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Questions and Answers
What is the most likely diagnosis in a patient with sore throat, fever, and medial displacement of the uvula and palatine tonsil?
What is the most likely diagnosis in a patient with sore throat, fever, and medial displacement of the uvula and palatine tonsil?
- Peritonsillar Abscess (correct)
- Pharyngitis
- Retropharyngeal Abscess
- Acute Epiglottitis
What is the peak incidence of retropharyngeal abscess?
What is the peak incidence of retropharyngeal abscess?
- 20-25 years
- 10-15 years
- 3-5 years (correct)
- 6-12 months
What is the significance of a temperature over 38°C (100.4°F) in a patient with sore throat?
What is the significance of a temperature over 38°C (100.4°F) in a patient with sore throat?
- It suggests a viral etiology
- It strongly suggests an infectious cause (correct)
- It is a normal variant
- It is a contraindication for antibiotic therapy
What is the treatment for retropharyngeal abscess?
What is the treatment for retropharyngeal abscess?
What is the role of imaging in the diagnosis of peritonsillar abscess?
What is the role of imaging in the diagnosis of peritonsillar abscess?
What is the primary concern in managing a patient with acute epiglottitis?
What is the primary concern in managing a patient with acute epiglottitis?
What is the characteristic voice quality in a patient with peritonsillar abscess?
What is the characteristic voice quality in a patient with peritonsillar abscess?
Which of the following is a common feature of acute epiglottitis?
Which of the following is a common feature of acute epiglottitis?
What is the most common age group affected by peritonsillar abscess?
What is the most common age group affected by peritonsillar abscess?
Which of the following is a complication of peritonsillar abscess?
Which of the following is a complication of peritonsillar abscess?
What is the estimated number of cases of GABHS pharyngitis that need to be treated to prevent 1 case of acute rheumatic fever (ARF) in the USA?
What is the estimated number of cases of GABHS pharyngitis that need to be treated to prevent 1 case of acute rheumatic fever (ARF) in the USA?
What is the time frame within which poststreptococcal glomerulonephritis can develop after infection with GABHS?
What is the time frame within which poststreptococcal glomerulonephritis can develop after infection with GABHS?
What is the name of the condition characterized by abrupt onset of severe exacerbations of obsessive-compulsive type behaviors or tics in children following GABHS infection?
What is the name of the condition characterized by abrupt onset of severe exacerbations of obsessive-compulsive type behaviors or tics in children following GABHS infection?
What is the name of the abscess that can occur in the space between the capsule of the tonsil and the surrounding tissues?
What is the name of the abscess that can occur in the space between the capsule of the tonsil and the surrounding tissues?
Which of the following is NOT a suppurative complication of GABHS pharyngitis?
Which of the following is NOT a suppurative complication of GABHS pharyngitis?
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Study Notes
Peritonsillar Abscess
- Medial displacement of the uvula, palatine tonsil, and anterior pillar can be seen in acute peritonsillar abscess
- Culture of pus from abscess drainage confirms diagnosis
- Imaging is not necessary to confirm diagnosis, but CT with IV contrast (LR+ 4, LR- 0) and intraoral ultrasonography (sensitivity 89-95%, specificity 79-100%) can be used
- Treatment includes drainage, antibiotic therapy, and supportive care
- Peritonsillar abscess is the most common deep infection of the head and neck (30% of abscesses), usually begins as acute tonsillitis → cellulitis → abscess formation
- Polymicrobial infection with common organisms: Group A streptococci, Staphylococcus aureus, Haemophilus influenzae, Fusobacterium, Peptostreptococcus, Pigmented Prevotella species, Veillonella
Clinical Presentation of Peritonsillar Abscess
- Severe unilateral sore throat
- Dysphagia and odynophagia leading to pooling of saliva or drooling
- Fever and malaise
- Dysphonia: muffled “hot potato” voice
- Rancid or fetor breath
- Otalgia
- Trismus (66% of patients)
- Oropharyngeal exam: erythematous enlarged tonsil and bulging soft palate on affected side, uvular deviation to contralateral side
- May have severely tender cervical lymphadenopathy
Retropharyngeal Abscess
- Retropharyngeal edema due to cellulitis and suppurative adenitis of lymph nodes in retropharyngeal space
- Preceded by upper respiratory infection, pharyngitis, otitis media, or wound infection following penetrating injury to posterior pharynx
- Peak incidence in 3-5 year olds
- Observed as prevertebral soft-tissue thickening on lateral X-ray of neck
- Treat as impending airway emergency, requires antibiotic therapy, and possible surgical consultation for needle aspiration or incision and drainage
Clinical Presentation of Retropharyngeal Abscess
- Sore throat and dysphagia
- Fever
- Drooling
- Dysphonia (muffled voice)
- Neck stiffness; limited neck ROM (especially hyperextension)
- Stridor
- May see bulging of the posterior wall of oropharynx on clinical examination
Complications of Pharyngitis
- Non-suppurative complications: acute rheumatic fever (ARF), poststreptococcal glomerulonephritis, pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal (PANDAS) infection
- Suppurative complications: peritonsillar abscess, retropharyngeal abscess, otitis media, sinusitis, mastoiditis, cervical lymphadenitis, meningitis, bacteremia
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