Large Normal Tonsils
Normal tonsils may be large without being infected, especially in children. They may protrude medially beyond the pillars and even to the midline. Here they touch the sides of the uvula and obscure the pharynx. Their color is within normal limits. The white marks are light reflections, not exudate.
This red throat has a white exudate on the tonsils. This, together with fever and enlarged cervical nodes, increases the probability of¿¡roup A streptococcal infection, or infectious mononucleosis. Some anterior cervical lymph nodes are usually enlarged in the former, posterior nodes in the latter.
(Sources of photos: Pharyngitis [A and B], Larjje Normal Tonsils, Exudative Tonsillitis—The Wellcome Trust, National Medical Slide Bank, London, UK.)
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Diphtheria (an acute infection caused by Corynebacterium diphtheriae) is now rare but still important. Prompt diagnosis may lead to life-saving treatment. The throat is dull red, and a gray exudate (pseudomembrane) is present on the uvula, pharynx, and tongue. The airway may become obstructed.
A torus palatinus is a midline bony growth in the hard palate that is fairly common in adults. Its size and lobulation vary. Although alarming at first glance, it is harmless. In this example, an upper denture has been fitted around the torus.
Thrush is a yeast infection due to Candida. Shown here on the palate, it may appear elsewhere in the mouth (see p. 206). Thick, white plaques are somewhat adherent to the underlying mucosa. Predisposing factors include (1) prolonged treatment with antibiotics or corticosteroids, and (2) AIDS.
Kaposi's Sarcoma in AIDS
The deep purple color of these lesions, although not necessarily present, strongly suggests Kaposi's sarcoma. The lesions may be raised or flat. Among people with AIDS, the palate, as illustrated here, is a common site for this tumor.
(Sources of photos: Diphtheria—Reproduced with permission from Harnisch JP et al: Diphtheria among alcoholic urban adults. Ann Intern Med 1989; 111:77; Thrush on the Palate— The Wellcome Trust, National Medical Slide Bank, London, LJK; Kaposi's Sarcoma in AIDS—Ioachim HL: Textbook and Atlas of Disease Associated With Acquired Immune Deficiency Syndrome. London, LJK, Gower Medical Publishing, 1989.)
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