Which condition presents with infection causing swelling of the epiglottis, drooling, and severe throat pain?

• A. Laryngitis
• B. Tonsillitis
• C. Bronchitis
• D. Epiglottitis

Answer: (D)

This question tests recognition of acute epiglottitis. When an infection drives swelling of the epiglottis, it can rapidly narrow the airway, so the patient often presents with severe throat pain, drooling, and difficulty swallowing. Drooling occurs because swallowing hurts and the swollen epiglottis makes it hard to manage saliva. The voice is often muffled, and there may be a preference for sitting up or leaning forward to keep the airway open. Because airway obstruction can progress quickly, this condition is an emergency: avoid forcing a view of the throat, and prepare for a secure airway in a controlled setting if needed. A lateral neck radiograph can show the classic “thumb sign” from a swollen epiglottis, supporting the diagnosis. Treatment involves securing the airway if necessary and giving IV antibiotics that cover Haemophilus influenzae type b and other potential pathogens, along with supportive care. Vaccination has reduced the incidence of epiglottitis, which is why this presentation is classically described, even as it becomes less common.

The other conditions involve different parts of the upper or lower airway and do not typically present with swelling of the epiglottis, drooling, and severe throat pain.