debridement, and hospital admission are also recommended. (d)Urologic
consultation may be necessary when a periurethral abscess is the inciting
event, or when there is involvement of the urinary tract and supravesical
urinary drainage is needed. However, widespread involvement of the fascia
and genital structures makes a bedside incision and drainage inadequate.
In addition, the treatment is incomplete without antibiotic coverage.
183.The answer is c.(Tintinalli, pp 851, 1494-1497.)Epiglottitisis a life-
threatening inflammatory condition, usually infectious, of the epiglottis and
the aryepiglottic and periglottic folds. Since most children are immunized
againstHaemophilus influenzaetype B (Hib), most cases of epiglottitis are
now seen in adults, with an average age of 46 years. Signs and symptoms
include a prodromal period of 1 to 2 days consisting of constitutional symp-
toms, then the patient exhibits high fever, dysphagia, odynophagia, drooling,
and dyspnea. Stridor is primarily inspiratory and softer and lower-pitched
than croup. The “thumbprint sign” seen on lateral cervical radiograph
demonstrates a swollen epiglottis obliterating the vallecula.
(a)Retropharyngeal abscess can present with similar signs and symp-
toms as epiglottitis. Cervical lymphadenopathy is prominent and inflam-
mation may be so severe that patients develop an inflammatory torticollis,
causing the patient to rotate the head toward the affected side. Soft tissue
cervical radiograph may demonstrate excess prevertebral swelling. Treat-
ment is IV hydration and antibiotics, which should be started in the ED,
and drainage in the OR. (b)Peritonsillar abscess would present with
swollen erythematous tonsils and uvula deviation. It is most common dur-
ing the second and third decades of life. Diagnosis is easily made by CT
scan or ultrasound, but aspiration of purulent material is sufficient for
diagnosis. Treatment is incision and drainage or needle aspiration, fol-
lowed by high-dose penicillin or clindamycin. (d)Pharyngitis is an infec-
tion of the pharynx and tonsils that occur in adults, but has a peak
incidence in children aged 4 to 7 years. The etiology is most often viral.
S. pyogenes(group A, β-hemolytic strep) is the most common cause of bac-
terial pharyngitis (5%-15%) in adults. Patients present with erythematous
tonsils, tonsillar exudates, enlarged and tender anterior cervical lymph
nodes.(e)Laryngotracheitis, or croup, is generally seen in children aged
6 months to 3 years and rarely seen after age 6 years.
184.The answer is d.(Center for Disease Control, Treatment Guidelines
2006, Sexually Transmitted Diseases, pp 58-63.) This patient has a tubo-ovarian
202 Emergency Medicine