Sore throat and tonsillitis — KFP-style written assessment

KFP 1 (10 marks)

A 19-year-old student presents with two days of sore throat, fever to 38.4°C yesterday, purulent tonsillitis, tender anterior cervical nodes and no cough or coryza. She has an exam tomorrow and asks for "the strongest antibiotic". ^[1]

1. Calculate her FeverPAIN score and state the recommended strategy. (3) ^[2]
2. She demands immediate antibiotics. Which agent, dose and duration — and what does the duration achieve? (4) ^[1]
3. What absolute symptom benefit will she actually feel? (3) ^[1]

Model answers

1. FeverPAIN 5: fever within 24 hours, tonsillar purulence, attendance within three days of onset, severely inflamed tonsils, no cough or coryza. Score 4–5 justifies immediate antibiotics; her streptococcal likelihood is high. ^[2]
2. Phenoxymethylpenicillin (penicillin V) for 10 days at weight-appropriate dosing. The 10-day course targets eradication of group A Streptococcus — the rationale is rheumatic fever prevention, not symptom relief; stopping at day 5 risks treatment failure without shortening symptoms meaningfully. ^[1]
3. Antibiotics roughly halve soreness and fever at their greatest effect around day three; by one week about 82% of untreated patients are symptom-free anyway. The absolute benefit is roughly 16 hours earlier settlement — worth stating so her expectations match reality. ^[1]