Regarding peritonsillar abscess, which ONE of the following statements is TRUE?
Answer: C: A peritonsillar abscess is formed secondary to an infection in the mucous salivary glands located superior to the tonsils in the soft palate. With infection, peritonsillar cellulitis develops in the soft palate and later pus formation occurs with the development of an abscess. It is a poly-microbial infection; however, group A streptococcus is found most frequently. Oral anaerobes are involved as well. The diagnosis of peritonsillar abscess is mainly clinical. If the diagnosis is in doubt, then needle aspiration of pus, contrast CT scan, MRI or transcutaneous ultrasound can confirm the diagnosis. Transcutaneous ultrasound has a moderate sensitivity and specificity.
Regarding treatment, both needle aspiration and incision and drainage of a peritonsillar abscess produce similar outcomes if performed by trained medical staff.
References:
A 55-year-old adult male presents to the ED with a severe sore throat and fever of 36 hours’ duration. Which ONE of the following features LEAST supports a presumptive diagnosis of adult epiglottitis (supraglottitis)?
Answer: A: The diagnosis of adult epiglottitis (supraglottitis) in a patient presenting to the ED is based mainly on the history and examination findings. This can be supported by lateral soft tissue X-ray of the neck, which is generally easy and safe to obtain. The features on history and clinical examination that supports the diagnosis include:
These subtle features are often not recognized early. Such patients may rapidly develop features of severe airway obstruction including drooling, severe stridor, and the inability to lie flat. Bilateral submandibular swelling is a feature of Ludwig’s angina and does not usually occur with adult epiglottitis.
Lateral soft tissue X-rays of the neck are easy to obtain in the ED, with the most frequently searched for sign being the enlarged thumb-shaped epiglottis. Examination of the larynx with nasoendoscopy can confirm the diagnosis, but this should be done with extreme caution by otolaryngologists as this may worsen the airway obstruction.
Regarding removal of nasal foreign bodies in children, all of the following statements are true EXCEPT:
Answer: B: Most nasal foreign bodies in children can be removed using appropriate techniques without sedation. If sedation is required, the preservation of gag-and cough reflexes is important to prevent aspiration of the foreign body should it slip backwards. Positive pressure techniques are recommended as first-line methods for foreign bodies that are not highly impacted because they are easy to apply to a non-sedated child. The positive pressure techniques include:
There is a risk of barotrauma with all these methods but that happens very infrequently with the big kiss or modified big kiss methods. The Beamsley blaster technique has a higher risk of causing barotrauma. The success rates when using balloon catheters is high for anteriorly located foreign bodies. The most widely available is the 5–8 F Foley catheter.
Regarding nasal fractures in children, which ONE of the following statements is TRUE?
Answer: A: Nasal fractures in children are significant injuries because potential greenstick fractures, injuries to the cartilage, growth plate injuries and septal injuries may occur. Because of relatively small nasal passages in children the fracture may cause an obstruction that may be worsened later by formation of synechiae. The risk for poor cosmetic outcome is higher for children with nasal fractures than for adults with similar fractures. Plain X-ray does not help in the management of nasal fractures and CT scans are unnecessary.
Nasal fractures are often reduced under general anaesthetic and that should be done very early (within 4 days) to overcome the faster fracture healing time in children.
Reference:
Regarding malignant otitis externa, which ONE of the following statements is INCORRECT?
Answer: D: Malignant otitis externa is a less common but potentially life-threatening form of otitis externa. The presence of diabetes and immunosuppression increases the risk of having this condition. In >90% of patients the causative organism is Pseudomonas aeruginosa and therefore if suspected initiation of parenteral IV antibiotic therapy to cover this organism is essential. In addition, surgical debridement may be necessary. The clinical features that are helpful in the diagnosis are:
In severe disease the following may occur:
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