The soft palate, pharynx, and tonsils are red and swollen. What is the most appropriate next step in the management of this patient?

22-year-old female presents with complaints of heat intolerance, sweating and palpitations. She also reports
menstrual irregularities, increased appetite and diarrhea. Her pulse is 102/min and regular, blood pressure is
116/80 mm Hg, temperature is 37.2° C (99° F), and respirations are 14/min. Physical examination reveals a
diffusely enlarged, nontender thyroid gland. TSH level is 0.05 mU/L. Free T4 and T3 levels are elevated.
Radioactive iodine uptake at 24 hours is 50 percent. Thyroid stimulating immunoglobulins are present. She is
started on propylthiouracil 300 mg daily in three divided doses. After two weeks, she returns and complains of a sore throat. Her pulse is 98/min and regular, temperature is 38.6° C (101.5° F), blood pressure is 115/76 mm Hg, and respirations are 15/min. The soft palate, pharynx, and tonsils are red and swollen. What is the most
appropriate next step in the management of this patient?

  • 0 A. Add propranolol
  • 0 B. Increase propylthiouracil dose
  • 0 C. Stop propylthiouracil
  • 0 D. Throat culture
  • 0 E. Oral penicillin
  • 0 F. Acetaminophen

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