Rosh Emergency Medicine Practice Test

What management step should be taken for a patient presenting with dysphagia, anterior cervical lymphadenopathy, and fever?

1. A. Immediate hospitalization

2. B. Empirical antibiotic therapy

3. C. Urgent ENT referral

4. D. Vasopressors and fluid resuscitation

The correct answer is: B. Empirical antibiotic therapy

The management of a patient presenting with dysphagia, anterior cervical lymphadenopathy, and fever typically involves addressing the likelihood of an infectious cause, such as a severe pharyngitis or a peritonsillar abscess. Empirical antibiotic therapy is crucial in this context because it targets potential bacterial infections that could be causing these symptoms, particularly if the clinical picture suggests a significant infection that could lead to complications, such as airway obstruction. In this scenario, starting empirical antibiotics is a practical first step to combat the infection while further diagnostics are considered. It also serves to mitigate the risk of worsening infection or complications during a period of observation, especially given the patient's symptoms reflecting systemic involvement such as fever. While hospitalization may be necessary depending on the severity of the patient's condition, empirical antibiotic therapy is a more immediate management step that can address the underlying cause. Urgent ENT referral may also be warranted after initial management and stabilization, but initiation of antibiotics takes precedence in this acute setting. Vasopressors and fluid resuscitation would be reserved for managing septic shock or significant hypotension, which does not directly correspond to the symptoms outlined in the question.