Salivary gland disorders — branching viva

Opening — the child with bilateral parotid swelling

Examiner: A five-year-old boy whose parents declined vaccinations has two days of fever, malaise and progressive bilateral cheek swelling. The parotid glands are enlarged and tender bilaterally, the ear lobes are pushed outward, and the Stensen duct orifice is inflamed but expresses no pus. Talk me through your diagnosis and your immediate assessment. ^[1]

Candidate should cover: the diagnosis of mumps from the bilateral tender parotid swelling, fever, malaise and under-immunised status, confirmed by the ear-lobe sign and the absence of purulent Stensen duct discharge; and a focused assessment of hydration, testicular tenderness in a post-pubertal boy, neurological signs of meningism, and abdominal tenderness for pancreatitis. ^[1]