Which of the following is true regarding erysipelas: (LQ)
|B||Subcutaneous inflammation due to Streptococcus|
|C||Lymphangitis due to Streptococcus|
|D||Lymphangitis due to Staphylococcus|
In acute bulbar poliomyelitis, function of respiratory centre is impaired and irregularities of rate and rhythm of breading leads to respiratory failure and sudden collapse.
The clinical findings seen with bulbar poliomyelitis with respiratory difficulty (other than paralysis of extra ocular, facial, and masticatory muscles) include
1. Nasal twang to the voice or cry caused by palatal and pharyngeal weakness (hard-consonant words such as “cookie” or “candy” bring this out best);
2. Inability to swallow smoothly, resulting in accumulation of saliva in the pharynx, indicates partial immobility (holding the larynx lightly and asking the patient to swallow will confirm such immobility);
3. Accumulated pharyngeal secretions, which may cause irregular respirations because each inspiration must be “planned” to avoid aspirating; the respirations may thus appear interrupted and abnormal even to the point of falsely simulating intercostal or diaphragmatic weakness;
4. Absence of effective coughing, shown by constant fatiguing efforts to clear the throat;
5. Nasal regurgitation of saliva and fluids as a result of palatal paralysis, with inability to separate the oropharynx from the nasopharynx during swallowing;
6. Deviation of the palate, uvula, or tongue;
7. Involvement of vital centers in the medulla, which are manifested by irregularities in rate, depth, and rhythm of respiration; by cardiovascular alterations including blood pressure changes (especially increased blood pressure), alternate flushing and mottling of the skin, and cardiac arrhythmias; and by rapid changes in body temperature;
8. Paralysis of one or both vocal cords, causing hoarseness, aphonia, and ultimately asphyxia unless this is recognized by Laryngoscopy and managed by immediate tracheostomy;
9. The rope sign, an acute angulation between the chin and larynx caused by weakness of the hyoid muscles (the hyoid bone is pulled posteriorly, narrowing the hypopharyngeal inlet).