Deep Neck Space Infections

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  • 1/10 Questions

    Dental infections occurring posterior to the second molar involve which space?

    • Submandibular
    • Masseteric
    • Sublingual
    • Parapharyngeal
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Deep Neck Space Infections - Quiz
About This Quiz

This quiz assesses knowledge on deep neck space infections, focusing on diagnosis, management, and complications. It covers critical aspects like identifying predominant organisms, recognizing symptoms linked to specific spaces, and understanding timely surgical interventions. Essential for medical professionals specializing in pediatrics and otolaryngology.

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  • 2. 

    A 4y/o child with a Hx of previous URI, present with fever, dysphagia, odynophagia, nuchal rigidity, and mild airway compromise.  What is the first space that may be affected with abcess?

    • Retropharyngeal

    • Prevertebral

    • Submandibular

    • Parapharyngeal

    Correct Answer
    A. Retropharyngeal
    Explanation
    Most abscesses of the retropharyngeal space occur in children. This is due to the fact that retropharyngeal nodes disappear by about the age of 5 years. Most infections begin in the nose or nasopharynx and adenoids, and paranasal sinuses and drain to these nodes which go on to suppurate. There is consequently a history of an upper respiratory tract infection. Fever, dysphagia, odynophagia, nuchal rigidity, and airway compromise may occur.

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  • 3. 

    A patient presents with spiking fevers, tenderness along the sternocleidomastoid muscle, neck stiffness, and septic arthritis.  CT scan shows ring enhancement with a central area of lucency of the IJV, what is the diagnosis?  

    • Cavernous sinus syndrome

    • Carotid artery erosion

    • Lemierre syndrome

    • Branchial cleft cyst

    Correct Answer
    A. Lemierre syndrome
    Explanation
    The patient's presentation of spiking fevers, tenderness along the sternocleidomastoid muscle, neck stiffness, and septic arthritis, along with the CT scan findings of ring enhancement with a central area of lucency of the IJV, are consistent with Lemierre syndrome. This syndrome is characterized by septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection. It typically presents with fever, neck pain, and swelling, and can progress to septic emboli and abscess formation. The CT scan findings of ring enhancement with a central area of lucency of the IJV is a characteristic feature of septic thrombophlebitis in Lemierre syndrome.

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  • 4. 

    A patient has a supperative thyroiditis infection, what space would most likely be involved?

    • Temporal space

    • Anterior visceral space

    • Suprasternal space

    • Visceral vascular space

    Correct Answer
    A. Anterior visceral space
    Explanation
    Anterior visceral space infections are usually the result of perforations of the esophagus, due to instrumentation, foreign body, or external trauma. A suppurative thyroiditis may also be a source of infection. Laryngeal necrosis following radiation and infection can also be a potential source for such an infection.

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  • 5. 

    What is the recommended time to take a patient to the OR for I&D of a neck abcess if there is failure to progress?

    • 24 hrs

    • 48 hrs

    • 72 hrs

    • 96 hrs

    Correct Answer
    A. 48 hrs
    Explanation
    The recommended time to take a patient to the OR for I&D (incision and drainage) of a neck abscess if there is failure to progress is 48 hours. This means that if there is no improvement in the patient's condition within 48 hours of initiating treatment, it is recommended to perform the surgical procedure to drain the abscess. This timeframe allows for a sufficient period of observation and conservative management before deciding on surgical intervention.

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  • 6. 

    A patient presents with ipsilateral ptosis, facial anhydrosis, and miosis, what space could be involved?  

    • Prevertebral space

    • Visceral vascular space

    • Parotid space

    • Temporal space

    Correct Answer
    A. Visceral vascular space
    Explanation
    In cases where the visceral vascular space or the parapharyngeal space is involved, the astute physician may pick up the signs of Horner syndrome, which is characterized by ipsilateral ptosis, facial anhydrosis, and miosis due to the proximity of the sympathetic chain.

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  • 7. 

    What complication still has a high rate of mortality despite antibiotic therapy?

    • Carotid artery erosion and hemorrhage

    • Osteomyelitis of the spine

    • Pulmonary edema

    • Mediastinitis

    Correct Answer
    A. Mediastinitis
    Explanation
    Mediastinitis is an inflammation of the tissues in the mediastinum, the area between the lungs. Despite antibiotic therapy, it still has a high rate of mortality. This could be due to several reasons, such as delayed diagnosis, difficulty in treating the infection due to the complex anatomy of the mediastinum, or the presence of underlying health conditions that make the infection harder to manage. The high mortality rate highlights the need for early recognition and aggressive treatment of mediastinitis.

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  • 8. 

    What is the predominant organism in children younger than 9 months of age according to the studies provided?

    • Streptococcus viridans

    • β-hemolytic streptococci

    • Bacteroides sp.

    • Staphylococcus aureus

    Correct Answer
    A. Staphylococcus aureus
    Explanation
    It appears that in infants younger than 9 months of age, Staphylococcus aureus is the predominant organism when abscesses that involve the anterior and posterior triangles of the neck are involved. They constituted 80% of cases in one study. S. aureus was found to be a predominant isolate, albeit at a lower rate of 56% in a study reported by Brook. This organism along with β-hemolytic streptococci was also reported by Ungkanont and colleagues, although the incidence was smaller.

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  • 9. 

    Dental infections occurring anterior to the second molar involve which space?  

    • Submandibular

    • Masseteric

    • Sublingual

    • Parapharyngeal

    Correct Answer
    A. Sublingual
    Explanation
    Dental infections occurring anterior to the second molar involve the sublingual space. This space is located under the tongue and extends from the midline to the mandibular symphysis. It is a potential space that can become infected due to the spread of dental infections.

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  • 10. 

    What is a possible complication with the use of steroid in a especially in a child with an evolving neck abcess?

    • Masking of fever

    • Progression of edema

    • Adrenal suppression

    • Masking of WBC

    Correct Answer
    A. Masking of WBC
    Explanation
    In infants and children, rapidly progressive airway compromise is usually present along with fever and neck mass. In infants in particular, a high index of suspicion is important, because complaints such as sore throat, voice changes, and odynophagia may not be forthcoming as they are in older children. In this series, 21 of 22 patients had an elevated white blood cell (WBC) count. Serial WBC counts are a good way to monitor response to antibiotic therapy, and consequently, it is the preference of these authors that steroids not be used unless airway compromise is impending or present.

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  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jan 12, 2010
    Quiz Created by
    Pascolini

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