MLA Domain 5 · Presentation

Sore throat

20 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 6

Human immunodeficiency virus (HIV)

AIDS-defining illness, very low CD4, seroconversion illness, needle-stick/exposure (PEP within 72h)

IgA nephropathy & IgA vasculitis

Nephritic syndrome with rising creatinine → RPGN risk → nephrology/biopsy

Infectious mononucleosis (glandular fever)

SPLENOMEGALY → risk of splenic rupture (avoid contact sport for ~4–6 weeks); rarely airway compromise from massive tonsi

Rheumatic fever

Severe carditis with heart failure → admit and treat

Scarlet fever

Complications: rheumatic fever, post-strep glomerulonephritis, invasive GAS/toxic shock

Upper respiratory tract infection (common cold)

Breathing difficulty, persistent high fever, dehydration (especially infants), or features of a complication (pneumonia,

recognised feature · 10

Acute epiglottitis

Any stridor, drooling or tripod posture = impending airway obstruction → do NOT lie the patient down, examine the throat

COVID-19

Hypoxia / respiratory failure → oxygen + escalation (cross-ref respiratory failure); VTE risk → thromboprophylaxis

Hand, foot and mouth disease

Dehydration from poor oral intake; rare neurological disease with enterovirus 71

Head and neck cancer (oral/laryngeal/salivary)

Persistent mouth ulcer/patch >3 weeks, hoarseness >3 weeks, unexplained neck lump, dysphagia, or a salivary lump with fa

Influenza

Deterioration with new consolidation → secondary bacterial pneumonia (esp. Staph. aureus) → antibiotics

Laryngitis & hoarseness

Hoarseness persisting >3 weeks (especially a smoker/drinker), neck lump, dysphagia, otalgia, haemoptysis, or stridor → 2

Mesenteric adenitis

Do not miss appendicitis — if in doubt, observe/image/operate

Pharyngitis / tonsillitis

Trismus + "hot-potato" voice + uvular deviation → quinsy; drooling/stridor/unable to swallow → epiglittitis/airway; unil

Quinsy (peritonsillar abscess)

Airway compromise, inability to swallow saliva/drooling, spread to a parapharyngeal/retropharyngeal abscess → urgent ENT

Streptococcal infections

Necrotising fasciitis / streptococcal toxic shock (GAS) → surgical debridement + benzylpenicillin + clindamycin

differential of the above · 4

Acute rhinosinusitis

Periorbital swelling/erythema, proptosis, painful/restricted eye movements or visual change → ORBITAL CELLULITIS; severe

Infective endocarditis

Acute S. aureus IE with valve destruction → heart failure/cardiogenic shock → emergency surgery

Kawasaki disease

Coronary artery aneurysms — the feared complication; incomplete Kawasaki in infants

Measles

Complications: otitis media, pneumonia, encephalitis, (late) SSPE; immunocompromised/pregnant