Abscesses

Question 1

a peritonsillar abscess is also called

Answer 1

quinsy

Question 2

what is a quinsy

Answer 2

a suppurative infection of the tissue between the palatine tonsil capsule and the pharyngeal muscles. It is usually a complication of acute tonsillitis but may be due to an infection of minor salivary glands

Question 3

clinical presentation of quinsy

Answer 3

Patients can present with trismus, severe unilateral throat pain, high fever or a change in voice.
uvula shifted to the contralateral side
inflamed ipsilateral tonsil
ipsilateral ear pain and cervical lymphadenopathy

Question 4

clinical presentation of parapharyngeal abscess

Answer 4

features of tonsillitis
trismus
medial displacement of the lateral pharyngeal wall and tonsil
or indurated swelling

Question 5

clinical presentation of retropharyngeal abscess

Answer 5

features of tonsillitis
sometimes truisms
unilateral swelling of the posterior pharyngeal wall
nack asymmetry with neck swelling and anterior cervical lymphadenopathy

Question 6

most common form of deep neck infection

Answer 6

peritonsillar abscess

Question 7

diagnostics of peritonsillar abscess

Answer 7

clinical diagnosis
bacterial culture of abscess aspirate
obtain a group A strep rapid detection test
EBV serology to rule out infectious mono

Question 8

treatment of peritonsillar abscess

Answer 8

prompt airway management
empiric Abx
abscess drainage via needle aspiration or incision and drainage

Question 9

diagnostics for parapharyngeal abscess

Answer 9

imagining required for diagnostic confirmation: CT neck with IV contrast
MRI neck is concern for complications

Question 10

treatment for parapharyngeal abscess

Answer 10

systemic IV abx
abscess drainage and supportive care

Question 11

what is the most dangerous deep space neck infection

Answer 11

retropharyngeal abscess

Question 12

aetiology of retropharyngeal abscess

Answer 12

ontiguous or lymphatic spread from oral (most common) or upper respiratory tract infections
Local penetrating pharyngeal trauma (e.g., from small bones such as of fish or chicken, or medical instruments)
Spread from other deep neck infections (nasopharynx, sinuses, adenoids)

Question 13

diagnostics for retropharyngeal abscess

Answer 13

lateral XR neck: initial screening study
CT neck with IV contrast if x-ray is negative but continued suspicion

Question 14

treatment of retropharyngeal abscess

Answer 14

systemic IV Abx with abscess drainage and supportive care

Question 15

complications of retropharyngeal abscess

Answer 15

airway obstruction
lemierre syndrome
descending mediastinitis
infection can spread to skull base (epidural abscess) or the posterior mediastinum (pericarditis)
aspiration pneumonia
atlantoaxial dislocation
bacteraemia and sepsis