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MBBS II HNNS > L36 - Infectious causes of upper airway obstruction > Flashcards

L36 - Infectious causes of upper airway obstruction Flashcards

1
Q

List 5 common oropharynx infections?

A

Acute epiglottitis

Corynebacterium diphtheriae

Bilateral peritonsillar abcess

Deep fascial space infections

EBV mononucleosis

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2
Q

Name one common larynx URTI?

A

Laryngotracheobronchitis (croup)

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3
Q

Epidemiology, clinical features, pathogen and diagnosis of acute epiglottitis?

A

children of 2-4 years old (but can also occur in adults)

Fever (6-12 hours), Severe sore throat, Dysphonia, drooling oral secretions**, stridor

Haemophilus influenzae type B

“cherry-red” epiglottis*** by laryngoscopy

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4
Q

Investigation techniques, management of acute epiglottitis?

A
  • XR neck: “thumb” sign (DO NOT wait for XR!)
  • Blood culture
  • Laryngoscopy
  • AIRWAY PROTECTION!
  • Antibiotic e.g. amoxcillin-clavulanate
  • Rifampicin prophylaxis if unvaccinated contact ≤4 years in household
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5
Q

Gram- stain, morphology, classification of the most common bacteria causing acute epiglottitis? Growth requirements?

A

Haemophilus influenzae

  • Gram-negative, coccobacilli
  • Classified into six types (a to f) or nontypeable
  • Growth requires both X (hemin) & V (NAD) factors
  • Produce beta-lactamases
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6
Q

Epidemiology, clinical features, pathogen of Peritonsillar abscess (quinsy)?

A

adolescents and young adults usually

  • Severe sore throat
  • Low grade fever
  • Dysphagia
  • Inflammation of peritonsillar area with medial displacement of tonsil**
  • Bilateral airway obstruction → stridor
  • Group A streptococcus (Streptococcus pyogenes)
  • Mixed (oropharyngeal organisms: viridans Streptococcus, anaerobes)
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7
Q

Management of peritonsillar abscess (quinsy)?

A

AIRWAY PROTECTION!

Antibiotic

Drainage of abscess

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8
Q

Compare Strep. pyogenes to viridans Streptococcus? What URTI do they commonly cause?

A

Peritonsillar abscess (quinsy)

Streptococcus pyogenes:

  • β-hemolytic streptococci
  • Lancefield group A, bile soluble
  • sensitive to bacitracin

viridans Streptococcus:

  • α-hemolytic streptococci
  • bile insoluble
  • resistant to optochin
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9
Q

List the three major deep spaces involved in deep fascial space infections?

A
  • submandibular & sublingual space (Ludwig’s angina)
  • lateral pharyngeal/parapharyngeal space
  • retropharyngeal space
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10
Q

Underlying cause, clinical features, pathogen in Submandibular and sublingual space infection?

A

Dental root abscess 50-90%**

  • Board-like swelling** involving bilateral submandibular and sublingual spaces
  • High fever, systemic toxicity
  • Mouth held open
  • Dysphagia

mixed oral flora

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11
Q

Management of submandibular and sublingual space infections?

A
  • AIRWAY PROTECTION!
  • Antibiotic
  • Soft tissue decompression
  • Dental assessment
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12
Q

Underlying cause, clinical features, complications and pathogen in Lateral pharyngeal/ parapharyngeal space infection?

A
  • Spread of infection from adjacent structures: Odontitis, pharyngitis, tonsillitis, parotitis, otitis, mastoiditis
  • Fever, sore throat, dysphagia, neck stiffness
  • Jugular vein thrombophlebitis (Lemierre syndrome)
  • Carotid artery erosion

pathogens of the primary site

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13
Q

Investigation and management of lateral pharyngeal space infections?

A

CT/MRI to assess extent of infection
Blood culture + Pus culture

AIRWAY PROTECTION!
Antibiotic
Surgical drainage
Treat primary infective focus

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14
Q

Underlying cause, clinical features, complications and pathogen in Retropharygeal space infections?

A

Odontitis, peritonsillar abscess, cervical vertebral osteomyelitis, perforated pharynx

Fever, sore throat, dysphagia, neck stiffness

Complication: Mediastinitis*

Pathogens of primary site:

  • Mixed oral flora (from pharynx or dental source)
  • Staphylococcus aureus (from vertebral osteomyelitis)
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15
Q

Investigation and management of retropharyngeal space infections?

A
  • Neck XR: prevertebral soft tissue swelling + Gas bubbles made by bacteria in abscess
  • CT for assessment of extent of involvement
  • Blood and pus culture
  • AIRWAY PROTECTION!
  • Antibiotic
  • Surgical drainage
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16
Q

What is the most common cause of stridor in children?

A

Croup (laryngotracheobronchitis)

17
Q

Epidemiology, clinical features and pathogens in Croup?

A

Young children of 3 months to 3 years old

URTI symptoms (2-3 days)
Fever, hoarseness, barking cough***, stridor

Parainfluenza virus, influenza virus, respiratory syncytial virus, adenovirus, rhinovirus, Mycoplasma

18
Q

Investigation and management of croup?

A
  • Neck XR: subglottic swelling, “hourglass” or “steeple” sign***
  • Nasopharyngeal aspirate (NPA) for respiratory virus antigens
  • AIRWAY PROTECTION!
  • Racemic adrenaline ± steroid
19
Q

Compare between acute epiglottitis and Croup:

Age, Appearance and Onset?

A

Acute epiglottitis:

  • 2-4 years old
  • Toxic and unwell
  • Abrupt onset

Croup:

  • 3 months to 3 years old
  • Relatively well looking
  • Viral prodrome (several days, consists of fever, headache, nausea and vomiting, lethargy, and myalgias)
20
Q

Compare between acute epiglottitis and Croup:

severity of fever, stridor and cough?

A

Acute epiglottitis:

  • High fever (>38 C)
  • Moderate to severe stridor
  • Minimal or no cough

Croup:

  • Moderate fever
  • Mild- moderate stridor
  • BARKING cough
21
Q

Compare between acute epiglottitis and Croup: effects on speech and swallowing?

A

Acute epiglottitis:
- Dysphonia + drooling saliva

Croup:
- Hoarse voice + able to swallow

22
Q

List some non-infections causes of URT obstruction?

A
  • Tumour
  • Goitre
  • Bilateral vocal cord palsy
  • Foreign body aspiration

(Others: Angioneurotic edema, Subcutaneous emphysema)

23
Q

Between deep fascial space infections, differentiate the sites of swelling?

A

Submandibular and sublingual space: Floor swelling

Lateral pharyngeal space: Jaw angle swelling

Retropharyngeal space: Posterior pharynx swelling

24
Q

Defining clinical features to distinguish the exact location of Lateral pharyngeal space infection ( Anterior or Posterior)?

A

Anterior = +++ pain and trismus

Posterior = +++ Dyspnea (shortness of breath)

25
Q

Which URTI can lead to mediastinitis?

A

Retropharyngeal space infections

26
Q

Lateral pharyngeal space infection can spread to which adjacent sites?

A

Submandibular and sublingual space

Carotid sheath

Retropharyngeal space

Masticator spaces

27
Q

Case 1:
M/41: Good past health
c/o severe sore throat for 2 days
Increase in pain, difficulty in swallowing saliva
Progressive SOB, drooling of saliva and sweating
Developed sudden cardiac arrest
Difficult endotracheal intubation

Dx?

A

Acute epiglottitis

28
Q 
Case 2:
Depression
c/o fever, sore throat for 2 days 
hoarseness, difficulty swallowing 
P/E: neck swelling 
Acute SOB with heavy stridor

Dx?

A

Acute epiglottitis

29
Q 
Case 3:
Acute myeloid leukemia in relapse 
chemotherapy 3 weeks ago 
c/o fever, hoarseness
Associated with sore throat, SOB 
P/E: inspiratory stridor

Dx? check

A

secondary infections complicating conditioning mucositis (after chemotherapy)

or

Bilateral vocal cord palsy

MBBS II HNNS (57 decks)

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