20 Questions
What is a key consideration in managing acute epiglottitis?
Maintaining a patent airway to prevent compromise
What is a characteristic feature of peritonsillar abscess?
Unilateral sore throat and trismus
What is a common causative organism of peritonsillar abscess?
Haemophilus influenzae
What is a characteristic symptom of acute epiglottitis?
Muffled voice and inspiratory stridor
What is a key aspect of diagnosing peritonsillar abscess?
Making a clinical diagnosis based on presentation
What is a common complication of acute epiglottitis?
Airway obstruction
What is the primary cause of bacterial infection in acute epiglottitis?
Haemophilus influenzae
What is the diagnostic sign on a lateral radiograph of the neck in acute epiglottitis?
Thumb sign
What is the age group that was most commonly affected by acute epiglottitis in the past?
Children aged 2-6
What has decreased the incidence of acute epiglottitis?
HiB vaccination in infants
What is a complication of retropharyngeal abscess?
All of the above
What is a symptom of primary HIV infection?
All of the above
What is a non-infectious cause of pharyngeal pain?
Cocaine smoking
What is a type of cancer that can present with pharyngeal pain?
Lymphoma
What is the most likely diagnosis for a patient with a sore throat, fever, and medial displacement of the uvula, palatine tonsil, and anterior pillar?
Peritonsillar abscess
What is the peak incidence age for retropharyngeal abscess?
3-5 year olds
What is the best way to confirm a diagnosis of peritonsillar abscess?
Culture of pus from abscess drainage
What is the treatment for a retropharyngeal abscess?
Antibiotic therapy, possible surgical consultation for needle aspiration or incision and drainage
What is the temperature above which a fever is considered?
38°C (100.4°F)
What symptom is strongly suggestive of an infectious cause of pharyngitis?
Fever
Study Notes
Airway Management
- Airway management is crucial to prevent airway compromise
- May require intubation
- Requires antibiotic therapy
Acute Epiglottitis
- Acute onset fever, severe sore throat, toxic appearance
- The 4 Ds: dysphagia, drooling, dysphonia, and distress
- Do not use a tongue depressor when examining the oropharynx as it can precipitate airway obstruction
Peritonsillar Abscess
- Also known as quinsy
- Most common deep infection of head and neck (30% of abscesses)
- Most common in young adults (ages 20-40); increased risk in immunocompromised and diabetics
- Begins as acute tonsillitis → cellulitis → abscess formation
- Polymicrobial infection with common organisms including Group A streptococci, Staphylococcus aureus, and Haemophilus influenzae
- Clinical presentation: severe unilateral sore throat, dysphagia, fever, and malaise
- Diagnosis can be made clinically without labwork/imaging in patients with typical presentation
- Oropharyngeal exam: erythematous enlarged tonsil and bulging soft palate on affected side, uvular deviation to contralateral side
- May have severely tender cervical lymphadenopathy
Retropharyngeal Abscess
- Retropharyngeal edema due to cellulitis and suppurative adenitis of lymph nodes in retropharyngeal space
- Preceded by upper respiratory infection, pharyngitis, otitis media, or wound infection following penetrating injury to posterior pharynx
- Peak incidence in 3-5 year olds
- Observed as prevertebral soft-tissue thickening on lateral X-ray of neck
- Treat as impending airway emergency
- Requires antibiotic therapy, possible surgical consultation for needle aspiration or incision and drainage
Clinical Presentation of Retropharyngeal Abscess
- Sore throat and dysphagia
- Fever
- Drooling
- Dysphonia (muffled voice)
- Neck stiffness; limited neck ROM (especially hyperextension)
- Stridor
- May see bulging of the posterior wall of oropharynx on clinical examination
A quiz on the clinical presentation and management of acute epiglottitis, a life-threatening condition that requires prompt recognition and treatment.
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