A 43-year-old man suddenly develops odynophagia. Which organism is most likely to be isolated on throat culture?
**Core Concept**
The sudden onset of odynophagia, which is painful swallowing, can be caused by an infectious or inflammatory process affecting the throat. In this context, the most common cause is a viral infection, which is often associated with the normal flora of the pharynx.
**Why the Correct Answer is Right**
The correct answer is C. Normal pharyngeal flora, which includes organisms such as Streptococcus viridans, Neisseria, and Corynebacterium. These organisms are part of the normal flora of the pharynx and can cause odynophagia when they overgrow and infect the mucosal lining of the throat. This is often seen in conditions such as acute pharyngitis or tonsillitis. The sudden onset of pain suggests a viral etiology, and the normal flora is the most likely culprit.
**Why Each Wrong Option is Incorrect**
**Option A:** Mononucleosis, caused by Epstein-Barr virus, can cause odynophagia but is less common than a viral infection caused by the normal pharyngeal flora. Moreover, mononucleosis typically presents with fever, fatigue, and lymphadenopathy in addition to odynophagia.
**Option B:** S. aureus is a bacterium that can cause skin and soft tissue infections, but it is not typically associated with odynophagia. While it can cause pharyngitis, it is not the most common cause of this condition.
**Option D:** Group A streptococci are a common cause of pharyngitis, but they typically present with a sore throat and fever, rather than odynophagia.
**Clinical Pearl / High-Yield Fact**
The normal flora of the pharynx can cause odynophagia when it overgrows and infects the mucosal lining of the throat. This is a common cause of acute pharyngitis and tonsillitis, and should be considered in the differential diagnosis of a patient presenting with sudden onset of pain while swallowing.
**✓ Correct Answer: C. Normal pharyngeal flora. Normal pharyngeal flora, including Streptococcus viridans, Neisseria, and Corynebacterium, is the most likely organism to be isolated on throat culture in a patient with sudden onset of odynophagia.**