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 pharynx, tonsillar pillars, and soft palate. The child's hands and feet are clear. What is the most likely diagnosis?
- AHerpangina
- BStreptococcal pharyngitis
- CHand-Foot-Mouth Disease (HFMD)
- DAphthous stomatitis
Show answer & explanationAnswer & explanation
Correct answer: A. Herpangina
The clinical presentation of fever, poor oral intake, and characteristic vesicles/ulcers localized to the posterior pharynx, tonsillar pillars, and soft palate, with clear hands and feet, is classic for Herpangina. This differentiates it from Hand-Foot-Mouth Disease, which involves lesions on the hands, feet, and anterior oral cavity.
Why the other options are wrong
- B. Strep throat usually presents with exudative tonsillitis, not vesicles and ulcers, and is bacterial.
- C. HFMD also caused by coxsackievirus, typically includes lesions on the hands and feet, which are absent here.
- D. Aphthous stomatitis causes painful ulcers but typically without fever and is not usually widespread in the posterior pharynx in this age group.
Herpangina Clinical Presentation
Herpangina is a viral illness, typically caused by coxsackievirus, characterized by fever and painful vesicular lesions/ulcers primarily on the posterior pharynx, tonsillar pillars, and soft palate.
- Common in young children during summer/fall.
- Distinguished from HFMD by location of oral lesions (posterior vs. anterior/hands/feet).
- Self-limiting, supportive care is the mainstay of treatment.
Memory trick: Herpangina Hides in the Hinterland of the mouth.