Rosh Emergency Medicine Practice Test

What is the most likely diagnosis for a patient with neck pain, fever, anterior neck tenderness, and a fluctuant mass?

1. A. Infectious thyroiditis

2. B. Retropharyngeal abscess

3. C. Subacute thyroiditis

4. D. Viral pharyngitis

The correct answer is: A. Infectious thyroiditis

The presentation of neck pain, fever, anterior neck tenderness, and a fluctuant mass is highly suggestive of a localized infection in the neck region. Infectious thyroiditis is characterized by inflammation of the thyroid gland, often due to a bacterial infection, which can lead to pain, fever, and tenderness in the anterior neck area. The fluctuant mass experienced by the patient indicates the presence of an abscess or fluid collection, which is consistent with severe infectious processes affecting the thyroid. In this case, the symptoms align closely with infectious thyroiditis, where the infection can cause significant swelling and tenderness of the thyroid gland, resulting in the described neck mass. This diagnosis becomes even more probable when there is fever present, highlighting a systemic response to the infection. Other conditions such as retropharyngeal abscess, subacute thyroiditis, or viral pharyngitis may present with overlapping symptoms but would generally not result in the same direct findings related to the thyroid, such as the anterior neck tenderness or a clear fluctuating mass specifically associated with infectious thyroiditis. Thus, considering these factors, infectious thyroiditis is the most plausible diagnosis.