Cases in Tonsil Disease: From the Routine to the Serious

Gordon H. Sun, MD, MS

Disclosures

May 23, 2017

An Irritated Throat

Anna, a 16-year-old girl, went to the high school health clinic for the first time with a 3-day complaint of sore throat and odynophagia. The patient reported missing class for 1 day earlier in the week due to fever and chills, although she also said that both symptoms resolved with over-the-counter acetaminophen. She denied neck stiffness, otalgia, nausea, dyspnea, and dysphagia. She denied changes in her voice, although it was sometimes painful to talk.

She has a history of recurrent sore throats growing up, estimating "at least twice a year since grade school," and said that her two younger siblings were often sick as well. She never had head and neck surgery. Other than acetaminophen, she was not taking medications and had no known drug allergies. The patient denied smoking, drinking alcohol, or using illicit substances.

Physical examination demonstrated a tired-looking but well-nourished adolescent girl in no apparent distress. Her body temperature was 38.9º C; other vital signs were within normal limits. She had a normal speaking voice and no stridor. Other pertinent findings on head and neck examination included inflamed tonsils that nearly touched at the midline, with exudate present on the surfaces. There was no facial tenderness, trismus, or dental pathology. The uvula was midline, and the soft palate was erythematous but not edematous. The neck was supple, without tenderness or palpable masses. Rapid strep testing in the clinic was negative.

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