Wednesday, October 19, 2016

A 30 year old man Presents with Acute Painful Swelling of the Right Parotid

A 30 year old man presents with acute painful swelling of the right parotid for 1 day.
Answer the following questions:
1. What 3 questions you would ask in history?
2. What examination would you conduct?
3. What will be your management plan?

( Question from MCPS paper October 19th 2016).

                                                   Acute swelling of the parotid . 

1. What 3 questions you would ask in history?


  1. h/o fever and malaise, pain and difficulty swallowing & chewing, any dental infection?  
  2. Any close contact having similar symptoms. ? ( viral Infection like Mumps can be spread easily from close contacts) 
  3. h/o mumps infection in past and either immunized for mumps? 
2. What examination would you conduct?


1. Examine the swelling as for any lump: 
  • Inspect the swelling and determine the extent ( involving the parotid region only or extending elsewhere) 
  • Look for facial asymmetry ( as facial nerve may be involved) 
  • Look for redness, any discharging fistula. 
  • Palpate the swelling and look for signs of tenderness. 
  • Check both sides and compare (swelling is either unilateral or bilateral) 
2. Check the cervical lymph nodes for enlargement and tenderness.  
3, Look inside the mouth and examine for any dental infection, and also examine the opening of the parotid duct opposite the 2nd molar tooth. 
4. Check for any ear infection. 
5. Check the cranial nerve 7 .
6. Look for any associated swelling of the testes. 

3. What will be your management plan?

Answer:  For acute parotitis secondary to viral infection (mumps) treatment is:  
  • symptomatic with analgesics and antipyretics to control fever and pain.
  • NSAIDs like ibuprofen to relieve pain and inflammation
  • Encourage good fluid intake to prevent dehydration
  • Topical application of cold or warm packs on the swollen parotid may provide relief from pain and inflammation. 
  • Advice soft diet for initial few days until the swelling resolves. 
  • If associated orchitis , provide bed rest with scrotal support. 


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