Week 39 Q&A

You are seeing a 12-year-old adolescent girl with no significant past medical history in your office for the chief complaint of “sore throat.”

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Dec 04, 2018
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Her mother states that the patient has had 5 days of low-grade fevers, malaise, and a sore throat. This morning she appeared more ill, with temperature of 39.4°C (103°F), a severe sore throat, and neck pain, and she does not want to open her mouth. Physical exam is notable for unilateral left-sided tonsillar swelling, uvular deviation to the right, and trismus.

Based on this history and physical exam, the most likely diagnosis is:

A. Viral upper respiratory infection.

B. Sinusitis.

C. Peritonsillar abscess.

D. Strep throat.

E. Mononucleosis.




The correct answer is “C.” Classic physical exam findings for a peritonsillar abscess include severe sore throat, unilateral tonsillar swelling, trismus, and deviation of the uvula away from the affected side. Patients may also present with fever, drooling, odynophagia, and a muffled or “hot potato” voice. Hot potato voice is a buzz word for this infection. It is usually seen in older children and adolescents after an antecedent infection such as tonsillitis (option “E”), strep throat (option “D”) or a viral URI (option “A”). The physical exam is not consistent with sinusitis (option “B”).

Sources:

Question & Explanation: Peterson AR, Wood KE. Pediatrics Examination and Board Review. New York, NY: McGraw-Hill Education; 2017.

Photo: Shah SS, Kemper AR, Ratner AJ. Pediatric Infectious Diseases: Essentials for Practice, 2e; 2019. 

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Leah Carton

Editorial Assistant, McGraw-Hill Education

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