UW. retroph. absc.; lymphadenitis 04-01 (2) Flashcards
UW. repropharyngeal abscess. table. age?
2-4y.o, but can occur in any age group
UW. repropharyngeal abscess. table. mos?
polymicrobal (group A strep., staph aureus and respiratory anaerobes)
UW. repropharyngeal abscess. table. CP?
fever
odynophagia/dysphagia
neck pain
drooling, muffled, ,,hot potato” voice, trismus
UW. repropharyngeal abscess. table. examination findings?2
retropharyngeal bulge
limited neck extension
UW. repropharyngeal abscess. table. Dx?
Lateral neck xray (increased prevertebral thickening, matosi soft tissue emphysema - tamsus vos matomi ruozeliai prie stuburo)
CT neck with contrast
UW. retropharyngeal abscess. table. Mx? 3
Airway protection
Iv abs (ampicillin-sulbactam, clindamycin)
+/- surgical drainage
UW. retropharyngeal abscess. how starts disease? routes
It is most often preceded by upper respiratory infection, but can also result from direct spread of local bacterial infection (eg, pharyngitis, tonsillitis).
UW. retropharyngeal abscess. why decreases prevalence after 4 yo?
due to retropharyngeal lymph node regression and fewer viral upper respiratory infections.
UW. retropharyngeal abscess. Large RPAs can obstruct the airway and major vascular structures.
.
UW. retropharyngeal abscess. kitas variantas - epiglotitis. Findings?
High fever, drooling, and stridor that can progress rapidly to life-threatening airway obstruction.
Lateral x-ray shows a swollen epiglottis (“thumb sign”).
UW. retropharyngeal abscess. kitas variantas - peritonsilar abcess. findings?
Fever, muffled voice, throat pain, and trismus.
Significant tonsillar swelling can cause uvular deviation to the contralateral tonsillar pillar.
UW. retropharyngeal abscess. kitas variantas - tracheitis. Findings?
Bacterial superinfection of the trachea following URTI and presents with severe croup-like symptoms, including fever and stridor.
Neck x-ray may show tracheal narrowing. This child has no stridor or tracheal narrowing on x-ray.
UW. cervical lymphadenitis in children. table. BILATERAl - what what mos?
VIRAL
only in viral bilateral. in bacterial can be unilateral
UW. cervical lymphadenitis in children. table. Unilateral. Staph aureus, Strep. pyogenes. key clinical findings?
Acute
most common
Suppuration common
UW. cervical lymphadenitis in children. table. Unilateral. Anaerobic bacteria (eg prevotella spp). key clinical findings?
Acute
Hx of periodontal disease or dental caries
UW. cervical lymphadenitis in children. table. Unilateral. Francisella tularensis. key clinical findings?
Acute
Hx of contact with infected animal (eg rabbit)
UW. cervical lymphadenitis in children. table. Unilateral. Mycobacterium avium. key clinical findings?
Chronic
Nontender, violaceous
UW. cervical lymphadenitis in children. table. Unilateral. Bartonella henselae. key clinical findings?
Chronic
Papule at site of cat scratch/bite
UW. cervical lymphadenitis in children. table. Bilateral. viral. key clinical findings?
Acute (eg adenovirus) associated with self-limited URI
Subacute/chronic (eg EBV, CMV) associated with mononucleosis symptoms
UW. Acute cervical lymphadenitis occurs predominantly in children age ??
<5 y.o. and frequently involves the submandibular nodes, although any cervical node can be affected
UW. Acute cervical lymphadenitis preceeding what?
URTI
UW. Acute cervical lymphadenitis. suppuration and abscess, which are identified by fluctuance
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UW. Acute cervical lymphadenitis.Dx?
clinical.
UW. Acute cervical lymphadenitis. Tx?
Tx acute, unilateral cervical lymphadenitis is with clindamycin, which has activity against methicillin-resistant S aureus, as well as S pyogenes.
UW. Acute cervical lymphadenitis. Needle aspiration of a suppurative node can identify the pathogen and further guide antibiotic management.
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