Free BCEN Certified Emergency Nurse (CEN) Practice Question

The correct answer is to perform needle aspiration. This scenario describes a classic presentation of a peritonsillar abscess, which is a collection of pus between the tonsillar capsule and the pharyngeal muscles. The key symptoms include severe sore throat, difficulty swallowing (odynophagia), and a muffled or 'hot potato' voice. Physical examination typically reveals unilateral tonsillar swelling and uvular deviation away from the affected side.

Needle aspiration is the preferred initial management for several reasons:

1. It confirms the diagnosis by obtaining purulent material.
2. It provides immediate relief of symptoms.
3. It can be therapeutic in some cases, potentially avoiding the need for incision and drainage.
4. It helps guide further management decisions.

While CT scanning can be useful in complicated cases or when the diagnosis is uncertain, it is not the first step in a typical presentation. Immediate incision and drainage, while sometimes necessary, is more invasive and is usually reserved for cases where aspiration is unsuccessful or insufficient. Oral antibiotics alone are inadequate for treating a fully formed abscess and do not provide the immediate relief needed in this situation.