Head & Neck Flashcards
DDx sore throat
Tonsillitis
Quinsey
Supraglottitis/Epiglottis
Deep neck infection
Pharyngitis, common cold, foreign body + dental infection
Tonsillitis spread
Inflammation of the pharyngeal tonsils
Usually spreads to the lingual tonsils and adenoids
Tonsillitis aetiology
Most commonly viral
15-30% are bacteria
Tonsillitis Hx
Fever, sore throat, galiotis halitosis (foul breath), dysphasia, odynophagia (painful swallowing), mild airway obstruction
Tonsillitis exam
- Degree of respiratory distress
- Full exam of oral cavity (tonsillitis erythema, oedema +/- exudate
Possible complications of strep pharyngotonsilitis
Non-suppurative: scarlet fever, rheumatic fever, post-streptococcal
Suppurative: Peritonsillar Abscess (Quinsy), deep neck space infection, cervical lymphadenitis
Peritonsillar abscess
Each tonsil is surrounded by a capsule. It is in the potential space (peritonsillar space) between the tonsil and capsule that the abscesses can form - a peritosillar abscess
Tonsillitis vs. Quinsy
- Uvula deviated to controlateral side
- inferior and medial tonsil displacement
- swelling of supratonsillar fold/soft palate rather than the tonsil itself
Quinsy Hx
Same as tonsillitis
Plus
- neck pain
- throat pain, more severe on the affect3d side +/- referred ear pain
- trismus due to inflammation of chewing muscles
- voice changes, in PTA pharyngeal oedema and trismus can cause a “hot potato” voice
Aetiology peritonsillar abcess
Can progress to cellulitis and then via tissue necrosis and pus formation to a peritonsillar abscess or starts via an infection of minorsalivary glands
Investigations for tonsillitis and PTA
General
- FBC, U+E
- Monspoet test
PTA / suspicious of DNSI
- later Alice neck x-ray
Management PTA
ABCs
Incision and drainage
aetiology of supraglottitis/epiglottis
H.influenzae type b
Examination of supraglottitis/epiglottis
- toxic appearance of patient
- sitting or leaning forward
- drooling/inability to handle secretions
- irritability
- stridor
supraglottitis/epiglottis investigation
- lateral neck x-ray
- flexible nasoendoscopy
- blood cultures
supraglottitis/epiglottis Hx
- sore throat
- odynophagia/dysphasia
- muffled voice/hot-potato
- URTI
supraglottitis/epiglottis Mangement
Airway
Minimise distress
Antibiotic (ceftriaxone)
Analgesia,anti-emetics, IV fluids
Thumb sign
Sign on lateral chest X-ray that indicates epiglottis due to swelling of the epiglottis
What are special compartments in the neck made of
Fascial planes
What is the cause of spread of infection
Special compartments communicate with each other
What is the danger space
Anterior to the prevertebral fascia is the dramatically named danger space.
It extends from the skull base to the diagram, meaning mediastinum is is possible complication of abscesses that spread into this space
Types of DSNI
- PTA
- Retropharyngeal abcess
- Parapharyngeal abcess
- Prevertebral abcess
Etiology of DSNI
Common complication of pharyngitis or dental infection
Sialadenitis, IV drug use, maligancy
Hx of DSNI
Sore throat, dysphasia, odyndophagia, trismus, neck pain, painful neck mass sometimes
Mangement DSNI
ABCs
Abx
Surgery (I+C)
Exam findings DSNI
Posterior pharynx erythema + swelling retropharyngeal abscess
Medial displacement of tonsil and later Alice pharyngeal wall in paralhaeyfeal abcess
Torticollis
Tender lympathenopathy
Investigations DSNI
CT neck
FBC, U+E
Blood cultur3s
