Review Question - QID 104432

This patient is presenting with a sore throat, fever, and deviation of his uvula suggesting a diagnosis of a peritonsillar abscess (PTA). In the setting of a recurrent PTA, incision and drainage is appropriate.

Peritonsillar abscesses occur primarily in young adults. This condition most often follows a group A streptococcal pharyngitis infection and exudative tonsillitis. The abscess is polymicrobial and generally presents with a fever, malaise, sore throat, dysphagia, and otalgia. On physical exam, the patient may have trismus and a muffled voice (classically called a "hot potato voice") with a deviation of the uvula. Management options that are appropriate include aspiration, incision and drainage, and antibiotics. In the setting of a recurrent PTA that is refractory to needle aspiration, incision and drainage and antibiotics may be indicated and have a lower recurrence rate of infection.

Figure/Illustration A is the physical exam finding in a PTA (blue arrow) with exudates and a deviated uvula.

Incorrect Answers:
Answers 1-2: Amoxicillin and penicillin offer insufficient treatment of a PTA. After the PTA has been drained (which is a mandatory step in management), antibiotics that could be appropriate include clindamycin, amoxicillin-clavulanate, and penicillin with metronidazole.

Answer 4: Needle aspiration can be an appropriate method to drain a PTA; however, it is less appropriate given the multiple recurrences of this patient's PTA.

Answer 5: Observation and reassurance is appropriate management of a viral pharyngitis which presents with a low-grade fever, minor dysphagia, and an absence of exudates.

Bullet Summary:
The treatment of a peritonsillar abscess that is refractory to aspiration is incision and drainage.