Trivia Time! A PTA by Any Other Name...

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Here's a slate of trivia questions to hopefully challenge and entertain!!

In a patient with a peritonsilar (PTA) abscess (as pictured above), where is the appropriate initial site of aspiration?

A - The initial site of aspiration for a PTA is in the superior pole (A) of the peritonsilar tissues. The needle is advanced in the saggital plane only to avoid the complication described in a separate question below. If aspiration at the superior pole is not successful, you should attempt to aspirate next at the middle pole (B) and finally at the inferior pole (C).

Reference: Rivell, R. and Brown, A. Otolaryngologic Procedures. Roberts and Hedges. Ch. 64. pp 1178-1216.

What is the approximate failure rate for needle aspiration of a PTA?

Recurrence rates after initial successful drainage with needle aspiration are approximately 10% with around 4-10% of patients requiring repeat aspiration. There is also the possibility of missing an abscess if you only perform needle aspiration of the superior pole (up to 30% miss rate).

Reference: Rivell, R. and Brown, A. Otolaryngologic Procedures. Roberts and Hedges. Ch. 64. pp 1178-1216.

What is the most feared complication from PTA aspiration or incision and drainage?

Aspiration or incision of the carotid artery is a possible complication from this procedure potentially leading to carotid artery aneurysm and subsequent complications for the patient if unrecognized. This risks of this complication can be lessened by using a needle guard (do this by cutting 1 cm off of the plastic sheath that comes with a spinal needle) and by ensuring in your technique that you do not aim too far laterally.

Reference: Rivell, R. and Brown, A. Otolaryngologic Procedures. Roberts and Hedges. Ch. 64. pp 1178-1216.

What is an alternative name for a peritonisilar abscess?

Quinsy is the alternative name. Originally from the French word "esquinancie" subequently anglicized to the modern "quinsy."

Reference: Wikipedia contributors. "Peritonsillar abscess." Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 27 Apr. 2017. Web. 14 Aug. 2017

George Washington was originally thought to have died from a peritonisilar abscess. However, it is now thought that he died from what other disease process?

Epiglottitis (and probably a dose of medical misadventure).

George Washington awoke on the morning of 12/13/1799 complaining of a sore throat. He worked throughout that day then awoke at 3 am on the morning of 12/14 with severe difficulty breathing, unable to speak or swallow. What followed was a series of blood letting procedures (in keeping with the medical practices of that time) where Washington lost approximately 1/2 of his blood volume over the span of several hours. Washington ultimately died at 10 pm on the evening of 12/14. Initial reports from physicians caring for Washington noted that they felt he was suffering from quinsy. However, most modern interpretations of the series of events leading to his death postulate that Washington died of epiglottitis complicated by hypovolemic shock.

Reference: Wikipedia contributors. "George Washington." Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 11 Aug. 2017. Web. 14 Aug. 2017