Throat and Neck Infections Practice Questions

30 multiple-choice questions on Throat and neck infections for paramedic and EMT students, from Chapter 20 (Diseases of the Eyes, Ears, Nose, and Throat). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. An 84-year-old nursing home resident who has been drinking poorly has a fever and a tender, swollen area in front of her ear and over the angle of the jaw. Pus appears inside her cheek when the area is pressed. What is the most likely cause?

   1. A. Infection of the parotid gland
   2. B. A dental abscess of a lower molar
   3. C. Mumps from a recent exposure
   4. D. An infected lymph node in the neck
   Show answer

   Answer: A. Infection of the parotid gland

   Dehydrated, older patients and those on drugs that dry the mouth are prone to bacterial infection of the parotid gland (suppurative parotitis), which causes painful swelling in front of the ear and over the jaw angle, with pus at the duct opening inside the cheek. She needs fluids, antibiotics and evaluation. A dental abscess of a lower molar centers on the tooth, mumps is viral and seldom seen in vaccinated older adults, and an infected lymph node does not drain pus into the mouth.

2. A 17-year-old started amoxicillin for a sore throat 4 days ago. Now she has a widespread red rash. She also has large tonsils with exudate, tender lymph nodes at the back of her neck and severe fatigue. She has no wheezing or swelling of the lips. What is the most likely explanation?

   1. A. Anaphylaxis to the amoxicillin
   2. B. Mononucleosis with a drug rash
   3. C. Scarlet fever from strep throat
   4. D. Measles from a recent exposure
   Show answer

   Answer: B. Mononucleosis with a drug rash

   Many patients with infectious mononucleosis who are given amoxicillin or ampicillin develop a widespread rash. Tender nodes at the back of the neck and severe fatigue with exudative tonsils point to mononucleosis, and the rash is not a dangerous reaction, though she should stop the drug and be evaluated. Anaphylaxis to the amoxicillin would involve wheezing, swelling or low BP, scarlet fever from strep throat causes a sandpaper rash without posterior nodes and extreme fatigue, and measles from a recent exposure begins with cough, runny nose and red eyes.

3. A 2-year-old with painful mouth sores has been given viscous lidocaine many times today by a parent trying to ease the pain. He just had a seizure. He is afebrile and his glucose is normal. What is the most likely cause?

   1. A. A febrile seizure from the virus
   2. B. Toxicity from the lidocaine
   3. C. Low glucose from not eating
   4. D. Meningitis spreading from the sores
   Show answer

   Answer: B. Toxicity from the lidocaine

   Viscous lidocaine is swallowed and absorbed, and repeated doses in a small child can reach toxic levels that cause seizures, slow heart rhythms and cardiac arrest, which is why the FDA warns against using it for teething and mouth pain in young children. Manage the airway and seizure per protocol and bring the bottle. A febrile seizure is unlikely without fever, low glucose has been ruled out, and meningitis would cause fever and a stiff neck.

4. Three days after feeling a fish bone stick in his throat, a 55-year-old has a fever, worsening neck pain, painful swallowing and crackling under the skin of his neck. What is the most likely problem?

   1. A. A tear in the throat or esophagus
   2. B. A fish bone that passed harmlessly
   3. C. A peritonsillar abscess
   4. D. Viral pharyngitis from the meal
   Show answer

   Answer: A. A tear in the throat or esophagus

   Crackling under the skin (subcutaneous emphysema) with fever and worsening neck pain after a lodged bone suggests a perforation of the pharynx or esophagus, which lets air and bacteria into the neck and can spread to the mediastinum. He needs urgent surgical evaluation. A bone that passed harmlessly would not cause crackling and fever, a peritonsillar abscess causes trismus and a deviated uvula without air in the neck, and viral pharyngitis does not cause subcutaneous air.

5. A 5-year-old with very large tonsils snores loudly every night. His parents see pauses in breathing followed by gasps, and he is tired and irritable during the day. What is the most likely problem?

   1. A. Normal childhood snoring
   2. B. Nightly seizures
   3. C. Asthma that is worse at night
   4. D. Obstructive sleep apnea
   Show answer

   Answer: D. Obstructive sleep apnea

   Large tonsils and adenoids are the most common cause of obstructive sleep apnea in children. Loud snoring with pauses and gasps, plus daytime tiredness and behavior changes, suggest the airway is closing during sleep, and these children are also at higher risk when sedated. Normal snoring has no pauses or gasps, seizures do not cause snoring with gasps, and asthma causes cough and wheezing rather than snoring pauses.

6. A 3-year-old has fever, refuses to move her neck, has drooling and noisy breathing, and holds her neck extended. Which condition should you suspect?

   1. A. Peritonsillar abscess
   2. B. Strep throat with nodes
   3. C. Acute bacterial meningitis
   4. D. Retropharyngeal abscess
   Show answer

   Answer: D. Retropharyngeal abscess

   Retropharyngeal abscess is most common in children under 5. Neck stiffness or reluctance to move the neck, drooling, fever, and stridor can occur, and the airway may be compromised.

7. Which complication of a retropharyngeal abscess is especially dangerous?

   1. A. Mastoiditis
   2. B. Orbital cellulitis
   3. C. Mediastinitis
   4. D. Facial nerve palsy
   Show answer

   Answer: C. Mediastinitis

   Infection can track down the prevertebral spaces into the mediastinum, causing mediastinitis, which carries high mortality. Airway obstruction and abscess rupture with aspiration are other risks. Mastoiditis spreads from the middle ear, orbital cellulitis from the sinuses or eyelid, and facial nerve palsy is not a typical result of a retropharyngeal abscess, which spreads downward into the chest.

8. A 16-year-old has sore throat, fever, tender swollen anterior neck nodes, tonsillar exudate, and no cough. What is the most likely cause?

   1. A. Epiglottitis
   2. B. Ludwig's angina
   3. C. Allergic reaction
   4. D. Strep pharyngitis
   Show answer

   Answer: D. Strep pharyngitis

   Fever, tender anterior cervical nodes, tonsillar exudate, and absence of cough suggest group A streptococcal pharyngitis.

9. A 38-year-old with advanced HIV has pain every time he swallows and white plaques on his tongue and palate. What is the most likely cause?

   1. A. Fungal esophagitis
   2. B. Strep pharyngitis
   3. C. A peritonsillar abscess
   4. D. Acid reflux disease
   Show answer

   Answer: A. Fungal esophagitis

   White plaques in the mouth (thrush) with painful swallowing in a person with a weak immune system suggest that Candida has spread to the esophagus (fungal esophagitis), which needs antifungal treatment and can lead to poor intake and dehydration. Strep pharyngitis causes tonsillar exudate and fever rather than plaques, a peritonsillar abscess causes one-sided swelling and trismus, and acid reflux disease does not cause white plaques.

10. A college student has fatigue, sore throat, fever, posterior neck lymph nodes, and an enlarged spleen. What is most likely?

    1. A. Retropharyngeal abscess
    2. B. Peritonsillar abscess
    3. C. Infectious mononucleosis
    4. D. Diphtheria
    Show answer

    Answer: C. Infectious mononucleosis

    Mononucleosis (Epstein-Barr virus) causes fatigue, pharyngitis, lymphadenopathy, and splenomegaly. Contact sports should be avoided because of the risk of splenic rupture.

11. A 2-year-old has a fever and a warm, red, tender lump under the jaw that feels soft and fluid-filled in the center. She breathes comfortably and is drinking. What is the most likely problem?

    1. A. An abscess of a lymph node
    2. B. Ludwig angina with airway risk
    3. C. A normal reactive node
    4. D. Mumps in the parotid gland
    Show answer

    Answer: A. An abscess of a lymph node

    A neck lymph node can become infected and form an abscess, which is warm, red and tender with a soft, fluid-filled center. With normal breathing and drinking she needs ED evaluation for drainage and antibiotics rather than airway intervention. Ludwig angina causes a firm, swollen floor of the mouth and a raised tongue, a normal reactive node is small and not fluid-filled, and mumps swells the parotid gland in front of the ear.

12. An unvaccinated child has sore throat, fever, and a thick gray membrane adherent to the tonsils and pharynx that bleeds when scraped. What should you suspect?

    1. A. Strep pharyngitis
    2. B. Mononucleosis
    3. C. Diphtheria
    4. D. Thrush
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    Answer: C. Diphtheria

    Diphtheria produces a gray pseudomembrane that can obstruct the airway, and its toxin can cause myocarditis. It is rare in vaccinated populations, so suspect it in unvaccinated patients.

13. Which PPE is most appropriate when caring for a patient with suspected bacterial throat infection and coughing?

    1. A. Gloves, mask, eye protection
    2. B. Gloves only, no mask needed
    3. C. No PPE beyond hand washing
    4. D. Gown and gloves only
    Show answer

    Answer: A. Gloves, mask, eye protection

    Standard precautions plus droplet precautions (a mask and eye protection) protect against respiratory pathogens. Place a mask on the patient if tolerated.

14. A patient has fever and a tender, swollen, red area along the side of the neck after a sore throat, with pain on turning the head. Which complication is concerning?

    1. A. Deep neck space infection
    2. B. Simple muscle strain
    3. C. Thyroid storm
    4. D. Cervical spine fracture
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    Answer: A. Deep neck space infection

    Deep neck infections can follow pharyngitis or dental infection and threaten the airway and major vessels. They need prompt evaluation, imaging, and antibiotics.

15. A teenager with a recent sore throat now has fever, rigors, and pleuritic chest pain, with tender swelling along the side of the neck. Which rare complication should you consider?

    1. A. Acute rheumatic fever
    2. B. Peritonsillar abscess
    3. C. Scarlet fever
    4. D. Lemierre's syndrome
    Show answer

    Answer: D. Lemierre's syndrome

    Lemierre's syndrome is septic thrombophlebitis of the internal jugular vein after pharyngitis, often with septic emboli to the lungs, which explains the rigors and pleuritic chest pain. It is rare but life threatening. Rheumatic fever develops weeks later with joint pain, carditis or chorea, a peritonsillar abscess causes one-sided throat swelling and trismus without lung emboli, and scarlet fever causes a sandpaper rash rather than rigors and pleuritic pain.

16. A patient with a severe sore throat cannot swallow his own saliva and is spitting into a cup. What does this suggest?

    1. A. Dehydration only
    2. B. Airway swelling
    3. C. Mild viral illness
    4. D. Anxiety disorder
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    Answer: B. Airway swelling

    Inability to handle secretions means swelling is significant enough to obstruct swallowing and possibly the airway. Treat as an airway threat.

17. A 50-year-old has painful swelling under the left side of his jaw that starts every time he eats and slowly goes down about an hour later. He has no fever. What is the most likely cause?

    1. A. A dental abscess of a lower tooth
    2. B. An enlarged lymph node from a cold
    3. C. Mumps involving the parotid gland
    4. D. A stone blocking a salivary duct
    Show answer

    Answer: D. A stone blocking a salivary duct

    Salivary stones most often form in the submandibular gland under the jaw. Eating triggers saliva flow, and a blocked duct makes the gland swell and hurt with meals and then slowly drain; fever, redness or pus would suggest the gland has become infected. A dental abscess of a lower tooth causes constant pain and a tender tooth rather than swelling with meals, an enlarged lymph node from a cold does not change with eating, and mumps involving the parotid gland swells in front of the ear with fever.

18. A 70-year-old with a large neck mass from her thyroid becomes short of breath with noisy breathing whenever she lies flat. Sitting up relieves it. What is the most likely cause?

    1. A. Heart failure with fluid in the lungs
    2. B. Asthma triggered by lying down
    3. C. Anxiety about her diagnosis
    4. D. The goiter pressing on her trachea
    Show answer

    Answer: D. The goiter pressing on her trachea

    A large goiter can narrow the trachea, and lying flat lets the gland press further on the airway, causing stridor and dyspnea that improve when she sits up. Keep her upright and avoid laying her flat. Heart failure causes crackles and fluid in the lungs rather than stridor, asthma causes wheezing rather than noisy inspiration, and anxiety does not explain stridor relieved by position.

19. A 20-year-old has a sore throat and fever. Both tonsils are swollen with white exudate, the uvula is in the midline, and he can open his mouth fully. Which condition best fits these findings?

    1. A. A peritonsillar abscess
    2. B. Epiglottitis
    3. C. Simple tonsillitis
    4. D. Ludwig angina
    Show answer

    Answer: C. Simple tonsillitis

    Swelling of both tonsils with exudate, a midline uvula and normal mouth opening fit simple tonsillitis. A peritonsillar abscess usually causes one-sided swelling, a uvula pushed to the other side and trismus. Epiglottitis causes severe pain, drooling and a muffled voice often with a normal-looking throat, and Ludwig angina causes a firm floor of the mouth with a raised tongue.

20. Your system allows patients with minor complaints to be referred to an urgent care clinic. Which patient with a sore throat is the best candidate?

    1. A. Drooling and unable to swallow saliva
    2. B. Fever with a muffled voice and trismus
    3. C. A sore throat with stridor while resting
    4. D. Mild pain, normal vitals, drinking well
    Show answer

    Answer: D. Mild pain, normal vitals, drinking well

    A patient with a mild sore throat, normal vital signs and normal swallowing and breathing has no red flags and may be referred per protocol. Drooling and inability to swallow saliva, a muffled voice with trismus, and stridor at rest are signs of a deep infection or airway narrowing that need ED transport.

21. A 26-year-old with a known peritonsillar abscess suddenly fills his mouth with foul-tasting pus and blood, and his pain eases. What is the main risk now?

    1. A. Sudden swelling of the tongue
    2. B. Spread of the abscess to the ear
    3. C. Aspirating the pus and blood
    4. D. A drop in blood glucose
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    Answer: C. Aspirating the pus and blood

    When a peritonsillar abscess ruptures, pus and blood pour into the throat, and the main danger is aspiration into the lungs. Keep him sitting up and leaning forward, have suction ready and transport. Sudden tongue swelling is not caused by the rupture, spread to the ear is not the immediate risk, and a drop in blood glucose is unrelated.

22. Which treatment is the definitive care for a peritonsillar abscess?

    1. A. Drainage and antibiotics
    2. B. Oral antibiotics alone
    3. C. Drainage alone, no antibiotics
    4. D. Steroids only, no antibiotics
    Show answer

    Answer: A. Drainage and antibiotics

    Peritonsillar abscesses are treated with needle aspiration or incision and drainage plus antibiotics. Antibiotics without drainage are not definitive care for an established abscess, drainage is paired with antibiotics to treat the surrounding infection, and steroids may ease swelling but do not replace drainage and antibiotics. Prehospital care focuses on airway, comfort, and transport.

23. A 28-year-old with a peritonsillar abscess has swallowed almost nothing for 2 days. Her heart rate is 118, her mouth is dry, and she is breathing comfortably. Besides watching her airway, what is most appropriate?

    1. A. Oral fluids in large gulps
    2. B. Withhold fluids until surgery
    3. C. IV fluids per protocol
    4. D. Encourage salty crackers
    Show answer

    Answer: C. IV fluids per protocol

    Pain from a peritonsillar abscess often stops patients from swallowing, causing dehydration with tachycardia and a dry mouth. IV fluids per protocol treat this while you watch the airway and transport. Large gulps of oral fluid will hurt and she cannot manage them, withholding fluids until surgery worsens dehydration, and salty crackers are painful to swallow and add no fluid.

24. Swollen, tender lymph nodes in the neck are called:

    1. A. Cervical spondylosis
    2. B. Cervical radiculopathy
    3. C. Cervical lymphadenopathy
    4. D. Thyroid goiter
    Show answer

    Answer: C. Cervical lymphadenopathy

    Cervical lymphadenopathy is common with infections of the throat, mouth, and ears. Hard, painless, fixed nodes may suggest malignancy.

25. A 55-year-old smoker has had hoarseness and difficulty swallowing for 2 months and a firm neck mass. What should you consider?

    1. A. Peritonsillar abscess
    2. B. Head and neck cancer
    3. C. Acute viral pharyngitis
    4. D. Simple laryngitis
    Show answer

    Answer: B. Head and neck cancer

    Persistent hoarseness, dysphagia, and a firm neck mass in a smoker or heavy drinker raise concern for head and neck cancer. Tumors can eventually compromise the airway.

26. A 17-year-old with mononucleosis has tonsils so swollen they almost touch. He is drooling, has soft stridor and cannot lie flat. What is the main concern?

    1. A. A ruptured spleen from the illness
    2. B. A peritonsillar abscess on one side
    3. C. Dehydration from the fever
    4. D. Airway blockage by the tonsils
    Show answer

    Answer: D. Airway blockage by the tonsils

    Mononucleosis can swell the tonsils so much that they block the upper airway. Drooling, stridor and an inability to lie flat are signs of a threatened airway, so keep him upright, prepare for a difficult airway and transport promptly. A ruptured spleen causes abdominal pain and shock, a peritonsillar abscess is usually one-sided with a deviated uvula, and dehydration does not cause stridor.

27. You are transporting a 45-year-old with suspected epiglottitis who is still maintaining his airway. Why is early notification of the receiving hospital important?

    1. A. It lets them start oral antibiotics
    2. B. It allows a throat swab on arrival
    3. C. It avoids the need for monitoring
    4. D. Airway specialists can be ready
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    Answer: D. Airway specialists can be ready

    Patients with epiglottitis can obstruct suddenly, and the safest airway is often placed in a controlled setting by anesthesia or ENT with surgical airway equipment at the bedside. Early notification lets the hospital gather that team and equipment before arrival. Oral antibiotics are not the treatment, a throat swab or exam can trigger obstruction, and these patients need more monitoring, not less.

28. A 64-year-old who has smoked for 40 years has had a hoarse voice for 6 weeks without a cold. He is breathing comfortably and has no stridor. What is the best advice?

    1. A. Rest his voice for another month
    2. B. Drink warm tea until it clears
    3. C. Take an antibiotic for laryngitis
    4. D. Get his larynx examined soon
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    Answer: D. Get his larynx examined soon

    Hoarseness that lasts more than about 4 weeks, or sooner when a serious cause is suspected, needs an examination of the larynx, and a long smoking history raises concern for laryngeal cancer. Resting his voice for another month or drinking warm tea until it clears only delays the diagnosis, and guidelines advise against taking an antibiotic for laryngitis or hoarseness because most laryngitis is viral.

29. Sore throat is most commonly caused by:

    1. A. Viruses
    2. B. Allergens alone
    3. C. Parasites
    4. D. Fungi
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    Answer: A. Viruses

    Most cases of pharyngitis are viral. Bacterial causes such as group A strep make up a minority, more often in school-age children.

30. A 62-year-old who had radiation for throat cancer has a small amount of bright red blood from his mouth that stopped on its own. His family says this has never happened before. Why is this concerning?

    1. A. It is an expected effect of radiation
    2. B. It means the cancer is cured
    3. C. It may warn of a major artery bleed
    4. D. It shows a minor nosebleed
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    Answer: C. It may warn of a major artery bleed

    In patients treated for head and neck cancer, a small bleed from the mouth or neck can be a sentinel bleed that comes before a sudden massive carotid artery bleed (carotid blowout). Prepare for heavy bleeding with suction and firm pressure, protect the airway and transport promptly. New bleeding is not an expected effect of radiation, it does not mean the cancer is cured, and blood coming from the mouth with this history should not be assumed to be a minor nosebleed.