🦷 TOACS FCPS Station · Parotid Swelling in Mumps
📷 Clinical Photograph – Parotid Swelling
🔍 Key clinical features:
- ✓ Unilateral or bilateral parotid swelling – obscures the angle of the jaw
- ✓ Painful, tender swelling – worse with chewing or sour foods
- ✓ Ear lobe displaced upward and outward – a classic sign
- ✓ Prodrome of fever, headache, myalgia – precedes parotitis
- ✓ Contagious period – 3 days before to 5 days after parotitis onset
📋 Clinical scenario (examiner prompt)
A 9‑year‑old child is brought in with a painful swelling below the left ear, which has been present for 2 days. The child had fever, headache, and malaise for 3 days before the swelling appeared. On examination, the left parotid gland is enlarged, firm, and tender, obscuring the angle of the mandible. The ear lobe is displaced upward and outward. The child has difficulty chewing and complains of ear pain. There is no erythema over the gland, and the Stensen's duct opening is erythematous but without purulent discharge. The child has not been vaccinated with MMR.
🧑⚕️ Examiner tasks · TOACS
1. Identify the diagnosis from the clinical image and context.
2. Describe the clinical features (parotid swelling obscuring jaw angle, displaced ear lobe, prodrome).
3. Explain the etiology and transmission (paramyxovirus, respiratory droplets, incubation 16-18 days).
4. Discuss management, complications, and prevention (supportive care, orchitis, aseptic meningitis, MMR vaccine).
🎯 Expected answers (for examiners)
- • Diagnosis: Mumps (parotitis)
- • Clinical features: Unilateral/bilateral parotid swelling, obscures angle of jaw, ear lobe displaced upward/outward, pain with chewing, prodrome of fever, headache, myalgia
- • Etiology: Paramyxovirus (RNA virus), transmitted by respiratory droplets and direct contact
- • Incubation: 16-18 days (range 12-25)
- • Contagious period: 3 days before to 5 days after parotitis onset
- • Diagnosis: Clinical; PCR of buccal swab (first 3 days), serology (mumps IgM)
- • Treatment: Supportive care (hydrate, antipyretics, analgesics); no antiviral
- • Complications: Orchitis (30-40% postpubertal males), aseptic meningitis (10-30%), pancreatitis, oophoritis, sensorineural hearing loss
- • Prevention: MMR vaccine (2 doses: 12-15 months, 4-6 years); post-exposure MMR within 72 hours
• Mumps – bilateral/unilateral, obscures jaw angle, no purulent drainage
• Purulent parotitis (bacterial) – usually unilateral, erythema, purulent Stensen's duct discharge, systemic illness
• Parotid tumor – firm, non-tender, slow-growing
• Lymphadenitis – separate from jaw angle, usually multiple nodes
• Sialadenitis (other viral) – HIV, influenza, parainfluenza
⚡ Quick FCPS‑style MCQ
A child presents with fever, headache, and unilateral parotid swelling that obscures the angle of the jaw. The ear lobe is displaced upward and outward. The most likely diagnosis is:
A. Purulent parotitis (bacterial) B. Mumps C. Parotid tumor D. Lymphadenitis📌 Topic summary · Mumps (Parotitis)
Paramyxovirus
16-18 days (12-25)
Parotid swelling obscures jaw angle
3 days before to 5 days after parotitis
Aseptic meningitis (10-30%)
Orchitis (30-40%)
| Feature | Mumps Parotitis |
|---|---|
| Virus family | Paramyxoviridae |
| Transmission | Respiratory droplets, direct contact |
| Parotid swelling | Unilateral or bilateral; obscures angle of jaw; ear lobe displaced upward/outward |
| Diagnosis | Clinical; PCR (buccal swab), serology (IgM) |
| Treatment | Supportive care (analgesics, hydration) |
| Complications | Orchitis (30-40% postpubertal males), aseptic meningitis (10-30%), pancreatitis, oophoritis, hearing loss |
| Prevention | MMR vaccine (2 doses) |