A. Physical Exam Key Points. Perform a complete physical exam to assess for generalized lymphadenopathy or hepatosplenomegaly, which would raise suspicion of systemic infection or malignancy.

1. General appearance. Determine if signs of respiratory distress (tachypnea, stridor, or wheezing) are present. Children with bacterial infections may appear quite ill and have fever and irritability. Some children with a retropharyngeal infection may present with torticollis or limited neck movement. Drooling is usually a sign of peritonsillar or retropharyngeal abscess but may be seen in other children with severe oropharyngeal pain.

2. Quality of voice. A "hot-potato" voice is seen with peritonsillar abscess, and a muffled voice may be seen with retropharyn-geal cellulitis or abscess.

3. Oropharynx. Assess carefully and thoroughly to determine presence of ulcerations, gingivitis, pharyngeal irritation, tonsillar hypertrophy and exudate, and posterior pharyngeal bulging.

4. External neck. Check for a palpable mass. Familiarity with anatomic location of the anterior and posterior cervical and occipital nodes is crucial. Swelling along the lymph node chain may represent reactive adenopathy, lymphadenitis, lymph node abscess, or lymphoma. Branchial cleft cysts may present as fluctuant masses in the anterior neck along the sternoclei-domastoid muscle; if infected, there may be erythema, warmth, and tenderness. Thyroglossal duct cysts are midline lesions that may be infected on presentation. Cystic hygromas are soft, nontender, and cystic, and are commonly found in the posterior triangle of the neck.

5. Reexamination. Essential to determine response to therapy, particularly in cases of suspected bacterial cervical lymphadenitis.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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