APPENDIX

Acute Pharyngitis Clinical Scenarios to Assess Physicians' Management Approach

A.In March, you see a 6-y-old child with a 2-d history of sore throat and headache. He has no cough or coryza. On examination, he is febrile, his pharynx is erythematous with pus on his tonsils, and he has tender cervical adenopathy.
    Perform no diagnostic tests and give antibiotics based on clinical criteria alone.
    Perform no diagnostic tests and give no antibiotics.
    Perform a rapid strep test. If positive, give antibiotics; if negative, give no antibiotics and do nothing further.
    Perform a rapid strep test. If positive, give antibiotics; if negative, obtain a throat culture, give antibiotics while awaiting culture results, and stop antibiotics if culture is negative.
    Perform a rapid strep test. If positive, give antibiotics; if negative, obtain a throat culture and give antibiotics only if culture is positive.
    Perform a throat culture and give antibiotics while awaiting culture results; stop antibiotics if culture is negative.
    Perform a throat culture and give antibiotics only if culture is positive.
    Perform a rapid strep test and/or a throat culture, and continue antibiotics despite a negative result.
B.In July, you see a 6-y-old child with a 2-d history of sore throat and coryza but no cough. On examination, he is afebrile, his pharynx is erythematous but there is no pus on his tonsils and he has no adenopathy.
    Perform no diagnostic tests and give antibiotics based on clinical criteria alone.
    Perform no diagnostic tests and give no antibiotics.
    Perform a rapid strep test. If positive, give antibiotics; if negative, give no antibiotics and do nothing further.
    Perform a rapid strep test. If positive, give antibiotics; if negative, obtain a throat culture, give antibiotics while awaiting culture results, and stop antibiotics if culture is negative.
    Perform a rapid strep test. If positive, give antibiotics; if negative, obtain a throat culture and give antibiotics only if culture is positive.
    Perform a throat culture and give antibiotics while awaiting culture results; stop antibiotics if culture is negative.
    Perform a throat culture and give antibiotics only if culture is positive.
    Perform a rapid strep test and/or a throat culture, and continue antibiotics despite a negative result.
  • After each of the following patient presentations, you will be given various diagnostic and treatment approaches. For each approach, indicate the management scenario you would be most likely to use.