Pharynx and tonsils: agranulocytic angina: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Pharynx and tonsils: agranulocytic angina

Sample item

A woman on long-term carbimazole develops fever and a severe sore throat. The tonsils and pharynx show grey-black necrotic ulcers with very little surrounding redness. What is the most important immediate step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Stop the drug and send a full blood count with differential

Necrotic pharyngeal ulceration with minimal inflammatory response in a patient on an antithyroid drug suggests agranulocytic angina from drug-induced neutropenia. The offending drug must be stopped and the neutrophil count checked, with broad-spectrum antibiotics and specialist support if neutropenic.

Option by option

  • A. Plan urgent tonsillectomy under general anaesthesia

    Surgery on a neutropenic septic patient is unsafe and does not treat the cause.

  • B. Take a throat swab and give oral penicillin alone

    Oral penicillin alone is inadequate if the patient is neutropenic and the drug is continued.

  • C. Start high-dose oral corticosteroids

    Steroids do not restore neutrophils and may worsen infection.

  • D. Stop the drug and send a full blood count with differential (correct)

    Correct. Suspected drug-induced agranulocytosis needs the drug withdrawn and a differential count.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is D, Stop the drug and send a full blood count with differential. Necrotic pharyngeal ulceration with minimal inflammatory response in a patient on an antithyroid drug suggests agranulocytic angina from drug-induced neutropenia.

Why is "Plan urgent tonsillectomy under general anaesthesia" not the answer?

Surgery on a neutropenic septic patient is unsafe and does not treat the cause.

Why is "Take a throat swab and give oral penicillin alone" not the answer?

Oral penicillin alone is inadequate if the patient is neutropenic and the drug is continued.

Why is "Start high-dose oral corticosteroids" not the answer?

Steroids do not restore neutrophils and may worsen infection.

What concept does this question test?

It tests Pharynx and tonsils: agranulocytic angina in ENT. The offending drug must be stopped and the neutrophil count checked, with broad-spectrum antibiotics and specialist support if neutropenic.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pharynx and tonsils: agranulocytic angina?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.