Immediate Questions

A. What are the vital signs? Fever and tachycardia are common to many conditions included in the differential diagnosis, but associated hypotension may signify sepsis or group A ^-hemolytic streptococcal (GABHS) toxic shock syndrome. Significant tachypnea and respiratory distress can be associated with upper airway obstruction from enlarged tonsils, deep neck abscesses, epiglot-titis, and bacterial tracheitis.

B. How old is patient? Different pediatric diseases are more common in children of different ages. Group A streptococcal pharyngitis is more prevalent between ages 5 and 15 years; retropharyngeal abscesses are rare after the age of 5 years because the retropharyngeal nodes involute.

C. What is respiratory status and patient position? Patients with upper airway obstruction often sit in the tripod and sniffing position to alleviate compression of the trachea.

D. Was there a preceding illness? Deep neck abscesses often follow nonspecific mild upper respiratory illnesses. Bacterial tra-cheitis usually follows croup.

E. Has patient been immunized? Haemophilus influenzae type b (Hib) immunization, and patient age in this case, makes epiglottitis unlikely.

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