Code Status case · Beginner · Premium
Sore throat in a 22-year-old woman
“It hurts to swallow. Will I be able to sing at my show Friday?”
“Two days of sore throat, fever since last night. Painful swallowing, but otherwise looks well.”
Your challenge
Most sore throats are viral and get better on their own. Some need antibiotics, and a rare few are emergencies that threaten the airway. Imani has had two days of pain and a fever since last night, and she wants to know if she can still sing at her show on Friday. Your job is to tell which kind of sore throat this is, and to decide whether to test before you treat.
After the case, Attending’s Notes explains the decisions that mattered, backed by 10 sources.
Ready to make the call?
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Spoiler: the diagnosis and what this case teaches
Diagnosis
Strep Pharyngitis
Lesson 1
Imani's Story Pointed to Strep
Strep typically causes fever and tonsillar exudate without cough or runny nose.
- Sudden sore throat with fever
- No cough, no runny nose
- Tonsillar exudate, tender anterior nodes
- A positive rapid strep confirms it
Lesson 2
A Strep Test Comes Before Antibiotics
Even classic strep symptoms don't reliably distinguish bacterial from viral pharyngitis.
- Centor: fever, no cough, exudate, tender nodes
- Cough or runny nose: likely viral, usually no strep test
- Adults: no backup culture after a negative rapid test
- An early Monospot can be falsely negative
- Mono can look exactly like strep
Lesson 3
Penicillin Is Still First Line, Decades Later
No clinical isolate of group A strep has been reported resistant to penicillin.
- Amoxicillin 500 mg twice daily for 10 days
- Or benzathine penicillin G 1.2 million units IM
- Ibuprofen or acetaminophen for pain and fever
- Treating shortens illness and reduces complications
Lesson 4
Most Go Home, a Few Are Emergencies
Drooling, muffled voice or trismus: think deeper infection.
- Epiglottitis: muffled voice, drooling, stridor
- Peritonsillar abscess: uvular deviation, trismus
- Return when fever-free and 12 to 24 hours into antibiotics
- Return for trouble breathing or swallowing
In the app, every line above opens into the detail behind it: doses, pitfalls and the evidence, with 10 sources linked to the originals.
Imani is a fictional patient. Code Status is for training only and is not intended for real-world patient care, diagnosis, treatment, or clinical decision-making.