Question 1

What is the FeverPAIN score and how does it guide antibiotic prescribing for sore throat?

Accepted Answer

FeverPAIN score (NICE NG84): Fever in last 24 hours (1 point); Purulence (exudate on tonsils, 1 point); Attend rapidly within 3 days (1 point); Severely Inflamed tonsils (1 point); No cough or coryza (1 point). Total 0–5. Score 0–1: <18% streptococcal infection — no antibiotic; Score 2–3: 36–34% strep — delayed (back-up) antibiotic only; Score 4–5: 62–65% strep — immediate antibiotic or delayed antibiotic. First-line antibiotic: Phenoxymethylpenicillin 500 mg QDS for 10 days (or amoxicillin 500 mg TDS). Penicillin allergy: Azithromycin 500 mg OD × 5 days. Note: Avoid amoxicillin if EBV/glandular fever suspected — causes maculopapular rash.

Question 2

How is BPPV (benign paroxysmal positional vertigo) diagnosed and treated in primary care?

Accepted Answer

BPPV diagnosis: Dix-Hallpike test — positive if torsional nystagmus appears within 5–20 seconds of positioning (latency), lasts <60 seconds (fatigability), and reproduces the patient's vertigo. Most common type: posterior semicircular canal BPPV (most responsive to treatment). Treatment: Epley manoeuvre — 4-step particle repositioning procedure performed in clinic; takes approximately 5 minutes; success rate 70–90% after one treatment. If HINTS exam (Head Impulse, Nystagmus pattern, Test of Skew) is abnormal — refer urgently to stroke team to exclude posterior fossa stroke. Central vertigo red flags: sudden onset severe headache, diplopia, dysarthria, dysphagia, facial numbness, ataxia — these need immediate CT/MRI.

Question 3

What is the GP management of acute otitis media in children?

Accepted Answer

Acute otitis media (AOM) GP management (NICE NG91): Most cases are viral and self-limiting — 80% resolve within 3 days without antibiotics. Watchful waiting strategy: Analgesia (paracetamol + ibuprofen) for 2–3 days; no antibiotics routinely. Immediate antibiotics indicated for: Under 2 years with bilateral AOM; Any age with otorrhoea; Severe illness or high fever (>39°C); Significant risk factors (immunosuppression, cochlear implant, Down syndrome). Delayed (back-up) antibiotic prescription for 3–5 days for mild/moderate AOM. First-line antibiotic: Amoxicillin 500 mg TDS × 5 days (adults/older children); High-dose amoxicillin 80–90 mg/kg/day for suspected resistant S. pneumoniae. Co-amoxiclav 625 mg TDS if treatment failure after 48 hours.

ENT — Ear, Nose & Throat

Sore Throat

Red Flags — Urgent/Emergency Referral

McIsaac Score (Modified Centor)

Viral Pharyngitis

Bacterial GAS (Strep)

Infectious Mononucleosis (EBV)

Peritonsillar Abscess (Quinsy)

Patient Education Points