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Streptococcal pharyngitis — USMLE Step 2 CK MCQ

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HardPediatricsStreptococcal pharyngitisUSMLE Step 2 CK

A 4-year-old boy has fever, neck stiffness, torticollis, muffled voice, and refusal to extend his neck after an upper-respiratory infection. He is drooling but maintains the airway and oxygen saturation. Lateral neck radiography suggests widened prevertebral soft tissue. Which study best defines the suspected collection before operative drainage?

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Correct answer: A — Contrast-enhanced CT encompassing the neck and upper mediastinum

The best answer is “Contrast-enhanced CT encompassing the neck and upper mediastinum”. This presentation suggests a retropharyngeal abscess. In a child whose airway is currently stable, contrast-enhanced neck CT rapidly shows whether a drainable collection exists and delineates its relationship to the airway, vessels, and mediastinum. Airway deterioration would instead require immediate controlled airway management before diagnostic imaging.

Reference: ACR Appropriateness Criteria: Neck Mass-Adenopathy: https://acsearch.acr.org/docs/69504/Narrative/