Term
| 3 common sources for deep space infections of the head and neck |
|
Definition
Odontogenic
Parotitis
Tonsillitis/peritonsillar abscess |
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Term
| Peritonsillar abscess is aka ___ |
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Definition
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Term
| 7 Possible symptoms of peritonsillar abscess |
|
Definition
Fever, malaise, sore throat, dysphagia
Trismus (limited mouth opening)
Ipsilateralear pain
Drooling
Muffled voice
Tender cervical adenopathy
Torticollis |
|
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Term
| 2 physical findings in someone with Peritonsillar abscess |
|
Definition
Swelling of anterior tonsillarpillar and soft palate
Uvular deviation |
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Term
| Common microbial cause of Peritonsillar abscess (be specific) |
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Definition
| Typically group A streptococcus plus anaerobes |
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Term
| How to treat Peritonsillar abscess (2) |
|
Definition
Drainage
+
Antibiotics: Ampicillin/Sulbactam
or Clindamycin |
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|
Term
|
Definition
Ductal obstruction with secondary infection
Can be related to sialolithiasis |
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Term
| 2 main signs of Parotitis |
|
Definition
Firm, erythematous swelling of pre-and postauricular areas extending to mandible
High fever, chills, toxic appearance
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Term
| 3 possible complications of Parotitis |
|
Definition
Massive swelling of neck-> respiratory obstruction
Septicemia
Osteomyelitis of the facial bones |
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Term
| 2 microbial causes of Parotitis |
|
Definition
Streptococcus plus anaerobes (Bacteroides, Peptostreptococcus)
or
S. aureus- worry about MRSA |
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Term
| How to treat Parotitis (3) |
|
Definition
Empirically Vancomycin
Plus
Metronidazole or Clindamycin |
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Term
What is the usual cause of deep space face/neck infections?
Give 3 categories of spaces that can be infected |
|
Definition
From spread of odontogenic infections to potential spaces between fascia
Facial
Suprahyoid
Infrahyoid |
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Term
| 3 facial locations where deep space infections can spread |
|
Definition
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Term
| 4 Suprahyoid locations where deep space infections can spread |
|
Definition
Parotid
Submandibular
Sublingual
Lateral pharyngeal |
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Term
| 3 Infrahyoid locations where deep space infections can spread |
|
Definition
Retropharyngeal
Danger
Pretracheal |
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Term
| If you find a deep space infection of the head and/or neck, and microbiology only shows normal flora, what is the likely microbe causing the infection? |
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Definition
| Streptococcus plus anaerobes |
|
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Term
| How do you treat deep space infections of the head and/or neck? |
|
Definition
|
|
Term
|
Definition
Bilateral submandibular space infection/cellulitis of the floor of the mouth
is an IMPENDING AIRWAY EMERGENCY, need an awake intubation or tracheostomy
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|
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Term
| How to treat Ludwig's angina |
|
Definition
fix airway emergency, then give Unasyn
(give more stuff if pt. is immunocompromised) |
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|
Term
Describe lateral pharyngeal deep space infections
Where is spread from this really dangerous? |
|
Definition
Communicates with tons of stuff, so is a major source of spread (with teeth, parotids, lymph nodes, and all the major fascial planes)
Spread to posterior compartment reaches the carotid sheath, 9th and 12 cranial nerves, etc. |
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Term
What are the symptoms of a Lateral pharyngeal deep space infection involving the anterior compartment? (5)
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|
Definition
| Dysphagia, trismus (poor jaw opening), pain in ipsilateralneck, jaw, and ear |
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|
Term
What are the symptoms of a Lateral pharyngeal deep space infection involving the posterior compartment?(5)
+ 3 possible complications |
|
Definition
NO trismus, occasionally sepsis, neurologic and vascular complications, pharyngeal edema
Complications-ipsilateral Horner’s, CN IX to XII palsies |
|
|
Term
What is Lemierre’s syndrome?
+
- 4 signs
- Microbe that causes it
- Treatment |
|
Definition
Septic thrombophlebitis of the internal jugular vein
- Usually with peritonsillarabscess
- Difficulty swallowing
- Neck pain
- Possibly neck mass
From Fusobacterium
Treatment: Antibiotics for 5 wks |
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|
Term
| Retropharyngeal deep space infection can spread to ___ |
|
Definition
| superior anterior mediastinum |
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Term
| Danger deep space extends through ___ to ___ |
|
Definition
| extends through posterior mediastinum to the diaphragm |
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|
Term
| Prevertebral space extends from ___ to ___ |
|
Definition
| from base of the skull down to the coccyx |
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Term
| 3 signs/symptoms of a Retorpharyngeal/Danger deep space infection |
|
Definition
- Sore throat with dysphagia, dyspnea and stiff neck
- Head rigidly tilted toward the contralateral side
- Pleuritic chest pain may indicate extension in the mediastinum |
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|
Term
| 4 complications of a Retorpharyngeal/Danger deep space infection |
|
Definition
- 25% mortality
- Descending necrotizing mediastinitis
- Purulent pericarditis
- Aspiration pneumonia in 50% |
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|
Term
Describe Prevertebral deep space infections
+ 4 possible signs/symptoms |
|
Definition
These are an epidural abscess, placing compression on spinal cord
Back or neck pain>
Fever>
Neurologic deficits
Psoas muscle extension |
|
|
Term
| Give the route of spread of Prevertebral deep space infections |
|
Definition
|
|
Term
| What microbe usually causes Prevertebral deep space infections? |
|
Definition
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Term
| 4 normal flora of the external auditory canal |
|
Definition
S. epidermidis, S. aureus, Corynebacterium, Propionibacterium
Sometimes Pseudomonas aeruginosa if moist |
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Term
| Otitis externa with a localized with pustular or furuncular (boil) lesion is often caused by ___ |
|
Definition
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Term
| Otitis externa with erysipelas (hard, inflamed, red skin) is usually caused by ___ |
|
Definition
|
|
Term
Diffuse otitis externa ("swimmer's ear")
- symptoms (3)
- microbial cause
- how to treat |
|
Definition
Symptoms: Inflammation of all of the external canal with pruritis and pain
Cause: Pseudomonas and other gram negatives
Treat: Remove debris + give a fluoroquinolone that kills pseudomonas |
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|
Term
What is malignant otitis externa?
Give 2 microbial causes
Who gets it? |
|
Definition
Extension of infection from epithelium to adjacent
soft tissue, blood vessels and bone due to underlying immunodeficiency (like diabetes or HIV)
Usually Pseudomonas
Can also be Aspergillus (fungal) |
|
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Term
| 4 major symptoms of malignant otitis externa |
|
Definition
Severe, unremitting otalgia (inner ear pain)
Sensation of fullness
Otorrhea (discharge from ear)
Conductive hearing loss |
|
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Term
| 3 possible complications of malignant otitis externa |
|
Definition
Dural sinus thrombosis
Meningitis
Cerebral abscess |
|
|
Term
| How long to give drugs for malignant otitis externa |
|
Definition
| 6-8 weeks of effective therapy |
|
|
Term
| 3 signs/syptoms of viral conjunctivitis |
|
Definition
Acute onset
Both eyes +watery discharge
Pre-auricular adenopathy |
|
|
Term
| 2 microbes that cause viral conjunctivitis |
|
Definition
Adenovirus
or
Herpes (assoc. w/ dendritis ulcer) |
|
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Term
| 3 characteristic of bacterial conjunctivitis |
|
Definition
More often unilateral
Heavy purulent
Matting of eyelids |
|
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Term
| 3 microbes that cause bacterial conjunctivitis |
|
Definition
S. aureus
or
H. influenzae, S. pneumonia in children |
|
|
Term
| How to treat bacterial conjunctivitis |
|
Definition
| Topical antibiotics like fluoroquinolone drops or bacitracin ointment |
|
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Term
| How to treat chlamydial conjunctivitis |
|
Definition
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Term
| Define Keratitis and give 4 signs/symptoms |
|
Definition
Infection of cornea rather than overlying mucus
membrane
**Eye pain**
Photophobia
No Discharge
Defect can usually be seen with fluorescein |
|
|
Term
| Common microbial cause of Keratitis and how to treat |
|
Definition
usually herpes
treat with acyclovir
Admit patient if bacterial or fungal suspected |
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|
Term
What is Endopthalmitis?
What 3 ways can you get it? |
|
Definition
Infection within the vitreous of the eye- is a medical emergency
Following eye surgery, from glaucoma, or from hematogenous spread of bacteria or fungus |
|
|
Term
| How to treat Endophthalmitis |
|
Definition
IV antibiotics of Vancomycin plus (Ceftazidime or gentamicin)
Vitrectomy
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