--- title: 5 year-old presents to clinic with erythematous pharnyx description: It's Quiz Time with Med-Challenger! image: https://challengercme.com/hubfs/image%20(1).jfif --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/5-year-old-presents-to-clinic-with-erythematous-pharnyx#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) quick quiz # 5 year-old presents to clinic with erythematous pharnyx It's Quiz Time with Med-Challenger! 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Examination shows an erythematous pharynx with white tonsillar exudates (see image).  ![image (1)](https://challengercme.com/hubfs/image%20(1).jfif) Which of the following statements is correct? - Concomitant rhinorrhea and cough support a diagnosis of pharyngitis due to mycoplasma - A negative RST test indicates a low risk for rheumatic fever - Bacterial pharyngitis due to group A betahemolytic streptococcus (GABHS) peaks in the 2-5 year old age group. - A positive rapid strep test (RST) is considered a reliable indication for the presence of group A betahemolytic streptococcus in the pharynx - Exudate in the pharynx points to a bacterial rather than viral pharyngitis The correct answer is: A positive rapid strep test (RST) is considered a reliable indication for the presence of group A betahemolytic streptococcus in the pharynx   A positive RST is considered a reliable indication that group A betahemolytic streptococcus (GABHS) is present in the oropharynx. The RST has a 90% to 95% sensitivity for detecting GABHS (much lower if antibiotics were already taken), though a positive antistreptolysin O blood test is still the only valid method for confirming a GABHS infection. A negative RST is less useful; the patient might still have undiagnosed GABHS and remain at risk for developing rheumatic fever. Most cases of pharyngitis/tonsillitis are due to viral agents and follow a benign, self-limiting course. Overall, the presence of viral symptoms such as cough, coryza, and rhinorrhea and the absence of cervical adenopathy make GABHS (or any other bacterial pharyngitis/tonsillitis) less likely, whereas high fevers, marked cervical adenopathy, a sandpaper rash (scarlet fever) and the absence of cough, coryza, and rhinorrhea makes a diagnosis of GABHS more likely. But this distinction is only moderately reliable and the positive diagnosis of "strep pharyngitis" can only be made in the context of bacterial confirmation with a test. Unfortunately, it is clinically impossible to reliably distinguish bacterial from viral pharyngitis. Bacterial pharyngitis due to GABHS peaks in the 5 to 15 year old group, but can occur at any age. In children within this age range, GABHS is the number one cause of bacterial phayrngitis. In adults, acute bacterial pharyngitis is typically caused by all groups (not just group A) of betahemolytic streptococci (23%), Mycoplasma pneumoniae (9%) or Chlamydia pneumoniae (8%). GABHS must be treated within 9 days to prevent rheumatic fever - a complication that occurs in 0.3 % of patients. Another complication - poststreptococcal glomerunephritis - is not affected by antibiotics. Exudate does NOT necessarily point to a bacterial infection. Adenovirus is common and can present with an especially severe pharyngitis/tonsillitis with a large amount of white exudates. Pearl: Influenza (scratchy throat) and syphilis (painless lesions) are two infections of the pharynx that are less commonly associated with exudates. See the second reference for good pictures of pharyngitis from various causes. **References:** Lean, Wei Ling, et al. "Rapid diagnostic tests for group A streptococcal pharyngitis: a meta-analysis." Pediatrics 134.4 (2014): 771-781. Subashini, Beula, Shalini Anandan, and Veeraraghavan Balaji. "Evaluation of a rapid antigen detection test for the diagnosis of group-A beta-hemolytic Streptococcus in pharyngotonsillitis." 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ "pharyngitis", "group A beta-hemolytic streptococcus (GABHS)", "rapid strep test (RST)", "rheumatic fever", "viral pharyngitis", "tonsillar exudates", "adenovirus", "Mycoplasma pneumoniae", "clinical differentiation of bacterial vs viral pharyngitis", "medical education", "exam preparation", "CME" ], "articleSection" : "Pediatric Medicine", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2024-11-08T20:51:07.118Z", "datePublished" : "2024-11-08T20:51:06.000Z", "description" : "It's Quiz Time with Med-Challenger!", "headline" : "5 year-old presents to clinic with erythematous pharnyx", "image" : [ { "@type" : "ImageObject", "description" : "Med-Challenger logo", "url" : "https://challengercme.com/logo.png" } ], "inLanguage" : "en-US", "keywords" : [ "pharyngitis", "tonsillitis", "GABHS", "rapid strep test", "RST", "rheumatic fever", "exudate", "adenovirus", "Mycoplasma", "pediatrics", "exam question", "Med-Challenger" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/5-year-old-presents-to-clinic-with-erythematous-pharnyx", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "The correct statement is: a positive rapid strep test (RST) is considered a reliable indication that group A beta-hemolytic streptococcus (GABHS) is present in the oropharynx. The article states the RST has about 90–95% sensitivity (lower if antibiotics were already taken). It also notes that a positive antistreptolysin O (ASO) blood test is still cited in the content as the only valid method for confirming a GABHS infection. A negative RST is less useful because GABHS may still be present; most pharyngitis is viral, and viral symptoms (cough, coryza, rhinorrhea) make bacterial pharyngitis less likely. The content also indicates GABHS peaks in children aged 5–15 and must be treated within 9 days to prevent rheumatic fever." }, "name" : "Which statement is correct about a 5-year-old with erythematous pharynx and tonsillar exudates?", "text" : "A mother brings in her 5-year-old son for a severe sore throat. Examination shows an erythematous pharynx with white tonsillar exudates (see image). Which of the following statements is correct? Options: 1) Concomitant rhinorrhea and cough support a diagnosis of pharyngitis due to mycoplasma. 2) A negative RST test indicates a low risk for rheumatic fever. 3) Bacterial pharyngitis due to group A betahemolytic streptococcus (GABHS) peaks in the 2-5 year old age group. 4) A positive rapid strep test (RST) is considered a reliable indication for the presence of group A betahemolytic streptococcus in the pharynx. 5) Exudate in the pharynx points to a bacterial rather than viral pharyngitis." } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "A positive rapid strep test (RST). The article states a positive RST is considered a reliable indication that GABHS is present in the oropharynx; the RST has approximately 90–95% sensitivity (lower if antibiotics were already taken). The content also notes a positive antistreptolysin O (ASO) blood test is cited as the only valid method for confirming GABHS infection." }, "name" : "Which test result reliably indicates the presence of group A beta-hemolytic streptococcus (GABHS)?" }, "position" : 1 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "GABHS peaks in the 5 to 15 year old group. The article states that within this age range, GABHS is the number one cause of bacterial pharyngitis." }, "name" : "In which age group does bacterial pharyngitis due to GABHS peak?" }, "position" : 2 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "No. The article emphasizes that exudate does not necessarily indicate bacterial infection — adenovirus and other viral agents can cause marked exudative pharyngitis, and clinical distinction between bacterial and viral pharyngitis is often unreliable without testing." }, "name" : "Does tonsillar exudate necessarily point to bacterial pharyngitis?" }, "position" : 3 } ], "name" : "Practice Questions", "numberOfItems" : 3 } ```