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Mumps
3%
1/38
Pleomorphic adenoma
Sjogren's syndrome
0%
0/38
Acute bacterial parotitis
92%
35/38
Superior vena cava syndrome
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Acute bacterial parotitis presents with painful swelling of the parotid gland and is usually caused by Staphylococcus aureus. In generally healthy patients, this is seen most commonly in the setting of positive pressure ventilation via bag mask during general anesthesia induction, in this case her tonsillectomy forced bacteria retrogradely into Stenson's duct. Bacteria ascend from the mouth, causing this type of infection. Most often seen in a chronically ill patient, bacterial parotitis can quickly worsen. Culture, gram stain, and antibiotic sensitivities are indicated. Initial treatment is usually with intravenous vancomycin until sensitivities return. Brook discusses the diagnosis and management of parotitis. Of all the salivary glands, the parotid is most commonly affected by inflammatory processes. Viral parotitis can be caused by paramyxovirus (mumps), Epstein-Barr virus, coxsackievirus, influenza A and parainfluenza viruses. Acute suppurative parotitis is generally caused by S. aureus, Streptococcus species, and rarely, gram-negative bacteria. In a separate article, Brook reviews the bacteriology of salivary gland infections. The predominant anaerobes include: anaerobic Gram negative bacilli (eg, pigmented Prevotella and Porphyromonas); Fusobacterium spp; and Peptostreptococcus spp. Figure A depicts the physical exam in acute bacterial parotitis. Incorrect Answers: Answer 1: Mumps presents with parotitis and, in more severe cases, orchitis, asceptic meningitis, and pancreatitis. Mumps is unlikely in a vaccinated individual and would be less likely than a bacterial parotitis post-surgery. Answer 2: Pleomorphic adenoma is the most common tumor affecting the salivary glands and is essentially benign. Malignancy can develop causing infiltration of the facial nerve. Answer 3: Sjogren's syndrome may result in chronic inflammation of the salivary glands but appears commonly in older individuals and more commonly in women. Also this patient has no dryness in the eyes or mouth. Answer 5: Superior vena cava syndrome occurs in 5% of patients with mediastinal lung tumors. Patients present with facial fullness, edema, and JVD.
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