Aquifer Family Medicine 23: 5-year-old female
with sore throat questions and answers 2025\2026
A+ Grade
Based on what you know about the patient so far, write a one-to-three sentence summary statement to
communicate your understanding of the patient to other providers.
- correct answer Althea is a generally healthy five-year-old with a two-day history of subjective fever,
sore throat, headache, dry cough, mild abdominal pain, and decreased appetite. She has a school friend
who is taking antibiotics for strep throat, no known COVID-19 contacts, and her father smokes. On
exam, she has a temperature of 38.6 °C (101.6 °F), red, enlarged tonsils with exudates, anterior cervical
lymphadenopathy, palatal petechiae, and a red, fine papular rash involving the neck, face, and trunk.
She had not had dysphagia and she took some Tylenol before coming to the office today.
The ideal summary statement concisely highlights the most pertinent features without omitting any
significant points. The summary statement above includes:
Epidemiology and risk factors: Generally healthy 5-year-old girl, potential strep exposure, no known
COVID-19 contacts, and second-hand smoke exposure.
Key clinical findings of the present illness using qualifying adjectives and transformative language:
Two-day history of sore throat with associated headache, dry cough, mild abdominal pain, and
decreased appetite
School friend who is being treated for strep throat with antibiotics
Fever
Red, enlarged tonsils with exudates
Anterior cervical chain lymphadenopathy
Palatal petechiae
Red, fine papular rash involving the neck, face, and trunk.
Lack of dysphagia
"So she has a rash?" says Dr. Medel. "It will be interesting to look at that together in a moment. What do
you think is going on here?"
, Question
Based on your findings from her history and physical exam, select from the following the two top
diagnoses on your differential. Choose the two best answers.
- correct answer Group A Beta-hemolytic Streptococcus (GABHS) pharyngitis
Non-specific viral pharyngitis
Althea's symptoms are most consistent with strep throat (D) or non-specific viral pharyngitis (E). Allergic
rhinitis/pharyngitis (A) is less likely given her fevers and acute presentation. Epiglottis (C) is less likely
given lack of drooling, inspiratory stridor, or "hot potato" voice. Peritonsillar abscess (F) is less likely in
this patient due to her lack of drooling, her symmetric tonsils, and her midline uvula. Pertussis (G) is less
likely given the presence of the rash and is more typically considered for persistent cough after an acute
illness. A retropharyngeal abscess (H) is less likely given the absence of dysphagia. Viral croup (I) is less
likely given the character of cough and lack of stridor or hoarse voice. COVID-19 (B) is less likely due to
the presence of tonsillar exudates, palatal petechiae, and papular rash. In the setting of widespread
community illness with COVID-19, it may still be reasonable to test a febrile child for SARS-CoV2
infection despite other diagnoses being more likely. See below for more teaching about pediatric
pharyngeal infections.
Dr. Medel says, "You've done a very complete job with the differential diagnosis of Althea's pharyngitis. I
agree that group A strep or a non-specific respiratory virus are the most likely causes of Althea's sore
throat. Differentiating between strep pharyngitis and viral pharyngitis helps us make appropriate
decisions about prescribing antibiotics. Giving antibiotics to someone who has viral pharyngitis will not
help the patient in any way, has the risk of causing an allergic reaction, contributes to the development
of antibiotic resistance, and creates unnecessary costs. How do you want to determine if this patient has
strep pharyngitis?"
Question
What is the most appropriate next step? Choose the single best answer.
A. Do a COVID-19 test alone.
B. Do a COVID-19 test with RADT strep testing.
C. Do a rapid antigen detection test for strep pharyngitis and a strep culture and COVID-19 PCR test if
the strep test is ne
- correct answer C. Do a rapid antigen detection test for strep pharyngitis and a strep culture and COVID-
19 PCR test if the strep test is negative.
ou review Althea's symptoms and clinical findings again with Dr. Medel. You note the lack of physical
findings to support a diagnosis of infectious mononucleosis or the presence of a retropharyngeal
with sore throat questions and answers 2025\2026
A+ Grade
Based on what you know about the patient so far, write a one-to-three sentence summary statement to
communicate your understanding of the patient to other providers.
- correct answer Althea is a generally healthy five-year-old with a two-day history of subjective fever,
sore throat, headache, dry cough, mild abdominal pain, and decreased appetite. She has a school friend
who is taking antibiotics for strep throat, no known COVID-19 contacts, and her father smokes. On
exam, she has a temperature of 38.6 °C (101.6 °F), red, enlarged tonsils with exudates, anterior cervical
lymphadenopathy, palatal petechiae, and a red, fine papular rash involving the neck, face, and trunk.
She had not had dysphagia and she took some Tylenol before coming to the office today.
The ideal summary statement concisely highlights the most pertinent features without omitting any
significant points. The summary statement above includes:
Epidemiology and risk factors: Generally healthy 5-year-old girl, potential strep exposure, no known
COVID-19 contacts, and second-hand smoke exposure.
Key clinical findings of the present illness using qualifying adjectives and transformative language:
Two-day history of sore throat with associated headache, dry cough, mild abdominal pain, and
decreased appetite
School friend who is being treated for strep throat with antibiotics
Fever
Red, enlarged tonsils with exudates
Anterior cervical chain lymphadenopathy
Palatal petechiae
Red, fine papular rash involving the neck, face, and trunk.
Lack of dysphagia
"So she has a rash?" says Dr. Medel. "It will be interesting to look at that together in a moment. What do
you think is going on here?"
, Question
Based on your findings from her history and physical exam, select from the following the two top
diagnoses on your differential. Choose the two best answers.
- correct answer Group A Beta-hemolytic Streptococcus (GABHS) pharyngitis
Non-specific viral pharyngitis
Althea's symptoms are most consistent with strep throat (D) or non-specific viral pharyngitis (E). Allergic
rhinitis/pharyngitis (A) is less likely given her fevers and acute presentation. Epiglottis (C) is less likely
given lack of drooling, inspiratory stridor, or "hot potato" voice. Peritonsillar abscess (F) is less likely in
this patient due to her lack of drooling, her symmetric tonsils, and her midline uvula. Pertussis (G) is less
likely given the presence of the rash and is more typically considered for persistent cough after an acute
illness. A retropharyngeal abscess (H) is less likely given the absence of dysphagia. Viral croup (I) is less
likely given the character of cough and lack of stridor or hoarse voice. COVID-19 (B) is less likely due to
the presence of tonsillar exudates, palatal petechiae, and papular rash. In the setting of widespread
community illness with COVID-19, it may still be reasonable to test a febrile child for SARS-CoV2
infection despite other diagnoses being more likely. See below for more teaching about pediatric
pharyngeal infections.
Dr. Medel says, "You've done a very complete job with the differential diagnosis of Althea's pharyngitis. I
agree that group A strep or a non-specific respiratory virus are the most likely causes of Althea's sore
throat. Differentiating between strep pharyngitis and viral pharyngitis helps us make appropriate
decisions about prescribing antibiotics. Giving antibiotics to someone who has viral pharyngitis will not
help the patient in any way, has the risk of causing an allergic reaction, contributes to the development
of antibiotic resistance, and creates unnecessary costs. How do you want to determine if this patient has
strep pharyngitis?"
Question
What is the most appropriate next step? Choose the single best answer.
A. Do a COVID-19 test alone.
B. Do a COVID-19 test with RADT strep testing.
C. Do a rapid antigen detection test for strep pharyngitis and a strep culture and COVID-19 PCR test if
the strep test is ne
- correct answer C. Do a rapid antigen detection test for strep pharyngitis and a strep culture and COVID-
19 PCR test if the strep test is negative.
ou review Althea's symptoms and clinical findings again with Dr. Medel. You note the lack of physical
findings to support a diagnosis of infectious mononucleosis or the presence of a retropharyngeal
