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13 ENT > Adult Stridor > Flashcards

Adult Stridor Flashcards

1
Q

the larynx begins its descent into its final position between the age of ___

A

18-24 mos

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2
Q

the foregut is the origin of the ___

A

larynx, trachea, and esophagus

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3
Q

____: sole abductor
___: major adductor and modules tone and volume

A

posterior cricoarytenoids: sole abductor

lateral cricoarytenoids: adducts vocal folds and modulates tone and volume

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4
Q

cricothyroid muscle: ___ nerve

all other intrinsic laryngeal muscles: __ nerve

A

cricothyroid: superior laryngeal nerve

all other laryngeal muscles: recurrent laryngeal nerve

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5
Q

blood supply of the larynx

A

superior thyroid artery -> superior laryngeal artery ->cricothyroid artery (laryngeal cartilage)

inferior thyroid artery -> inferior laryngeal arteries

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6
Q

voice production

A

thyroarytenoid lowers the pitch
cricothyroid + thyroarytenoid raises the pitch
cricothyroid makes falsetto

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7
Q

aberrations in the microanatomy of the vocal fold causes __

A

dysphonia, aphonia with or without airway compromise

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8
Q

microanatomy of the vocal fold

A

reinke’s space/ superficial lamina propria: acellular and gelatinous

intermediate and deep lamina propria: elastin and collagen

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9
Q

bernoulli’s principle

A

read it girl

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10
Q

cough reflex

A
  • inspiratory phase
  • intrathoracic pressure exceeds extrathoracic pressure + expiratory muscle contraction
  • opening of the glottis
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11
Q

protective functions of the cough reflex

A
  • clean the tracheobronchial tree

- maintain patency of lower airways

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12
Q

most common cause of acute laryngopharyngitis

A

infectious (viral)

  • rhinovirus most common
  • coronavirus and parainfluenza
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13
Q

pathophysio of acute laryngopharyngitis

A
  • inflammatory mediators -> edema and hyperemia of laryngopharyngeal mucosa
  • inability to phonate, swallow, breathe properly and pain
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14
Q

death from influenza a is from ___

A

bacterial pneumonia (s aureus or gbs)

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15
Q

clinical course of influenza type a

A
  • abrupt onset of fever, headache, myalgia

- symptoms resolve in 3-5 days

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16
Q

treatment for influenza type a

A

antiviral with m2 ion channel blockers: amantadine

neuraminidase inhibitors: zanamivir, oseltamivir

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17
Q

cause of bacterial acute laryngopharyngitis

A

gabhs transmitter by aerosolized microdroplets

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18
Q

clinical course of bacterial al

A
  • contagious during acute illness until 1 week after

- resolution in 3-7 days

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19
Q

treatment for bacterial al

A
  • antibiotic within 24-48 hours of symptom onset
  • penicillin or amoxicillin for 10 days
  • clindamycin is an acceptable alternative
20
Q

types of chronic laryngopharyngitis

A
  • chronic bacterial
  • chronic fungal (blastomyces, histoplasma, coccidioides, paracoccidioides, cryptococcus)
  • chronic mycobacterial laryngitis (myobacterium leprae)
21
Q

what is chronic mycobacterial laryngitis

A
  • m leprae transmitted via aerosolized droplet
  • dx: tissue biopsy and tissue staining
  • tx: multidrug therapy
22
Q

most common symptoms of laryngeal tb

A

hoarseness with or without

  • odynophagia
  • dysphagia, cough, otalgia, and/or stridor
23
Q

lesions of laryngeal tb are more commonly found in ___

A

glottis and anterior glottis

24
Q

diagnosis and treatment of laryngeal tb

A
  • direct laryngoscopy with biopsy
  • histopathologic examination is required
  • tx: extrapulmonary tb
25
Q

cause of recurrent respiratory papillomatosis

A

hpv 6 and 11 (11 more aggressive)

hpv 16 and 18 = more malignancy

26
Q

childhood vs adulthood rrp

A

childhood: hoarseness and stridor, grape like structures, more anterior
adulthood: solitary or carpet

27
Q

gold standard for diagnosing rrp

A

direct laryngoscopy with tissue biopsy

28
Q

treatment for rrp

A
  • carbon dioxide laser or laryngeal microdebrider!!!
  • cryotherapy, irradiation, photodynamic therapy
  • vaccines (gardasil)
  • indole 3 carbinol
  • intralesional cidofovir
29
Q

what are vocal fold nodules

A
  • benign mid-membranous lesions
  • symmetrical, hour glass closure
  • minimally reduced mucosal wave
  • tx: voice therapy
30
Q

what is vocal fold cyst

A
  • blocked mucus gland or congenital
  • unilateral
  • hourglass pattern
  • tx: excision only
31
Q

what is vocal fold polyp

A
  • exophytic or pedunculated (gelatinous material)

- videostroboscopy: hourglass closure, normal or minimal reduction of mucosal wave

32
Q

what is fibrous mass

A
  • accumulation of fibrous fluid
  • hourglass closure
  • tx: surgical only
33
Q

what is a reactive lesion

A
  • in the submucosa
  • response to a contralateral vocal fold lesion
  • hourglass closure
  • tx: voice rest and therapy
34
Q

what is a polypoid corditis (reinke’s edema)

A
  • gelatinous like fluid
  • asymmteric
  • always bilateral
  • most common cause: tobacco abuse
35
Q

what is sulcus vocalis

A
  • from severe abnormality of lamina propria

- replacement of extracellular matrix proteins of lamina propria = furrowing of vf ligament

36
Q

white plaques of questionable risk having excluded other known causes, no increased risk for cancer

A

leukoplakia of true vocal cords

37
Q

t/f there is a clear association between smoking and excessive alcohol and development of malignancy in the upper aerodigestive tract

A

true

38
Q

treatment for laryngeal squamous cell carcinoma

A

radiotherapy, conservation laryngectomy, total laryngectomy with/without radiotherapy

39
Q

gold standard for diagnosis of laryngeal squaca

A

direct laryngoscopy with biopsy

40
Q

causes of reflux laryngitis

A
  • acidic injury

- bile and pepsin: doesn’t respond to antacid therapy

41
Q

diagnosis for reflux laryngitis

A

rigid laryngeal endoscopy or flexible laryngeal endoscopy + clinical history
- posterior pachyderma and erythema of arytenoids

42
Q

treatment for reflux laryngitis

A

acid neutralization, dietary and hebavioral changes, adequate hydration
- h2 receptor antagonists, ppi, mucosal protectants, hydration

43
Q

most common inciting event that can cause chronic aspiration

A

cerebrovascular accidents, especially brainstem with bilateral cranial nerve deficits

44
Q

most common cause for chronic aspiration in pedia

A

severe neurologic dysfunction

45
Q

diagnosis of chronic aspiration

A
  • indirect mirror exam
  • fiberoptic nasopharyngoscopy
  • esophagoscopy
  • pulmonary function tests (for functional reserve)
  • functional endoscopic evaluation of swallowing (for dysphagia)
46
Q

treatment for chronic aspiration

A
  • enteral feeding (alternative routes)
  • parenteral hyperalimentation
  • surgery: tracheostomy!!, vocal cord medialization, laryngectomy
47
Q

functions of tracheostomy

A
  • provide comfortable airway
  • facilitate pulmonary toilet in patients with copious secretions
  • reduce pulmonary dead space

13 ENT (18 decks)

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