MCQ – 71109

Correct Answer � C Explanation

Ans:C.) Acute Epiglottitis.

Image shows:Epiglottitis. A lateral radiograph of the neck using soft tissue technique demonstrates an enlarged epiglottis (red arrow) with markedly thickened aryepiglottic fold (white arrow) diagnostic of acute epiglottitis.

ACUTE EPIGLOTTITS

• It is an acute inflammation of epiglottis with inflammatory edema of hypopharynx.
• It is a true medical emergency.
•  The most common pathogens are those that cause tonsillitis, namely beta-haemolytic Streptococci, with Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae also common causes 
  
  • Most cases of epiglottitis and meningitis due to H. influenzae are caused by type b organisms that possess a polyribitol phosphate capsule. Otitis media is generally not caused by type b organisms.

CLINICAL FEATURES OF EPIGLOTTITIS

• Onset is sudden
• Symptoms are fever, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis and soft stridor.
• Patients often sit in sniffing dog position.
• Complications:
  • The main complication is death from respiratory arrest due to acute airway obstruction.
  • Other complications are rare but include epiglottic abscess, pulmonary edema secondary to relieving airway obstruction and thrombosis of internal jugular vein (Lemierre’s syndrome)

DIAGNOSIS AND TREATMENT OF EPIGLOTTITIS

• Laryngoscopy-“Cherry red” swollen epiglottis is seen.
  • Acute Laryngeal Spasm may occur during Indirect Laryngoscopy.
• Radiograph – Culture of blood and secretions covering Epiglottis
  •  A plain lateral soft tissue radiograph of neck shows the following specific features
    • Thickening of the epiglottis—the thumb sign
    • Absence of a deep well-defined vallecula—the vallecula sign
• Treatment
  • Immediate endotracheal intubation.
  • IV antibiotics to cover H.influenzae.
    • The antibiotic of choice in acute epiglottitis pending culture sensitivity report is Ampicillin or 3rd generation Cephalosporin like Ceftriaxone.