A patient presents with severe pharyngitis, muffled voice, drooling and uvula deviation. Which test is most appropriate to order?

• A. CT with contrast
• B. CBC
• C. Monospot
• D. Rapid strep

Answer: (A)

The main idea is recognizing a peritonsillar abscess, a deep infection causing a collection in the peritonsillar space. The presence of severe pharyngitis with a muffled voice, drooling, and uvular deviation points to abscess formation rather than simple tonsillitis.

Imaging with a CT scan using IV contrast is the best test to order because it directly visualizes a localized fluid collection in the peritonsillar space and shows rim enhancement if an abscess is present. This helps distinguish an abscess from cellulitis, determines the size and exact location, and guides management such as drainage and targeted antibiotics. It also assesses involvement of adjacent spaces and potential airway risk.

A CBC can indicate infection but does not confirm an abscess. Monospot is used for suspected mononucleosis and rapid strep tests diagnose streptococcal pharyngitis, neither of which confirms an abscess. In classic PTA, some clinicians may proceed to drainage without imaging, but when the question asks for the most appropriate test to order to confirm and plan treatment, CT with IV contrast is the best choice.