Tropical Travel Trouble 011 Tonsillitis and the Bull
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 011
Peer Reviewers: Dr Jennifer Ho, ID physician QLD, Australia and Dr Mark Little, ED physician QLD, Australia.
You are working in far North Queensland and encounter a 20 year old Indigenous man with tonsillitis on your ED short stay ward round. He has been receiving IV penicillin and metronidazole overnight but is deteriorating and now cannot open his mouth beyond 1.5cm, and has a swollen neck (some might say ‘Bull neck’). In addition, he now has “gurgly” breathing. He is taken to OT to be intubated by ENT and they report a grade 4 airway with “large grey tonsils and moist scales”.
Questions:
Q1. What is your differential?
Answer and interpretation
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Viral pharyngitis
EBV
Group A Strep
Oral Candidiasis
Epiglottitis
Diphtheria
Ludwigs angina
Q2. What is the cause of this man’s tonsillitis?
Answer and interpretation
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Diphtheria.
The word diphtheria comes from the Greek word for leather, which refers to the tough pharyngeal membrane that is the clinical hallmark of infection.
Below is a collection of images of the ‘grey pseudomembranous plaque’. This plaq...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Amanda McConnell Tags: Clinical Cases Tropical Medicine antitoxin bull neck c. diphtheriae c.ulcerans DAT pseudomembrane vaccine Source Type: blogs
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