A 13-year-old boy has a 3-day history of low-grade fever, upper respiratory symptoms, and a sore throat. A few hours before his presentation to the emergency room, he has an abrupt onset of high fever, difficulty swallowing, and poor handling of his secretions. He indicates that he has a marked worsening in the severity of his sore throat. His pharynx has a fluctuant bulge in the posterior wall. Which of the following is the most appropriate initial therapy for this patient?
a. Narcotic analgesics
b. Trial of oral penicillin V
c. Surgical consultation for incision and drainage under general anesthesia
d. Rapid streptococcal screen
e. Monospot test
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is c; Surgical consultation for incision and drainage under general anesthesia.
Suppurative infection of the chain of lymph nodes between the posterior pharyngeal wall and the prevertebral fascia leads to retropharyngeal abscesses. The most common causative organisms are Staphylococcus aureus, group A ß-hemolytic streptococci, and oral anaerobes. Presenting signs and symptoms include a history of pharyngitis, abrupt onset of fever with severe sore throat, refusal of food, drooling, and muffled or noisy breathing. A bulge in the posterior pharyngeal wall is diagnostic, as are radiographs of the lateral neck that reveal the retropharyngeal mass. Palpation (with adequate provision for emergency control of the airway in case of rupture) reveals a fluctuant mass. Treatment should include incision and drainage if fluctuance is present.