Acute Bacterial Parotitis — ORE Part 1 MCQ

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ModerateOral MedicineAcute Bacterial ParotitisORE Part 1

A 65-year-old man presents with a painful, erythematous, swollen right parotid gland. He is febrile (38.5°C) and dehydrated following recent abdominal surgery. Pus can be expressed from Stensen's duct on milking the gland. What is the most likely diagnosis?

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Correct answer: A — Acute bacterial (suppurative) parotitis

Acute bacterial (suppurative) parotitis is the correct diagnosis. The pathognomonic finding is purulent discharge from Stensen's duct on gland compression—a hallmark that distinguishes bacterial infection from other causes of parotid swelling. Combined with fever, unilateral erythematous swelling, and dehydration (a key risk factor for impaired salivary flow and retrograde infection), the diagnosis is definitive. Post-operative dehydration predisposes to stasis and ascending bacterial infection from the oral cavity. Mumps presents bilaterally without suppuration; Sjögren is chronic and autoimmune, not acutely infectious; tumours do not produce fever or pus; sialolithiasis alone does not cause fever unless secondarily infected (which would then be suppurative parotitis).

Reference: Clinical and microbiological analysis of six children with acute suppurative parotitis, PubMed, https://pubmed.ncbi.nlm.nih.gov/8834990/