Rosh Pediatrics Practice Exam

What does the presence of bilateral tonsillar exudates generally indicate?

1. Chronic allergy reaction

2. Eosinophilia

3. Acute infectious process

4. Nasopharyngeal obstruction

The correct answer is: Acute infectious process

The presence of bilateral tonsillar exudates is most commonly associated with an acute infectious process, particularly viral or bacterial tonsillitis. This clinical finding suggests inflammation and infection of the tonsils, which can be caused by pathogens like Streptococcus pyogenes (the bacteria responsible for strep throat) or various viruses such as Epstein-Barr virus. When the tonsils become infected, they often produce exudates—thick white or yellow patches that can be seen on the tonsillar surface. This exudative response is part of the body's immune reaction to fight off the infection and indicates that the body is responding to a potentially pathogenic organism. In contrast, a chronic allergic reaction typically would not present with exudates but rather with inflammation and swelling without the purulent appearance. Eosinophilia refers to an increase in eosinophils, often linked with allergic responses or parasitic infections, and doesn't correlate directly with the presence of exudates. Nasopharyngeal obstruction can cause symptoms like difficulty breathing or swallowing but would not typically lead to the formation of bilateral tonsillar exudates. Thus, the presence of these exudates is a clear indicator of an acute infectious process.