Return to Scenario ListShow Learning Points most relevant to Phase 1:

Sore throat management in the New Zealand context

Clinical Discipline(s)/Organ System(s)
Infectious Diseases, Microbiology, General Practice, Immunology, Paediatrics
Progress Test Topic(s)
Blood and lymph, Child health, Infectious disease
A Māori mother brings her 9 year old son to the drop-in sore throat clinic in Dargaville after he complained of a sore throat for a few days. His sore throat is improving and on clinical examination he does not have any coryzal symptoms or fever currently. His mother says that her older son had treatment for “strep throat” a few weeks ago and is allergic to penicillin.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Microbiology of sore throat including Streptococcus pyogenes, respiratory viruses and herpes virus family (Epstein-Barr virus [EBV],cytomegalovirus [CMV])
   - Immunology of post-streptococcal sequelae including post-streptococcal glomerulonephritis and rheumatic fever
   - Pharmacology of pencillin V, amoxicillin and benzyl and benzathine penicillin

Pharmacology of erythromycin
   - Anatomy of lymphoid tissue including cervical, submandibular and jugulodigastric nodes, and spleen

Clinical and Communication Skills 
   - History and examination of a child including ears, upper airway and throat examination Know the clinical ‘red flags’ for airway obstruction such as drooling, stridor
   - Elicit an accurate medication allergy history
   - Elicit symptom history and clinical signs of acute rheumatic fever following a sore throat Differential diagnosis of sore throat
   - Management of "strep throat" in high risk and low risk populations
   - Identification of population at high risk (sore throat in Māori and Pacific children/adults from age 4 years to 35 years)
   - Indication for throat swab in high risk patient
   - Possible usefulness of clinical diagnostic signs and symptoms in low risk population to differentiate bacterial from viral cause of sore throat
   - Interpretation of positive group A streptococcus swab in high risk and symptomatic individual
   - Indication for use of antibiotics for sore throat
   - How to prescribe antibiotics for eradication of group A streptococcus (duration minimum 10 days, adherence)
Personal and Professional Skills 
   - Best interests principle
   - Communicating with patient and their family/whānau
Hauora Māori 
   - Disproportionate impact of rheumatic fever and infectious disease on Māori compared with non-Māori in New Zealand
   - Understand inequities in access to health services and quality of medical care for Māori compared with non-Māori, and implications of this to clinical decision making and management
   - Ensuring a culturally safe environment and interpretation of symptoms in an appropriate cultural context
Population Health 
   - Epidemiology of rheumatic fever; New Zealand rates in international context; rheumatic fever register
   - Social determinants of rheumatic fever
   - Understand the current screening approach to rheumatic fever prevention in New Zealand context including free sore throat clinic services offered in areas of high incidence and sore throat checks in schools
   - Public health implications including notification and contact tracing of sore throats in high risk households/whānau
   - Importance of antimicrobial stewardship and use of the narrowest spectrum antibiotic
   - Incidence of antibiotic allergy
   - Indications for referral for tonsillectomy for recurrent sore throat
Conditions to be considered relating to this scenario
common viral upper respiratory tract infection (viral sore throat), Streptococcus pyogenes pharyngitis, glandular fever (EBV and CMV mononucleosis)
Less common but 'important not to miss'
peritonsillar abscess/quinsy, tracheitis, retropharyngeal abscess
Related Scenarios
[Child with sore joints]