## Peritonsillar Abscess: Clinical Features **Key Point:** Peritonsillar abscess is a unilateral collection of pus between the tonsillar capsule and the superior pharyngeal constrictor muscle, typically following acute tonsillitis. ### Typical Clinical Features | Feature | Presence | Explanation | |---------|----------|-------------| | **Unilateral tonsillar enlargement** | ✓ Always | Abscess is localized to one side | | **Uvula deviation** | ✓ Always | Pushed AWAY from affected side by mass effect | | **Muffled/hot potato voice** | ✓ Characteristic | Due to soft palate splinting and pharyngeal edema | | **Trismus** | ✓ Common | Inflammation involves muscles of mastication | | **Dysphagia** | ✓ Severe | Pain and mechanical obstruction | | **Bilateral exudate** | ✗ NOT typical | Abscess is unilateral; bilateral exudate suggests acute tonsillitis | | **Fever (high-grade)** | ✓ Typical | Often 39–40°C | **High-Yield:** The hallmark of peritonsillar abscess is **unilateral** presentation with uvula deviation **away** from the lesion. Bilateral findings suggest acute bacterial tonsillitis, not abscess formation. ### Why Option 1 is the Answer Bilateral tonsillar enlargement with symmetric exudate is the classic presentation of **acute bacterial tonsillitis** (e.g., Group A Streptococcus), NOT peritonsillar abscess. An abscess is a localized, unilateral collection and does not present with bilateral symmetric involvement. **Clinical Pearl:** If you see bilateral exudate and fever, think acute tonsillitis and start antibiotics. If you see unilateral bulging with uvula deviation, think abscess and plan for drainage (needle aspiration or incision and drainage). **Warning:** Do not confuse acute tonsillitis with peritonsillar abscess. The latter is a complication of the former and requires drainage; antibiotics alone are insufficient.
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