Archives: MRCEM Intermediate

mrcem2-0380

A 21 year old male comes to the emergency department complaining of a sore throat that has been bothering him for the past 2 days. The patient denies having a cough. Upon examination, the patient’s temperature is measured at 38.3°C, blood pressure at 122/78 mmHg, and pulse rate at 92 bpm. There is visible white exudate on both tonsils and tenderness and swelling when palpating the lymph nodes around the sternocleidomastoid muscles on both sides.

What is the CENTOR score for this patient?

mrcem2-0381

A 25 year old female comes to the emergency department complaining of a sore throat that has been bothering her for the past 2 days. She denies having any cough or runny nose. During the examination, her temperature is measured at 37.7°C, blood pressure at 120/68 mmHg, and pulse rate at 88 bpm. The oropharynx and tonsils show signs of redness. The patient’s neck is not tender and there are no palpable masses.

What is the CENTOR score for this patient?

mrcem2-0382

A 72 year old female comes to the emergency department with a complaint of dizziness when she changes positions. The patient states that the symptoms began today upon getting out of bed. She describes the episodes as a sensation of the room spinning and they typically last for about half a minute. The patient also mentions feeling nauseous during these episodes. There is no reported hearing impairment or ringing in the ears.

What test findings would be anticipated in this patient?

mrcem2-0383

A 65-year-old man presents with short episodes of vertigo that worsen in the morning and are triggered by head movement. You suspect a diagnosis of benign paroxysmal positional vertigo (BPPV).
Which straightforward bedside test can be conducted to confirm the diagnosis?

mrcem2-0384

A 21 year old male presents to the emergency department with a 3 day history of a sore throat and fever. The patient denies having a cough. On examination, the patient’s temperature is 37.9°C, blood pressure is 120/80 mmHg, and pulse rate is 90 bpm. There is visible white exudate on both tonsils, which are severely inflamed, and tenderness on palpation of the lymph nodes around the sternocleidomastoid muscles bilaterally.

What is this patient’s FeverPAIN score?

mrcem2-0385

A 25 year old male presents to the emergency department complaining of a sore throat and fever that has been bothering him for the past 2 days. The patient is specifically asking for a prescription for antibiotics. Which scoring system would be the most suitable for evaluating the patient’s requirement for antibiotics?

mrcem2-0386

A 25-year-old woman presents with a persistent sore throat that has been bothering her for the past five days. She denies having any symptoms of a cold and does not have a cough. She has a clean medical history, does not take any medications, and has no known drug allergies. During the examination, she has a normal body temperature and a few tender lymph nodes in her neck. Her throat and tonsils appear red and inflamed, with a significant amount of exudate on her left tonsil.

Using the FeverPAIN Score to evaluate her sore throat, what would be the most appropriate course of action for her at this point?

mrcem2-0387

A 30-year-old woman presents with a persistent sore throat that has been bothering her for five days. She has also been experiencing symptoms of a cold for the past few days and has a bothersome dry cough. Upon examination, she does not have a fever and there are no swollen lymph nodes in her neck. Her throat appears red overall, but her tonsils are not enlarged and there is no visible discharge.
Using the FeverPAIN Score to evaluate her sore throat, what would be the most appropriate course of action for her at this point?

mrcem2-0388

A 7-year-old boy presents with a sore throat and a dry cough that has been present for five days. He has no medical history of note, takes no medication and reports no known drug allergies. On examination, he is febrile with a temperature of 38.5°C and has a few tender anterior cervical lymph nodes. His throat and tonsils appear red and inflamed, and you can see copious exudate on his right tonsil.
Using the FeverPAIN Score to assess his sore throat, which of the following would be the MOST APPROPRIATE management for him at this stage?

mrcem2-0389

A 25-year-old man comes in with a persistent sore throat that has lasted for five days. He denies having a cough. During the examination, his temperature is measured at 39°C and a few tender anterior cervical lymph nodes are found. There is a noticeable amount of exudate on his right tonsil, which appears red and inflamed.

What is his FeverPAIN score?