Sore throat

Question 1

Key history in sore throat

Answer 1

Duration
Fever
Other ENT symptoms (ear pain, nasal or sinus congestion)
Odynophagia
Swollen glands
Cough
Rash
Sick contacts
HIV risk factors

Question 2

Key physical exam in sore throat

Answer 2

Vital signs
ENT exam (oral thrush, tonsillar exudate, lymphadenopathy)
Lung exam
Abdominal exam (for splenomegaly)
Skin exam

Question 3

26 yo F with sore throat, fever, severe fatigue and loss of appetite for past week
+ epigastric and LUQ discomfort
+ cervical lymphadenopathy
+ rash
+ boyfriend experiencing similar symptoms

Answer 3

Infectious mononucleosis
Acute hepatitis
Viral or bacterial pharyngitis

CBC with peripheral smear, Monospot test, throat culture, AST/ALT/bilirubin/alkaline phosphatase, HIV antibody and viral load

Question 4

26 yo M with sore throat, fever, rash and weight loss

+ IV drug user and shares needles

Answer 4

Acute retroviral syndrome
Infectious mononucleosis
Hepatitis
Viral or bacterial pharyngitis
Secondary syphilis

CBC with peripheral smear, Monospot test, ALT/AST/bilirubin/alkaline phosphatase, throat culture, VDRL/RPR, HIV antibody and viral load, CD4 count

Question 5

46 yo F with fever and sore throat

Answer 5

Bacterial or viral pharyngitis
Mycoplasma pneumonia
Acute retroviral infection
Infectious mononucleosis

Throat culture, rapid streptococcal antigen, Monospot test, CBC, serologic test (cold agglutinin titer) for Mycoplasma, HIV antibody and viral load