Which of the following is NOT true about acute retropharyngeal abscess -
(A (Caries of cervical spine is usually a common cause) (262 - Dhingra 5th)* Acute retropharyngeal abscess is due to suppurative retropharyngeal lymphadenitis.* There is dysphagia, dysnea (difficult breathing, stridor, croupy cough, torticollis and swelling in posterior pharyngeal wall on one side of the midline (i.e. in the lateral part of posterior pharyngeal wall).Retropharyngeal abscess* Retropharyngeal space lies behind the pharynx, i.e. between buccopharyngeal fascia covering pharyngeal constrictor muscles (anteriorly and prevertebral fascia covering the prevertebral muscles (posteriorly). So retropharyngeal space lies behind the pharyngeal constrictor muscles and anterior to prevertebral fascia covering the prevertebral muscles.* Abscess in this space may present differently depending upon the age:-Abscess in infants (acute Retropharyngeal abscess)> It is commonly seen in infants and children below 3 years of age. Most commonly it results from retropharyngeal lymphadenitis due to an upper respiratory tract infection. The presentation is acute, i.e. child has high temperature and sore throat. There is smooth swelling (bulge) in posterior pharyngeal wall on one side of the midline. There is dysphagia, difficulty in breathing, stridor, croupy cough and torticollis, Swelling can be palpable per orally on the posterior pharyngeal wall. Treatment is incision and drainage.Abscess in adults (chronic retropharyngeal abscess)> If an adult or an older child has a retropharyngeal infection it is likely to be due to a tuberculous infection of the cervical spine (caries of cervical spine). Sometime it may be secondary to tuberculous infection of retropharyngeal lymph nodes. It is of slow onset and gives rise to pharyngeal discomfort, rather than pain. There is fluctuant swelling in posterior pharyngeal wall, centrally in the midline (fit it is secondary to caries of cervical spine) or on one side of midline (if it is secondary to tuberculosis of retropharyngeal nodes) treatment includes incision and drainage of abscess along with full course of antitubercular treatment.GRADENGO'S SYNDROME:(i) External rectus palsy (Vth nerve / abducent nerve palsy) causing diplopia.(ii) Deep seated orbital or retro orbital pain (Vth nerve involvement)(iii) Persistent ear discharge due to ipsilateral acute or chronic otitis media.Ludwig's angina is a rapidly spreading bilateral cellulitis, usually begins in the submandibular space and then rapidly spreads to involves the sublingual space. Most common cause is infection of the teeth especially 2nd and 3rd mandibular molar.* Gillette's space - two lateral space in retropharyngeal space.* Thornwaldt cyst is a benign midline Nasopharyngeal mucosal cyst**Antibiotics are given to treat infection and marsupialisation of the cystic swelling and adequate removal of its lining membrane is done.* Nodes of Rouviere - in Retropharyngeal nodes. Most superior nodes of the lateral group is called nodes of Rouviere.* Waldeyer's lymphatic rings - consist of palatine, pharyngeal tubal and Ungual tonsils***Peritonsillar Abscess (Quinsy) - Collection of pus between the capsule of tonsil and the superior constrictor muscle i.e. in the peritonsillar area. It is a complication of tonsillitis and is most commonly caused by group A beta-hemolytic streptococcus. Tonsillectomy is done 6 weeks following an attack of quinsy (Interval tonsillectomy).1. The horizontal semicircular canal produces - Horizontal nystagmus The superior semicircular canal produces - Rotatory' nystagmus The posterior semicircular canal produces - Vertical nystagmus2. Light house effect in ASOM seen in stage of resolution (due to pulsatile otorrhea)3. Epley's maneuver (vestibular exercise) is used in BPPV - where the head is taken through a series of position changes that allow the crystals to be emptied out of the semicircular canal (Positional vertigo)4. A loose tracheal foreign body like seed may move up and down the trachea between the carina and the undersurface of vocal cords causing "Audible slap" or "Palpatory thud"5. Functional endoscopic sinus surgery (FESS) is the treatment of choice for all nasal polyps.6. The most common cause of epistaxis is the mucosal maceration caused by upper respiratory infection and nose picking (Trauma)7. Causes of recurrent epistaxis in children* Retained nasal foreign body* Use of nasal sprays as intranasal steroid spray* Haemorrhagic disease as in ITP, Von Willibrand disease* Angiofibroma (suspect in adolescent boys)* Nasal parasitosis/Nasal myiasisi. Perilymph - resemble ECF and rich in Na+ ions. Closely resembles CSFii. Endolymph- resembles ICF and rich in K+. Electrically positive by 85mV.8. The nasal polyps is the most common nasal cavity massi. Most common (me) nasal mass - Inflammatory polypsii. MC tumour of nasal cavity - Inverted papillomaiii. MC malignant tumor of nasal cavity - Squamous cell Caiv. MC nasal sarcoma in adolescent - Rhabdomyosarcoma9. Irritation of the auricular branch of vagus (Alderman's nerve) in the external ear may reflexly cause Cough, Vomiting or even death due to sudden cardiac inhibition10. An external laryngocele arises as a result of herniation of the laryngeal mucosa through the thyrohyoid membrane and presents in the neck* Laryngocele arises from the saccule for the ventricle.* Paired cartilage - Arytenoid, Comiculate, Cuneiform* Unpaired cartilage - Thyroid, Cricoid, EpiglottisHyaline cartilage - Thyroid, Cricoid, basal part of arytenoids cartilageElastic cartilage - Epiglottis, comiculate, cuneiform, processes of arytenoids11. Excessive bleeding at the time of operation (Tonsillectomy) usually arises because of trauma to an aberrant vessel or paratonsillar vein12. Natural resonance and efficiency of auditory apparatus - external auditory canal (3000 Hz) Tympanic membrane (800-1600Hz). Middle ear (800Hz) Ossicular chain (500-2000Hz).
Caries of cervical spine is usually a common cause
Swelling on posterolateral wall of pharynx
Torticollis
Dysphagia
Pharynx