AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 4-year-old child is brought to the clinic by their parent due to a 2-day history of fever, irritability, and refusal to eat or drink. On examination, the FNP notes vesicles and ulcers on the posterior pharynx, tonsils, and soft palate. There are no skin lesions. Which of the following is the most likely diagnosis?
- AHand-foot-and-mouth disease.
- BHerpes simplex gingivostomatitis.
- CStreptococcal pharyngitis.
- DHerpangina.
Show answer & explanationAnswer & explanation
Correct answer: D. Herpangina.
Herpangina is a viral illness characterized by small, painful vesicles and ulcers typically found on the posterior pharynx, tonsils, and soft palate, often accompanied by fever and sore throat. This presentation differs from Hand-foot-and-mouth disease, which also affects the hands and feet, and herpes gingivostomatitis, which primarily involves the anterior oral cavity and gums.
Why the other options are wrong
- A. Hand-foot-and-mouth disease typically presents with lesions on the hands, feet, and buccal mucosa/tongue, in addition to the pharynx, which are absent here.
- B. Herpes simplex gingivostomatitis primarily affects the anterior oral cavity, gums, and lips, with widespread painful lesions.
- C. Streptococcal pharyngitis typically presents with erythema, exudates, and petechiae but not vesicles and ulcers on the posterior pharynx.
Herpangina
An acute febrile illness caused by coxsackieviruses, characterized by painful vesicular and ulcerative lesions primarily in the posterior oropharynx.
- Caused by Coxsackievirus.
- Lesions are vesicles/ulcers on posterior pharynx, tonsils, soft palate.
- Common in children, especially during summer/fall.
Memory trick: Herpangina Hides in the Hinterland of the Throat