Review Question - QID 107246

This patient's presentation is suggestive of pharyngotonsilitis, which may be caused by viruses or bacteria (e.g. Group A strep, GAS). A rapid strep test is appropriate if group A strep is clinically suggested based on the history and physical examination findings.

There are numerous scoring systems in existence for predicting if GAS is the cause of pharyngitis. The most well-known is the Centor scoring system, which guides decision making in determining whether supportive treatment, a rapid strep test, or empiric antibiotics is the appropriate management, based on a score derived from the patient's history and physical exam presentation. In general, due to concerns over increasing antibiotic resistance, patients should demonstrate a positive rapid antigen detection test or a positive throat culture prior to being prescribed antibiotics.

Incorrect Answers:
Answer 1: Given this patient's presentation and calculated Centor score of 3, a rapid strep test is recommended to confirm the diagnosis prior to prescribing antibiotics.

Answer 2: Given this patient's presentation and calculated Centor score of 3, a rapid strep test is recommended over simply symptomatic treatment.

Answer 3: This patient's presentation is more suggestive of a bacterial etiology; however, antivirals are not recommended even for known viral pharyngitis. Supportive and symptomatic treatment with rest, fluids, saline gargling, and NSAIDs or acetaminophen is appropriate.

Answer 4: Although highly sensitive for GAS pharyngitis, it requires longer follow-up to obtain results and therefore is only appropriate for pediatric patients with a negative rapid strep antigen test that still have a presentation suspicious for bacterial pharyngitis.