😀 EASY

The days are drawing in which means sore throat season is upon us, gather the cold and flu remedies and test yourself on this set of questions!

 

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Acute upper respiratory symptoms and sore throat

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Question 1

Stem 1, question 1 of 5

Lucas, a 7 year old male, presents to GP with his Mother. Lucas has a 1 day history of sore throat, "a snotty nose" and denies any cough

What is the most likely diagnosis?
A
Acute sinusitis
B
Acute tonsillitis
C
Acute pharyngitis
D
Common cold
E
Influenza
Question 1 Explanation: 
Acute pharyngitis is hallmarked by the acute onset of sore throat, the absence of cough and presence of nasal congestion. It is common in children or adolescents. Presentations in winter or spring tend to be bacterial and summer or autumn tends to be enteroviral.
Question 2

Stem 1, question 2 of 5

Acute tonsillitis is another cause of sore throat. What is the definition of acute tonsillitis?
A
A symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses
B
An acute infection of the parenchyma of the palatine lymphoid tissue
C
A self limiting lower respiratory tract infection
D
Infection in the lung parenchyma resulting in consolidation of the affected segment or lobe
E
An acute infection of the pharyngeal tissue resulting in inflammation
Question 2 Explanation: 
Acute tonsillitis is an infection of the parenchyma of the palatine tonsils. Remember that tonsil are composed of lymphoid tissue! The other answer choices describe other causes of sore throat and upper airway infections
Question 3

Stem 1, question 3 of 5

Lucas' Mother asks if he needs antibiotics for his sore throat. Which of the following is not part of the Centor Criteria?
A
Absence of cough
B
Attend rapidly within 3 days of onset of symptoms
C
History of fever over 38C
D
Tonsillar exudate
E
Tender anterior cervical lymphadenopathy
Question 3 Explanation: 
The Centor criteria is used to assess whether the likelihood of isolating streptococcus is low or high. There are 4 aspects in the Centor Criteria, whereas FeverPAIN is another criteria which uses 5 aspects, "attends rapidly within 3 days of onset of symptoms" is a criteria of FeverPAIN not Centor. Both are explained here: https://www.nice.org.uk/guidance/ng84/chapter/terms-used-in-the-guideline
Question 4

Stem 1, question 4 of 5

If a streptococcus throat infection was left untreated, what heart murmur is most likely to be heard?
A
Aortic stenosis
B
Aortic regurgitation
C
Pulmonary stenosis
D
Mitral regurgitation
E
Tricuspid regurgitation
Question 4 Explanation: 
You would be forgiven for thinking "what an earth is the link between a sore throat and heart murmurs?!" but bare with me! Strep throat infections can lead to an autoimmune disease, rheumatic fever, which can lead to damage to the mitral valve, thus causing mitral regurgitation. Rheumatic heart disease is very prevalence in the developing world who do not necessarily have access to antibiotics for the original Strep throat infection.
Question 5

Stem 1, question 5 of 5

Lucas suddenly worsens and presents to A&E. His parents state he now has a severe and worsening sore throat on the right side, with right sided ear ache, difficulty swallowing and is feeling very unwell.

What is the most likely diagnosis?
A
Acute bacterial pharyngitis
B
Infectious mononucleosis
C
Acute bronchiolitis
D
Rhinosinuitis
E
Peri-tonsiliar abscess
Question 5 Explanation: 
This question is testing your knowledge of the complications of a sore throat, as this case has now developed into a peri-toniilar abscess or quinsy. This requires prompt treatment and interventions in a hospital setting.
Question 6

Stem 2, question 1 of 4

Chris (They/Them pronouns), a 23 year , presents with a sore throat, fatigue and lump in their neck. On examination their temperature is 38.4C and their pharynx is red and inflamed

What is the most likely diagnosis?
A
Peri-toniilar abscess
B
Acute lymphoblastic leukaemia
C
Non-Hodgkin's lymphoma
D
Infectious mononucleosis
E
Common cold
Question 6 Explanation: 
This is an example fo the classic triad of fever, pharyngitis and lymphadenopathy of Infectious mononucleosis aka Glandular fever. This infection is most common in ages 10-30 years old and so Chris fits this demographic
Question 7

Stem 2, question 2 of 4

What is the infectious agent of Infectious mononucleosis?
A
Herpes simplex virus
B
Varicella zoster virus
C
Epstein-Barr virus
D
Influenza virus
E
Marbug virus
Question 7 Explanation: 
Infectious mononucleosis is caused by the Epstein-Barr virus, all the other viruses are important in medicine but do not cause infectious mononucleosis
Question 8

Stem 2, question 3 of 4

Oseltamivir is an anti-viral drug used to treat other viral infections, what is it's mechanism of action?
A
Activation of antivirals intracellular and immune responses
B
Viral DNA polymerase inhibitor
C
Nucleoside analogue disrupting viral RNA synthesis
D
Blockade of virus fusion to target cell membrane
E
Neuraminidase inhibitor preventing viral budding and infectivity
Question 8 Explanation: 
Oseltamivir is a neuraminidase inhibitor used to prevent viral budding and infectivity, blocking the virus from leaving the infected cell.
Question 9

Stem 2, question 4 of 4

Which of the following not a component of the lymph nodes of the head and neck?
A
Parotid
B
Submental
C
Cervical
D
Virchow's
E
Pre-auricular
Question 9 Explanation: 
Virchow's lymph node is a supraclavicular node located in the left supraclavicular fossa and receives lymph drainage from the abdominal cavity. TeachMeAnatomy has a great resource on lymph nodes of the head and neck
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