Exam 1 - Peritonsillar abscess

Question 1

What is peritonsillar abscess?

Answer 1

Deep infection of head and neck; collection of pus that forms between palatine tonsils and muscles

Question 2

Which patient population are peritonsilar abscesses more common?

Answer 2

More common in young adults

Question 3

Peritonsilar abscess symptoms

Answer 3

• Fever, malaise
• Worsening sore throat
• Pain worse on one side (ear)
• Dysphagia
• Odynophagia
• Decreased oral intake

Question 4

Physical exam findings that would cause the provider to suspect a peritonsilar abscess

Answer 4

• Trismus with difficulty opening mouth (due to neck spasms)
• Pooling of saliva and drooling
• Muffled or “hot potato voice”
• Tender anterior cervical adenopathy on affected side
• Tense swelling and erythema of anterior pillar and soft palate
• Tonsil displaced and deviation of uvula

Question 5

Peritonsilar abscess differential diagnoses

Answer 5

• Peritonsilar cellulitis
• Retropharyngeal or retromolar abscess
• Epiglottitis - medical emergency
• Neoplasm

Question 6

What would the provider use to diagnose peritonsilar abscesses?

Answer 6

Diagnosis based on clinical presentation and exam findings

• CT scan can be done to see if infection has spread to deeper tissues

Question 7

Are peritonsilar abscesses a medical emergency?

Answer 7

Requires immediate ED referral

Question 8

Is drainage indicated for peritonsilar abscesses?

Answer 8

Yes - needle aspirations done to see if there is pus

• Pus helps to differentiate between cellulitis or abscess (determines treatment plan)

Question 9

What medications can be given to treat peritonsilar abscesses?

Answer 9

• Antibiotics - IV PCN + flagyl
• Corticosteroids - single dose dexamethasone

Question 10

Supportive therapy for peritonsilar abscesses

Answer 10

• Pain control
• Hydration