Peritonsillar Abscess: The Daily PANCE Blueprint

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Peritonsillar Abscess: The Daily PANCE Blueprint

A 19-year-old college student has four days of worsening sore throat, now one-sided, with fever, drooling, and a muffled "hot potato" voice. He can barely open his mouth (trismus). On exam the right tonsil is swollen and pushed toward the midline, the soft palate bulges, and the uvula is deviated to the left. He is well enough to protect his airway. Which of the following is the most appropriate next step in management?

A. Oral antibiotics and outpatient follow-up
B. IV antibiotics alone
C. Needle aspiration or incision and drainage, plus antibiotics
D. Tonsillectomy today
E. Reassurance and saltwater gargles

Answer and topic summary

The answer is C. Needle aspiration or incision and drainage, plus antibiotics.

A unilateral bulging tonsil with uvular deviation, trismus, and a muffled “hot potato” voice is a peritonsillar abscess — a collection of pus, not just an inflamed throat. The definitive move is drainage (needle aspiration or incision and drainage) combined with antibiotics; you cannot cure a walled-off abscess with antibiotics alone. Antibiotics should cover group A Streptococcus and oral anaerobes, and immediate tonsillectomy is reserved for special situations (such as recurrent abscesses or failure to drain), not routine first-line care. Always assess the airway first, but this patient is protecting his.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint EENT ⇒ Infectious and Inflammatory Disorders ⇒ Peritonsillar Abscess

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