Simulated Patient Scenario

Scenario Details

MDT Information

• Non-Urgent Response - Sore Throat / Flu-like Symptoms
• 28-year-old female feeling unwell
• Sore throat, headache, feeling tired
• Patient called seeking advice / assessment
• Location: Patient's apartment

On Arrival

You arrive at an apartment. The patient, a 28-year-old female, answers the door wearing casual clothes. She appears tired but is alert and ambulatory. She apologises for calling but states she feels quite unwell with a very sore throat and wasn't sure what to do.

Initial Impression and Primary Survey

Secondary Survey and Simulation Progression

History (obtained from patient)

Vital Signs/Assessment (Initial)

Physical Examination

• General Appearance: Alert, appears mildly unwell but comfortable at rest.
• Oropharynx: Pharynx and tonsils appear moderately erythematous (red). No significant tonsillar swelling or exudates (pus). Uvula is midline. Palate appears normal.
• Neck: Mildly tender, slightly enlarged anterior cervical lymph nodes palpable bilaterally. No neck stiffness. Trachea midline.
• ENT: Nose clear apart from mild rhinorrhoea. Tympanic membranes appear normal bilaterally.
• Respiratory: Chest clear on auscultation. No respiratory distress.
• Skin: No rash noted.

Assessment and Treatment

Appropriate Management Focus

• Primary Survey (ABCDE): Confirm stability.
• Differential Diagnosis: Consider likely viral pharyngitis based on gradual onset, associated coryzal symptoms, moderate throat erythema without exudate, and contact history. Differentiate from bacterial tonsillitis (less likely given lack of exudate/high fever/marked nodes) and red flag conditions.
• Rule Out Red Flags: Assess for signs of airway compromise (stridor, drooling, muffled voice, respiratory distress), severe systemic illness/sepsis (high fever, rigors, hypotension, marked tachycardia, altered mental state), peritonsillar abscess/quinsy (unilateral swelling, uvular deviation, trismus), epiglottitis (rare in adults - rapid onset, severe pain, drooling). None present here.
• Scoring Systems (Contextual): Mention awareness of scoring systems like Centor or FeverPAIN used to predict likelihood of Strep A infection, but acknowledge limitations and primary role in guiding antibiotic decisions (usually in primary care). Patient scores low on these criteria (e.g., FeverPAIN: Fever +1, No Purulence 0, Attend rapidly <3 days +1, No cough 0, Inflamed tonsils +1 = Score 3 - intermediate risk, viral more likely).
• Symptomatic Relief Advice:
  • Recommend regular simple analgesia (Paracetamol, Ibuprofen - if tolerated).
  • Advise rest and adequate fluid intake.
  • Suggest throat lozenges or sprays for temporary relief.
• Patient Education & Safety Netting:**
  • Explain the likely viral nature of the illness and that antibiotics are usually not needed and won't help.
  • Advise on expected duration (usually improves within 5-7 days).
  • **Provide clear safety netting advice:** Instruct patient to seek further medical attention (GP or ED) if symptoms worsen significantly, develop difficulty breathing or swallowing, severe headache, neck stiffness, rash, high fever persists >3 days, or if they feel generally much more unwell.
  • Provide written information if available.
• Transport Decision: Based on stable vital signs, absence of red flags, and likely viral illness, transport to ED is generally **not required**. Advise patient to follow up with their GP if symptoms persist or worsen as per safety netting advice.
• Documentation: Record history, vital signs, examination findings (especially throat appearance, nodes, absence of red flags), likely diagnosis (viral pharyngitis), treatment advice given (analgesia, fluids, rest), comprehensive safety netting advice provided, and confirmation of patient understanding and agreement with non-transport plan.
• Teamwork & Communication: Ensure clear communication with the patient, confirming understanding of the condition and advice.