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A sore throat with a "hot potato" voice
A 19-year-old has had a sore throat for 5 days that is now much worse on the right. He can barely open his mouth, is drooling, and his voice sounds muffled, like he is talking with a hot potato in his mouth.
Step 1 of 4
The right soft palate bulges and the uvula is pushed to the left.
What is the most likely diagnosis?
Correct answer: E
Severe unilateral throat pain, a "hot potato" voice, trismus, drooling and a uvula deviated away from the affected side is a peritonsillar abscess (quinsy) — here on the right (see palatine tonsils).
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E
Severe unilateral throat pain, a "hot potato" voice, trismus, drooling and a uvula deviated away from the affected side is a peritonsillar abscess (quinsy) — here on the right (see palatine tonsils).
Step 2 of 4
Where does the pus collect?
Correct answer: B
Tonsillitis spreads into the space between the tonsillar capsule and the superior constrictor (the tonsillar bed).
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B
Tonsillitis spreads into the space between the tonsillar capsule and the superior constrictor (the tonsillar bed).
Step 3 of 4
What is the appropriate treatment?
Correct answer: C
A peritonsillar abscess is treated with needle aspiration or incision and drainage plus antibiotics. Ultrasound can confirm it and guide aspiration; contrast CT is used if the diagnosis is unclear or a deeper infection is suspected.
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C
A peritonsillar abscess is treated with needle aspiration or incision and drainage plus antibiotics. Ultrasound can confirm it and guide aspiration; contrast CT is used if the diagnosis is unclear or a deeper infection is suspected.
Step 4 of 4
If the infection spreads deeper, which space does it reach next?
Correct answer: B
The deep neck spaces communicate: tonsillar infection tracks peritonsillar → parapharyngeal, and from there can reach the carotid sheath and down to the mediastinum (see deep neck spaces).
Show answer
B
The deep neck spaces communicate: tonsillar infection tracks peritonsillar → parapharyngeal, and from there can reach the carotid sheath and down to the mediastinum (see deep neck spaces).
Key points
- Hot potato voice + trismus + uvula deviated away → peritonsillar abscess → drain + antibiotics.
- Deep neck spaces communicate: peritonsillar → parapharyngeal → carotid sheath and mediastinum.
Study: Palatine tonsils, Deep neck spaces, Pharynx