A 2-year-old girl is seen in an urgent care center for difficulty breathing and a sore throat. Her father states that over the previous 48 hours she complained of a sore throat, developed a fever to touch, and had some rhinorrhea.
He states that the sore throat seems to have progressed over the previous 4 hours such that she now refuses to take liquids or to swallow. He states
that she has developed difficulty breathing in the last 1 hour.
The child has had no previous serious illnesses, takes no medications, and has had normal development compared to her siblings. She is current with her immunizations. On physical examination, she is lying on the examination table, wary of strangers but easily consoled. Vital signs show temperature of 39.3°C (102.8°F), heart rate 150 beats/min, respiratory rate 24 breaths/min, blood pressure 102/71 mm Hg, and oxygen saturation of 95% on room air.
The head is normocephalic. Movement of the head from side to side is limited. Ear canals are clear; the tympanic membranes are translucent. Mucous
membranes are moist; saliva is noted dripping from the mouth. The tongue and tonsils are of normal size. The posterior pharynx is full and red. The
uvula is midline. The nares have clear discharge bilaterally. The heart has normal S1 and S2; no murmur is heard. The chest and abdominal examinations are normal. Neurologic and musculoskeletal examinations are normal.
Infection of which of the following structures is the most likely etiology of
these findings?
- A. Retropharyngeal space
- B. Peritonsillar spaces
- C. Epiglottis
- D. Remnant of a thyroglossal duct
- E. Meninges
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