General oto infectious diseases of the neck

Question 1

What is the most common cause of deep neck

space infections in the adult population?

Answer 1

Odontogenic infection

Question 2

What is the most common cause of deep neck

space infections within the pediatric population?

Answer 2

Tonsillitis

Question 3

Describe the head and neck manifestations of

Actinomyces israelii infection?

Answer 3

Development of a “lumpy jaw” and multiple painless, red or
bluish raised, firm lesions containing multiple draining sinus
tracts

Question 4

Describe the histologic appearance of Actinomyces

israelii?

Answer 4

Gram-positive, non–acid-fast, anaerobic bacilli demon-

strating a filamentous fungal-like growth pattern and “sulfur granule” formation

Question 5

What are the most common sites of the head and

neck to develop Mycobacterium infections?

Answer 5

Anterior superior cervical region near the submandibular
space, followed by the posterior cervical, middle cervical, and supraclavicular regions. Atypical mycobacterial infection is sometimes found in the preauricular region

Question 6

What is the most common manifestation for atypical Mycobacterium infections involving the
neck?

Answer 6

Persistent firm painless cervical adenopathy with overlying

violaceous skin discoloration

Question 7

What is the current recommended management
of atypical Mycobacterium infections involving the
neck?

Answer 7

Persistent lesions are best managed by surgical excision or incision and curettage. Common antibiotic choices include clarithromycin, ethambutol, isoniazid, and rifampin, de-
pending on the species.

Question 8

What tests should be ordered for patients with suspected mycobacterial infections involving the
head and neck?

Answer 8

PPD, chest plain film, cultures (Ziehl-Neelson stain,

Lowenstein-Jensen medium), nucleic acid probes, and PCR

Question 9

Are PPD tests usually positive in patients with atypical mycobacterial infections of the head and neck?

Answer 9

No. PPD tests are generally negative or weakly reactive.

Question 10

Why are mycobacteria called acid-fast bacteria?

Answer 10

Once they are colorized with a red dye, they cannot be decolorized with acid solutions.

Question 11

What is the most common head and neck mani-

festation of tuberculosis?

Answer 11

Cervical lymphadenopathy

Question 12

What is the treatment of cervical lymphadenop-

athy associated with tuberculosis?

Answer 12

Isoniazid, rifampin, ethambutol, and pyrazinamide

Question 13

What pathogen is associated with catscratch

disease?

Answer 13

Bartonella henselae

Question 14

Name the three types of Langerhans cell histiocytosis.

Answer 14

● Eosinophilic granuloma
● Hand-Schüller-Christian (disseminated chronic)
● Letterer-Siwe (disseminated acute)

Question 15

What condition manifests with the triad of osteolytic skull lesions, exophthalmos, and diabetes insipidus?

Answer 15

Hand-Schüller-Christian disease (disseminated chronic)

Question 16

Which type of Langerhans cell histiocytosis is
associated with early in life onset and a rapidly
progressive course?

Answer 16

Letterer-Siwe (disseminated acute)

Question 17

What is Lemierre syndrome?

Answer 17

Septic thrombophlebitis of the neck that most commonly
results from Fusobacterium necrophorum. It often begins
with pharyngitis progressing to lymphadenopathy, fevers,
chills, and rigors. Septic emboli may involve the lung, brain,
spleen, and liver, among other sites.

Question 18

What is the most common cause of pediatric

cervical lymphadenopathy?

Answer 18

Reactive lymphadenopathy from viral infection

Question 19

What is the most common cause(s) of pediatric

suppurative lymphadenopathy?

Answer 19

Group A Streptococcus and Staphylococcus aureus

Question 20

What is the test of choice for primary syphilis?

Answer 20

The FTA-ABS test evaluates for the presence of treponemal
antibodies. The test is positive in 90% of patients who seek
therapy for primary syphilis and remains positive for life.

Question 21

What are the symptoms of meningeal neuro-

syphilis?

Answer 21

Headache, nuchal rigidity, nausea, and vomiting. Cranial
nerve involvement is seen in 40% of patients resulting in
hearing loss, facial paralysis, and visual disturbances.

Question 22

What constitutes the Hutchinson triad of congenital syphilis?

Answer 22

Small notched teeth, deafness, and interstitial keratitis

Question 23

What test is most useful in establishing the diagnosis of neurosyphilis?

Answer 23

Reactive cerebrospinal fluid (CSF) VDRL and a CSF white

blood cell count of 20 cells/μL or greater

Question 24

What is the definition of otosyphilis?

Answer 24

The presence of a positive FTA-ABS in the setting of

unexplained sensorineural hearing loss

Question 25

What are the causes of syphilis-associated

hoarseness?

Answer 25

Laryngeal chancres, mucous membrane manifestations of
secondary syphilis involving the upper aerodigestive tract,
and gummata of the larynx may directly cause hoarseness.
Long-term syphilis may result in infraglottic stenosis,
adhesions between vocal folds or arytenoid fixation.
Neurosyphilis may result in recurrent laryngeal nerve
paresis.

Question 26

Describe the common initial symptoms of toxoplasmosis.

Answer 26

Fever, malaise, pharyngitis, and myalgias, with cervical

lymphadenopathy occurring in the most patients

Question 27

What are the pathogen, vector, and carrier

responsible for the development of tularemia?

Answer 27

Francisella tularensis, Amblyomma americanum (lone star tick), rabbits, and wild rodents, respectively

Question 28

What are the early symptoms of tularemia

infection?

Answer 28

Fever, headache, chills, myalgia, photophobia, diminished

visual acuity, and lymphadenopathy

Question 29

What are the possible side effects of amphotericin

B?

Answer 29

Nephrotoxicity, anemia, fever, chills, nausea, and vomiting

Question 30

What is the mechanism of action of the “azole”

antifungal medications?

Answer 30

Fungistatic. All azoles work by inhibiting a cytochrome P-

450–dependent enzyme that is required to convert lanosterol to ergosterol.

Question 31

What are the five recognized forms of fungal

sinusitis?

Answer 31

● Acute fulminant invasive fungal sinusitis
● Chronic invasive fungal sinusitis
● Granulomatous invasive fungal sinusitis
● Fungus ball
● Allergic fungal rhinosinusitis

Question 32

What is the most common causative organism in

chronic invasive fungal sinusitis?

Answer 32

Aspergillus fumigatus

Question 33

Describe the condition of HIV lymphadenopathy.

Answer 33

Diffuse lymphadenopathy (> 2 cm) involving two or more
extrainguinal sites for longer than 3 months. Two thirds of
patients infected with HIV will develop this syndrome
shortly after seroconversion.

Question 34

What are the anatomical boundaries of the deep

neck space involved in Ludwig angina?

Answer 34

The submandibular space is bound superiorly by the
mucosa of the floor of mouth, laterally and anteriorly by the
mandible, and inferiorly by the superficial layer of the deep
cervical fascia. It contains two divisions (sublingual and
submaxillary), separated by the mylohyoid muscle.

Question 35

How do submandibular infections spread to other deep neck space compartments?

Answer 35

Communication between potential spaces exists at the
buccopharyngeal gap, which connects the submandibular
and lateral pharyngeal spaces.

Question 36

Why is there a lack of trismus in patients suffering

from Ludwig angina?

Answer 36

Trismus develops from irritation of the masticatory muscles
(masseter and pterygoids), which insert into the mandibular
ramus. The submandibular space is not contiguous with
these muscles.

Question 37

What is the mechanism of airway compromise in

patients with Ludwig angina?

Answer 37

Increased swelling in the bilateral submandibular space
pushes the tongue superiorly and posteriorly, thereby
causing progressive airway obstruction.

Question 38

What is the best management of the airway in a

patient with a progressive infection of the submandibular space with increasing airway compromise?

Answer 38

Awake intubation or tracheostomy

Question 39

What is the most common causative organism in

necrotizing soft tissue infections?

Answer 39

Group A streptococcus

Question 40

What are the clinical characteristics of necrotizing

fasciitis?

Answer 40

Tense edema, pain disproportionate to examination, skin

discoloration, bullae, necrosis, and crepitus

Question 41

What is the treatment of necrotizing fasciitis?

Answer 41

Incision and drainage are inadequate. Necrotic tissue must be debrided and the wound left open with packing. Broad-
spectrum antibiotics should be administered, and the patient should be monitored in an intensive care unit
setting. Hyperbaric oxygen may provide additional benefit.

Question 42

Describe the clinical presentation of infectious

mononucleosis.

Answer 42

Fever, fatigue, generalized lymphadenopathy, splenomegaly,

and exudative pharyngitis with adenotonsillar hypertrophy