Ms X, a 31-year-old nursing assistant, can’t recall the last time she had the flu and initially thought her sore throat could just be a transient problem as she had no other flu-like symptoms or fever.
The next day, however, it started getting more and more painful, especially on the right-hand side. She felt feverish and her right ear was also very painful. She went to her local pharmacy and bought over the counter throat lozenges and mouth wash.
After a night of no sleep, experiencing severe pain in her throat and ear, she decided to visit her GP.
The following is a summary of his notes:
Week history of sore throat:
· Initially generalised, now most painful on the right hand side
· Associated with fever and a painful right ear
· Unable to swallow properly
· Reports no difficulty breathing. Complaining that her jaw is “tight”.
· No medical or surgical history
No current medication use
Non-smoker and rarely uses alcohol
Patient appears to be in pain. Speaks softly. Some saliva noticed at mouth corners.
Systemic examination: no abnormalities found
Throat: very red, swollen mass on right side of throat, in the area of tonsillar bed. Uvula appears to be pushed to the left side of throat. Airway still open.
Patient finds it very difficult to open her mouth.
Temperature: 38.9° C
Based on the information above, what do you think is the most likely diagnosis?
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