Question

A 27 year old male has had a sore throat for two weeks. The pain has now become so great that he has great difficulty swallowing and has only been able to eat and drink small amounts over the past few days. He has had occasional fevers, but denies cough or coryza. Prior to this, the patient had been very healthy and had not been to a physician for fifteen years. Vital signs on presentation include temperature 38.0 C (100.4 F), pulse 90, blood pressure 118/75, and respirations 14/min. On physical exam, no tonsillar exudates are seen, but there are numerous soft, fluffy white plaques in the patient's tongue and oropharynx. The lesions bleed slightly when they are scraped. Which of the following is the most appropriate next step in the management of this patient?

A. Peripheral blood smear for atypical lymphocytes
B. Rapid antigen detection test for Group A beta-hemolytic
C. Streptococcus Antibody assay for measles virus IgM (MVIgM)
D. Lateral neck radiographs
E. ELISA for HIV-1 antibodies

Answer 1

The most appropriate next step in the management of this patient is to perform a Rapid Antigen Detection Test for Group A beta-hemolytic streptococcus (GABHS).

Step-by-step explanation:

In this case, the most appropriate next step in the management of this patient is to perform a Rapid Antigen Detection Test for Group A beta-hemolytic streptococcus (GABHS).

Based on the patient's symptoms of sore throat, difficulty swallowing, fever, and the presence of white plaques in the tongue and oropharynx that bleed when scraped, it suggests a possible streptococcal infection. The Rapid Antigen Detection Test (RADT) is a quick and accurate method to diagnose strep throat caused by GABHS.

Culture identification is the gold standard to confirm pharyngitis due to S. pyogenes, but the RADT is recommended as the initial test due to its speed and convenience.