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Oral Board Flashcards > Infection > Flashcards

Infection Flashcards

1
Q

What is your initial subjective work-up of an infection?

A

Determine severity:
-History
-Onset
-Duration
-Rate of progression
-Previous treatment
-Medically compromised host

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2
Q

What is your physical exam for an infection?

A

-Pain, swelling, erythema, purulence, warmth, loss of function
-Vitals: Malaise, temp, tachycardia
-Labs: Leukocytosis
-Airway eval/management

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3
Q

How should airway be evaluated and managed in an infection?

A

Eval:
-Mallampati Class, obstruction (stridor, coarse airway sounds, sniffing position)
-Trismus (masticator/pterygomandibular)
-O2 sat <94%

Management:
-Pt should be sitting up with supplemental oxygen and suction
-Fiberoptic scope by ENT
-Early intubation (awake fiberoptic, tracheotomy)

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4
Q

What imaging do you obtain and what do you look for with an infection?

A

-CT with contrast
-Rim enhancing lesions, airway deviation, gas formation
-Obtain a new CT for any worsening scenerio

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5
Q

What is the pathogenesis of an odontogenic infection?

A

-Establishment of infection
-Spread through cancellous bone
-Erosion through cortical bone
-Enter soft tissue
-Facial plane infection

-Fascial spaces- Potential spaces between anatomic structures, act as barriers to limit spread of infection but do connect and allos spread of infection

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6
Q

What are the borders of the buccal space?

A

-Anterior: Corner of mouth
-Posterior: Masseter m, pterygomandibular space
-Superior: Maxilla, infraorbital space
-Inferior: Mandible tissue and skin
-Superficial: Subcutaneous
-Deep: Buccinator m

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7
Q

What are the borders of the infraorbital space?

A

-Anterior: Nasal cartilage
-Posterior: Buccal space
-Superior: Quadratus labii superioris m
-Inferior: Oral mucosa
-Superficial: Quadratus labii superioris m
-Deep: Levator anguli oris m, maxilla

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8
Q

What are the borders of the submandibular space?

A

-Anterior: Anterior belly digastric m
-Posterior: Posterior belly of digastric, stylohyoid, stylopharyngeus mm
-Superior: Inferior/medial surface of mandible
-Inferior: Digastric tendon
-Superficial: Platysma m
-Deep: Mylohyoid, hypoglossus, superior constrictor mm

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9
Q

What are the borders of the submental space?

A

-Anterior: Inferior border of mandible
-Posterior: Hyoid bone
-Superior: Mylohyoid m
-Inferior: Investing fascia
-Superficial: Investing fascia
-Lateral: Anterior bellies of digastric m

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10
Q

What are the borders of the sublingual space?

A

-Anterior: lingual surface of mandible
-Posterior: submandibular space
-Superior: Oral mucosa
-Inferior: mylohyoid m.
-Medial: Tongue muscles
-Lateral: Lingual surface of mandible

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11
Q

What are the borders of the pterygomandibular space?

A

-Anterior: Buccal space
-Posterior: Parotid gland
-Superior: Lateral pterygoid m
-Inferior: Inferior border of mandible
-Medial: Medial pterygoid m
-Lateral: Ascending ramus of mandible

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12
Q

What are the borders of the submasseteric space?

A

-Anterior: Buccal space
-Posterior: Parotid gland
-Superior: Zygomatic arch
-Inferior: Inferior border of mandible
-Medial: Ascending ramus of mandible
-Lateral: Masseter m.

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13
Q

What are the borders of the lateral pharyngeal space?

A

-Anterior: Superior and middle pharyngeal constrictor m
-Posterior: Carotid sheath
-Superior: Skull base
-Inferior: Hyoid bone
-Medial: Pharyngeal constrictors and retropharyngeal space
-Lateral: Medial pterygoid m

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14
Q

What are the borders of the retropharyngeal space?

A

-Anterior: Superior and middle pharyngeal constrictor m
-Posterior: Alar fascia
-Superior: Skull base
-Inferior: Fusion of alara and prevertebral fascia at C6-T4
-Lateral: Carotid sheath and lateral pharyngeal space

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15
Q

What are the borders of the pretracheal space?

A

-Anterior: Sternothyroid-thyrohyoid fascia
-Posterior: Retropharyngeal space
-Superior: Thyroid cartilage
-Inferior: Superior mediastinum
-Medial: Sternothyroid-thyrohyoid fascia
-Lateral: Visceral fascia over trachea and thyroid gland

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16
Q

What is Ludwig’s angina?

A

Bilateral submandibular, sublingual and submental space cellulitis may extend to epiglottis, rarely fluctuant. Hot potato voice

17
Q

What are the borders of the deep temporal space?

A

-Anterior: Infratemporal surface of maxilla and posterior surface of orbit
-Posterior: Attachment to temporal bone
-Superior: Attachment to temporal bone
-Inferior: Lateral pterygoid muscle
-Medial: Temporal and sphenoid bone
-Lateral: Temporalis muscle

18
Q

What are the classifications of the orbital space?

A

Preseptal: No involvement of EOMI, no change in vision, no globe issues

Postseptal: Proptosis, othalmoplegia, extension from sinuses

19
Q

What are the bacterial differences between cellulitis and an abscess?

A

Cellulitis: Aerobic

Abscess: Anaerobic

20
Q

What is the microbiology of infections?

A

Polymicrobial, mix of aerobic/anaerobic bacteria

Aerobic:
-Gram + cocci: Strep viridans, staph, eikenella
-Gram - rods: Haemophilus

Anaerobic:
-Gram + cocci: Strep, peptostrep
-Gram - rods: Prevotella, porphyromonas (bacteroides), fusobacterium

21
Q

What is the pathobiology of an infection?

A

-Aerobic bacteria gain entrance into tissue
-Development of cellulitis leads to tissue hypoxia and acidosis with resultant favorable anaerobic environment
-Anaerobes follow with tissue destruction
-Development of purulence

22
Q

What is bacteremia, sepsis, septic shock?

A

-Bacteremia: Bacteria in bloodstream
-Sepsis: Bacteremia causing systemic immune response
-Septic shock: Sepsis with drop in BP and organ failure such as vasodilation, renal failure, ARDS, DIC, release of tumor necrosis factor

23
Q

What systemic diseases can affect the hosts defense in an infection?

A

-Uncontrolled metabolic/accquired immunodeficiency: DM, renal failure, ETOH abuse, IV Drug abuse, malnutrition, HIV, collagen vascular disease

-Suppressing diseases: Leukemia, lymphoma, malignant neoplasm

-Suppressing drugs: Cancer chemotherapy, immunosuppressive (transplant pts), chronic corticosteroids

24
Q

What are the criteria for inpatient management of an infection?

A

-Toxic appearance
-Severe trismus (masseteric, temporal)
-Difficulty speaking/swallowing/handling secretions
-Temp over 101
-Rapid progression
-Compromised host
-Secondary facial space involvement

25
Q

What are the key components to surgically managing an infection?

A

-Remove nidus of infection (tooth)

-Cultures if possible (especially in rapidly spreading infections, suspect actinomycosis with sinus tract, osteo, recurrent infections, compromised host)

-Incision and drainage (explore all spaces, copious irrigation, dependent drainage)

26
Q

What are components of medical support in regards to infections?

A

-Hydration
-Nutrition
-Glycemic control
-Steroids (controversial)

-Diabetics: require more aggressive therapy, may require sliding scale, more virulent bacteria possible

27
Q

What is the ideal antibiotic?

A

Narrow spectrum, low toxicity, bactericidal, low cost

28
Q

What is the adult/pediatric dose and mechanism of action for Penicillin?

A

-Adults: 500 mg QID
-Children: 25-50 mg/kg/day

-Bactericidal: interferes with cell wall synthesis of bacteria during growth phace

Treats oral strep, anaerobes, actinomycosis, eikenella

29
Q

What is the adult dose and mechanism of action for Augmentin?

A

-Adults 500-875 mg BID

-Beta lactamase inhibitor- bactericidal

-Unasyn: Ampicillin with Sulbactam (IV only)

30
Q

What is the adult/pediatric dose and mechanism of action for Clindamycin?

A

-Adults: 150-600 mg QID
-Pediatric: 15-30 mg/kg/day

Bactericidal (high dose) or bacteriostatic (low dose). Interferes with protrin synthesis metabolized in liver, excreted in urine

Treat oral strep, staph, anaerobes. Resistant to eikenella

31
Q

How are carbapenems (imipenem) used in infections?

A

IV only

-Cell wall lysis for serious gram +/- aerobic and anaerobic infections.

Proper dose is 3-4 times MIC. Proper interval is 4 times t1/2

32
Q

Describe your inpatient management of an infection patient after surgery?

A

-Subjective eval: how patient is feeling, malaise

-Objective eval: Decrease in swelling, decrease in trismus, decrease in temp, decrease in WBC

-Repeat CT if patient shows regrssion

33
Q

What are emissary veins?

A

-Areas of skull where infection spreads from superficial vein to intracranial vein.

-Deep vein thru pterygoid plexus (to cavernous sinus)
-Mastoid emissary to sigmoid sinus
-Saggital emissary from scalp to superior sagittal sinus
-Danger area is central upper lip/tip of nose and medial cheek with facial vein to ophthalmic vein

34
Q

What is a cavernous sinus thrombosis?

A

Very rare from odontogenic infections

-Ascending intracranial endovascular infection
-Severe headache, fever, malaise occur first
-Ocular findings CN 3, 4, 6, V1, V2 deficit
-Treat with antibiotics, anti-coagulation, steroids

35
Q

What is necrotizing fasciitis?

A

-Rare infection: Necrosis of fascia and subcutaneous tissue
-Ill defined borders, skin is erythematous, tense and dusky
-Localized necrosis secondary to thrombosis
-Soft tissue crepitus due to gas formation
-Strep pyogens, staph aureus
-Usually immunocompromised pt (DM peripheral vasciular disease)
-High mortality, must not delay treatment
-Wide local excision, multiple debridements
-Broad spectrum antibiotics, nutritional/respiratory support

36
Q

Describe osteomyelitis.

A

-Infection of the bone. Begins in medullary bone and extends to cortical bone
-Failure of microcirculation
-Mandible>maxilla
-Predisposing factors: DM, hematologic disease, tooth ext, jaw fx, periapical abscess
-Usually anaerobic
-Pain, numbness, pathologic fx
-Treat: Remove sequestrum with debridement, expose medullary bone vascularized overlying soft tissue envelope
-Antibiotics for sufficient time (may need PICC)
-Consider HBO

37
Q

Describe sinusitis.

A

-Pain, pressure over maxillary walls
-Purulent drainage, fever, malaise
-Increased pain on bending, dental pain
-Rhinorrhea, post-nasal drip
-Acute: H. Influenzae, S. Pneumonia, S. pyogens
-Chronic: Peptostrep, bacteroides, clostridium

Tx: Shrink nasal mucosa (afrin, steroid), antibiotic (augmentin, moxifloxican), possible surgical intervention to re-establish drainage

Oral Board Flashcards (9 decks)

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