuffly but well, temperature 36.6 degrees C. Her throat is mildly injected.
A. Amoxycillin for five days
B. Amoxycillin for 10 days
C. Delayed antibiotic prescription
D. No antibiotics
E. Penicillin V for five days
F. Penicillin V for 10 days
Answer: D
There are no positive Centor criteria and management should be centred on parental education and the development of a shared management plan
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