Rosh Emergency Medicine Practice Test

What is the best next step in managing a patient with a sore throat and enlarged tonsils along with fever?

1. A. Begin treatment with corticosteroids

2. B. Prescribe penicillin V PO for 10 days

3. C. Provide supportive care and recommend adequate rest

4. D. Recommend resuming sports as tolerated

The correct answer is: B. Prescribe penicillin V PO for 10 days

The best next step in managing a patient with a sore throat, enlarged tonsils, and fever is to prescribe penicillin V orally for 10 days. This choice is appropriate because these symptoms are highly suggestive of a bacterial infection, particularly streptococcal pharyngitis (strep throat). Penicillin V is the first-line treatment for streptococcal infections as it effectively eradicates the bacteria and reduces the risk of complications, such as rheumatic fever and peritonsillar abscess. This antibiotic treatment helps alleviate symptoms and accelerates recovery by clearing the infection. In contrast, beginning treatment with corticosteroids could reduce inflammation, but it does not address the underlying infection and may mask symptoms without providing definitive treatment. Providing supportive care and recommending adequate rest might be appropriate for viral infections, but it falls short in managing a likely bacterial infection. Finally, recommending resuming sports as tolerated would be inappropriate, especially if there is an ongoing bacterial infection, as it could increase the risk of complications or spreading the infection. Thus, prescribing penicillin V is the most responsible and effective next step for this patient.