A 3-year - pacemaker

[ArchivalUser]

A 3-year-old boy is brought to the emergency department
because of drooling. He developed a sore throat 3 days
ago with fever up to 38.8 C (101.8 F). His mother gave
him acetaminophen and an over-the-counter mixture for
what she assumed was a common cold; however, since last
night the fever had increased to 40 C (104.0 F) and the
child has become increasingly unwell.He did not want to
drink and his respirations were becoming noisy.When he
woke up this morning he began drooling and appears to
be in pain. There was no history of trauma, cough, or
vomiting, and his immunizations are complete to date.
Examination reveals a toxic and frightened-looking child
who refuses to flex his neck. Vital signs are: temperature
40.3 C (104.5 F), pulse 148/min, respirations 32/min,
blood pressure 110/68 mm Hg, and oxygen saturation
98% in room air. There is a bulge in the posterior pharyngeal
wall, along with erythema and collection of oral
secretions. Which of the following investigations would
be most helpful in establishing a diagnosis?
(A) Complete blood count
(B) Lateral neck x-ray
© Lumbar puncture
(D) Nasopharyngeal aspirate
(E) Throat swab

[ArchivalUser]

bbbbb

[ArchivalUser]

bbb...........sounds like epiglottitis even though vaccines are up to date...NOthing is 100% protective........

[ArchivalUser]

thumb print sign

[ArchivalUser]

(B) Lateral neck x-ray

retropharyngeal abscess

[ArchivalUser]

is this abscess or epiglotitis...?

[ArchivalUser]

The correct answer is B. Retropharyngeal abscesses can
develop in preschool children due to the presence of
lymph nodes behind the posterior pharyngeal wall. It is
usually a complication of acute pharyngitis, although
some cases arise as a result of penetrating trauma or
osteomyelitis affecting the cervical vertebrae. Group A
Streptococcus, Staphylococcus aureus, and anaerobes are
the most common causative agents. There is sudden
onset of high fever and the enlarging abscess causes
pain and obstruction, which prevent the child from
swallowing saliva. The neck is held in hyperextension
and the breathing can become difficult. A lateral neck xray
will show increase in retropharyngeal soft tissue and
help to confirm the diagnosis. CT of the neck can help
in cases where the diagnosis is in doubt.
A complete blood count (choice A) is likely to show
leukocytosis with increased neutrophils in such
patients, but is a nonspecific finding.
The pain can cause patients with retropharyngeal
abscess to hold their necks in rigid extension, thus raising
the possibility of meningitis (choice C). However,
the presence of upper airway obstruction and normal
sensorium should make this diagnosis less likely and so
a lumbar puncture would not be helpful in establishing
a diagnosis.
Nasopharyngeal aspirate (choice D) can be cultured to
diagnose viral infections. Retropharyngeal abscess is a
bacterial illness, and thus this test is not helpful in this
patient.
Throat swab (choice E) is useful for diagnosis of bacterial
pharyngitis, but does not help in establishing a
diagnosis of retropharyngeal abscess.