Rosh Pediatrics Practice Exam

If the rapid streptococcal antigen test returns negative, what should be the next step?

1. Immediate treatment with antibiotics

2. Perform a throat culture

3. Start antiviral medications

4. Schedule a follow-up in one week

The correct answer is: Perform a throat culture

When a rapid streptococcal antigen test returns negative, the next step is to perform a throat culture. This is important because while rapid tests are useful for quickly identifying Group A Streptococcus, they can yield false-negative results. A throat culture is considered the gold standard for diagnosing streptococcal pharyngitis, as it involves incubating a throat swab on a growth medium to allow for the identification of the bacteria, providing a more definitive diagnosis. In situations where a patient presents with symptoms suggestive of strep throat, such as severe sore throat, fever, and swollen lymph nodes, relying solely on a negative rapid test could lead to missing a true infection. Therefore, performing a throat culture not only confirms or rules out the diagnosis but also guides appropriate treatment. Other potential actions, such as immediately treating with antibiotics or starting antiviral medications, would not be appropriate following a negative test result for streptococcus, as viral infections do not respond to antibiotics and unnecessary antibiotic use can contribute to resistance. Scheduling a follow-up in one week may lead to delays in treatment if the throat culture is positive, potentially causing complications from untreated strep throat. Therefore, performing a throat culture is the correct next step in this scenario.