AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentEasy
A 4-year-old child presents with a 2-day history of fever (101°F), poor oral intake, and multiple small, painful vesicles and ulcers on the posterior oropharynx (tonsillar pillars, soft palate, uvula). The child does not have a rash on the hands or feet. What is the most likely diagnosis?
- AHerpes Simplex Gingivostomatitis
- BHand-Foot-Mouth Disease
- CStreptococcal Pharyngitis
- DHerpangina
Show answer & explanationAnswer & explanation
Correct answer: D. Herpangina
Herpangina is characterized by fever, sore throat, and small, painful vesicles and ulcers primarily located on the posterior oropharynx (tonsillar pillars, soft palate, uvula). The absence of lesions on hands and feet distinguishes it from typical Hand-Foot-Mouth Disease, although both are caused by enteroviruses.
Why the other options are wrong
- A. Herpes simplex gingivostomatitis typically involves the anterior oral cavity (gums, tongue, buccal mucosa) with widespread painful ulcers and inflammation, not primarily the posterior oropharynx.
- B. Hand-Foot-Mouth Disease typically presents with oral lesions (often more diffuse than herpangina) AND a characteristic rash on the hands and feet, which is absent in this case.
- C. Streptococcal pharyngitis presents with exudative tonsillitis, pharyngeal erythema, and often petechiae on the soft palate, but typically no vesicles or ulcers.
Herpangina Clinical Presentation
A viral illness, usually caused by coxsackieviruses, characterized by acute febrile illness with small, painful vesicles and ulcers on the posterior oropharynx.
- Fever, sore throat, poor oral intake.
- Lesions are typically confined to the tonsillar pillars, soft palate, and uvula.
- Often seen in children during summer/fall months.
Memory trick: Herpangina: Hot Throat, Hurts, Hidden in Back.