Test yourself
Peritonsillar abscess: scan from the neck
5 questions. Pick an answer to see whether you are right and why. Your score appears at the end.
Question 1Why use the transcervical approach in a patient with peritonsillar swelling?
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Answer a. Trismus and gagging limit intraoral scanning. A linear probe under the jaw reaches the tonsil without the patient opening the mouth. The intraoral approach gives better resolution when the patient tolerates it.
Question 2Which vessel must you find before aspirating a peritonsillar abscess?
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Answer a. The internal carotid artery lies behind and to the side of the tonsil. Colour Doppler shows its position and depth, so you aim the needle away from it and no deeper than the collection.
Question 3Swollen tonsillar tissue shows increased flow but no defined collection. What does this suggest?
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Answer a. Inflamed tissue without a defined fluid collection is cellulitis or phlegmon. It needs antibiotics and review, not aspiration. A collection can form over the next day or two.
Question 4A patient with a sore throat has drooling, stridor and a negative transcervical scan. What do you do?
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Answer c. Drooling and stridor are airway warning signs and point to a deep neck infection or epiglottitis. A negative scan does not exclude these. Get senior help early.
Question 5What does a peritonsillar abscess look like on ultrasound?
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Answer a. An abscess is a defined collection of pus beside the tonsil, often dark or mixed, with flow around it and none inside. An evenly speckled oval is the normal tonsil. A pulsatile round structure is the carotid artery.
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