#march2020mccqe1
A 21-year-old man is evaluated for 5 days of sore throat, anterior neck pain and fever. Four days ago he was treated for streptoccocal pharyngitis with penicillin. Despite antibiotic therapy, his symptoms progressed and now he has difficulty swallowing and managing his secretions. Medical history is otherwise unremarkable and his only medication is oral penicillin.
On physical examination his temperature is 38.9°C (102°F), blood pressure is 140/86 mm Hg, pulse rate is 110/min and respiration rate is 20/min. He spits frequently and drools. His oral pharynx is notable for enlarged tonsils, right significantly greater than the left. The right tonsil enlargement crowds the uvula to the left. He has tender right cervical lymphadenopathy.
Which of the following is the most appropriate management?
(A) Add azithromycin
(B) Change to clindamycin
(C) Change to intramuscular penicillin
(D) Emergency ENT consultation
A 21-year-old man is evaluated for 5 days of sore throat, anterior neck pain and fever. Four days ago he was treated for streptoccocal pharyngitis with penicillin. Despite antibiotic therapy, his symptoms progressed and now he has difficulty swallowing and managing his secretions. Medical history is otherwise unremarkable and his only medication is oral penicillin.
On physical examination his temperature is 38.9°C (102°F), blood pressure is 140/86 mm Hg, pulse rate is 110/min and respiration rate is 20/min. He spits frequently and drools. His oral pharynx is notable for enlarged tonsils, right significantly greater than the left. The right tonsil enlargement crowds the uvula to the left. He has tender right cervical lymphadenopathy.
Which of the following is the most appropriate management?
(A) Add azithromycin
(B) Change to clindamycin
(C) Change to intramuscular penicillin
(D) Emergency ENT consultation