S19C241 - Infections and disorders of the neck and upper airway Flashcards
1
Q
Pharyngitis etiology
A
bacterial: GABHS (group A strep), mycoplasma, chlamydia
viral: rhino, mono (EBV), HIV
2
Q
Mono triad
A
- pharyngitis
- fever
- lymphadenopathy
- up to 25% of pts will have a neg monospot in their first week of Sx, 10% will remain persistently negative
- tx with amoxicillin causes a rash
3
Q
GABHS - group A betahemolytic strep
A
- in up to 15% of adult pharyngitis and 30% of children
- incubation 2-5d, ten sore throat
- certain strains cause rheumatic fever and glomerulonephritis
- infxs during acute face and for one more week, if treated only infxs x24h
- tx reduces Sx by 1d and reduces complications
-group C and group B beta-hemolytic strep does NOT need tx
4
Q
Strep throat - Centor criteria
A
- tonsillar exudate
- tender anterior Cx adenopathy
- absence of cough
- hx of fever
- no Abx if only one
- if 2 present, swab and tx if positive
- if 3 or 4 present just treat
5
Q
Strep throat: tx
A
- PNC is first line
- PCN 500mg PO BID/TID x10d
- macrolide if pnc allergic or clindamycin
- dexamethasone if severe for sx relief
6
Q
Diphtheria
A
- immunizations exist
- slow onset of mild-moderate pharyngitis
- low, grade fever
- gray membrane firmly adherent to tonsillar or pharyngeal surface, may extend to soft palate/larynx
7
Q
PTA
A
- signs: fever, malaise, sore throat, trismus, muffled voice (hot potato), swollen tonsil
- ddx: cellulitis, mono, lymphoma, HSV, RPA, neoplasm, FB, internal artery aneurysm
- tx: needle aspiration, tonsillectomy (rare), 10d of amox-clav 875mg BID or PCN 500mg QID plus flagyl 500mg QID
- f/u 24h
- consider CT
8
Q
PTA: needle aspiration
A
- lidocaine inhaled or spray
- inject 1-2cc lidocain with epi into mucosa of tonsillar pillar
- then 18g needle lateral to tonsil 1/2 way b/w base of uvula and maxillary alveolar ridge NMT 1cm deep (consider palpating first to determine location of ICA)
9
Q
Epiglottitis
A
- b/of Haemophilus influenza b vaccine most cases are 46yo pts
- etiology: strep, staph, cirus, fungi, 25% are h flu still
- sx: 1-2d of dysphagia, odynophagia, dyspnea, pain with palpation of larynx and upper trachea, inspiratory stridor, tripod position
- 3D triad (drooling, dysphagia, distress)
- tx: protect airway (intubate if necessarY), O2, hydrate, monitor, IV Abx, heliox, intubate with bronchoscope if possible
- CTX 2g IV
- others: ampicillin-sulbactam, cefotaxime, pip-tazo, steroids
10
Q
Epiglottitis signs on xray
A
- obliteration of vallecula
- swelling of aryepiglottic folds
- edema of prevertebral and retropharyngeal soft tissues
- ballooning of hypopharynx
- epiglottis thumb shaped and enlarged
11
Q
RPA:
A
- anywhere from base of skull to corina
- adults with RPA are more likely to extend to mediastinum
- Sx: sore throat, fever, torticollis, dysphagia
- Dx: contrast-CT is gold standard
- Tx: clinda 600-900mg IV or cefoxitin 2g IV or pip-tazo, most require surgical intervention
12
Q
Odontogenic Abscess
A
-may occur
13
Q
Ludwig Angina
A
- infxn of submental, sublingual, submandibular spaces bilaterally
- Sx: poor dental hygience, dysphagia, odynophagia, trismus, edema upper neck and floor of mouth
- spreads quickly
- need immediate definite airway mgmt as it takes >1w for edema resolution with Abx
14
Q
Facial Necrotizing INfections
A
- Sx: critically ill, skin discoloration, crepitus, fever, tachy, HoTN, confusion
- CT: SC emphysema, deep tissue gas
- Tx: surgical fasciotomy, wide debridement, Abx
- Complications: mediastinal extension, great vessel erosion, retroperitoneal extension, pleural abscess, pericardial effusion, sepsis
- mortality 25-40%
- Dx: contrast CT
- Tx: Abx and drainage (pip-tazo, imipenem)
15
Q
Branchial Cleft Cysts
A
- occur at any age
- painless, fluctuant, anterior to border of anterior sternocleidomastoid muscle, may enlarge after URTI, may become infected
- if infected they need Abx and surgical excision once infection resolved
