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ICM Unit 3 HEENT > Diseases of Larynx and Pharynx > Flashcards

Diseases of Larynx and Pharynx Flashcards

1
Q

Sore throat

common causes

A

MC = viral
Group A strep (strep pharyngitis 15%)
EBV/Monoucleosis

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2
Q

Pharyngitis and Tonsillitis

A

50% of outpatient antibiotic use - inappropriate usually bc VIRAL cause

augmentin/ Amox MC used

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3
Q

Failure to recognize and treat Group A strep infection risk of

A

rheumatic fever and glomerulonephritis

May progress into a Peritonsillar abscess

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4
Q

Viral Pharyngitis

A

MC cause sore throat

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5
Q

Viral Pharyngitis - s/s

A

Odynophagia (painful swallowing)
F/muscle aches
tender/swollen lymph nodes
+/- exudates

cough!
nasal congestion/coryza/sneezing

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6
Q

Viral Pharyngitis - Dx

A

rapid strep test
throat culture

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7
Q

Viral Pharyngitis - Tx

A

conservative tx

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8
Q

Strep Pharyngitis (centor criteria)

A
  • Fever >38
  • tender ant. cervical adenopathy
  • lack of cough
  • pharyngo- tonsillar exudate

+/- 1 point for age

all 4 = strongly suggest GABHS
3/4 = sensitivity of rapid tests >90%
1/4 = GABHS unlikely

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9
Q

Strep Pharyngitis (CDC suggestions)

A

0-1 : no culture or test; no abx
2-3 : throat culture OR rapid test; + = abx
4 : high risk GABHS; tx w/o test

if hoarsness, cough or coryza present = NOT likely strep

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10
Q

Strep Pharyngitis - Dx

A

rapid strep test
culture

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11
Q

Strep Pharyngitis - Tx

A

Benzathine IM (painful)
Pen V

AMOX BID 10 days

erythro, azithro, cephalosporin if PCN allergy

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12
Q

Strep Pharyngitis - Complications

A

scarlet fever
glomerulonephritis,
abscess,
rheumatic fever

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13
Q

Strep Pharyngitis - s/s

A

Sudden onset sore throat
Fever
Tonsillopharyngeal &/or uvular edema
Anterior cervical adenitis
Scarlatiniform skin rash (scarlet fever)

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14
Q

Infectious Mononucleosis

A

EBV (HHV4) - blood test IgM, IgG
MC 12-19 y/o (but any age)

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15
Q

Infectious Mononucleosis - transmission

A

saliva
“kissing dz”

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16
Q

Infectious Mononucleosis - s/s

A

F
severe sore throat
POSTERIOR CERVICAL ADENOPATHY
tonsillar exudate
malaise
SPLENOMEGALY (about 50% cases)
photophobia

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17
Q

After effects of mono

A

Painful Cervical Adenopathy x weeks

large, firm cervical adenopathy – history is important!

unresolved after weeks - LN biopsy (FNA or excision is best) to rule out things like lymphoma

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18
Q

Infectious Mononucleosis - Dx

A

clinical!

Monospot

EBV test (IgM - acute; IgG - 4 weeks after)

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19
Q

Infectious Mononucleosis - Tx

A

95% improve w/o specific tx

NSAIDS, acetaminophen

salt water rinses/gargles

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20
Q

Infectious Mononucleosis - education

A

No contact sports until splenomegaly is resolved!
Reduce the risk of splenic rupture

Fever and sore throat resolve in 7-10 days

Lymphadenopathy and splenomegaly may persist >4 weeks

Significant fatigue for 2-3 months

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21
Q

Infectious Mononucleosis - complications

A

hepatitis
myocarditis,
encephalitis

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22
Q

Corynebacterium Diphtheriae

A

Diphtheria (Gram+, club shaped rod)

Transmitted via respiratory secretions

MC attacks resp tract

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23
Q

Corynebacterium Diphtheriae s/s

A

Nasal infxn = nasal discharge

Laryngeal infxn - upper airway and bronchial obstruction

Pharyngeal infxn - MC = tenacious gray membrane covering the tonsils/pharynx

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24
Q

Corynebacterium Diphtheriae - complications

A

Myocarditis
Neuropathy

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25
Q

Corynebacterium Diphtheriae - Dx

A

clinical

culture to confirm

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26
Q

Corynebacterium Diphtheriae - Tx

A

horse serum antitoxin must be given in all cases of diphtheria (CDC)

ENT (laryngoscopy) - remove membrane if airway obstruction

oral abx - PCN or erythro

Isolate until 3 - pharyngeal cultures

vaccine to prevent

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27
Q

Pharyngitis- Other Causes

A

N. Gonorrhea (STD of pharynx, direct contact)

HSV (very painful, “whitish” ulcerations post. oropharynx; gums gray and slough)

Coxsackie virus (Hand, Foot, Mouth) -

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28
Q

Abnormal Voice Sounds

Dysphonia

A

impairment in the ability to produce sound with the vocal organs

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29
Q

Any abnormal voice sounds = A GOOD H&P!

A

tobacco use?
laryngeal CA?
lung CA w/ paralysis recurrent laryngeal n?
weight loss?
onset >2 weeks = ENT w/ laryngoscopy

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30
Q

Hoarseness

A

Abnormal vibration/flow of air past the vocal folds/cords

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31
Q

Hoarseness types

A

Breathy

Harsh

Rough, low-pitched

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32
Q

Hoarseness causes

A

Acute Laryngitis

Chronic Laryngitis

Overuse

Benign vocal fold lesions - nodules, polyps

Laryngeal cancer

Neurologic dysfunction

33
Q

Hoarseness

Referral recommendations

A

Persistent symptoms > 2 weeks

OR if any concern for serious underlying cause

OR with any associated symptoms such as:

Hemoptysis
Dysphagia
Odynophagia
Otalgia
airway compromise

34
Q

Stridor

A

high-pitched breath sounds produced by a narrowed or obstructed airway

timing and rapiditiy of onset KEY

ALL CASES NEED EVAL

must rule out foreign body

35
Q

Inspiratory stridor

A

narrowing AT or ABOVE the vocal cords

36
Q

Expiratory or mixed (biphasic) stridor

A

BELOW the vocal cords

37
Q

Acute Laryngitis

A

Any inflammatory process that affects the larynx

38
Q

Acute Laryngitis MC cause of

A

hoarseness (hallmark symptom)

39
Q

Acute Laryngitis S/S

A

Hoarseness, Aphonia
Reduced vocal pitch
Associated URI symptoms- cough

40
Q

Acute Laryngitis - Tx

A

Supportive therapy

Bacterial- oral antibiotics

Oral/IM steroids?

41
Q

Laryngopharyngeal Reflux (LPRD)

A

Chronic laryngitis

GERD into larynx

42
Q

Laryngopharyngeal Reflux (LPRD)

S/S

A

throat clearing, throat discomfort, chronic cough, postnasal drip, esophageal spasm

<50% heartburn

excess mucus in throat

increased rhinorrhea

43
Q

Laryngopharyngeal Reflux (LPRD)

DX

A

ENT referral

laryngoscopy critical to exclude other causes hoarsness (tumors/ nodules)

+ response to empiric PROTON PUMP INHIB Therapy

decrease spicy foods, tomato based foods

44
Q

Peritonsillar Abscess (Quinsy)

Dx

A

Imaging CT

Confirmed aspiration of pus = ENT

45
Q

Peritonsillar Abscess (Quinsy)

A

Penetration of infection through the tonsillar capsule and into adjacent tissue

46
Q

Peritonsillar Abscess (Quinsy)

S/S

A

severe sore throat

Trismus (limited ability to open mouth, due to spasm)

Muffled “hot potato” voice

deviation of soft palate and uvula (normal side)

47
Q

Peritonsillar Abscess (Quinsy)

Tx

A

Abx
tolerate PO = oral abx

unable tolerate PO + more severe s/s = Admit + IV abx

Tonsillectomy if more than 2x - indicated for recurrence

Needle aspiration

I&D

48
Q

Epiglottitis (supraglottitis)

A

Acute, rapidly progressive cellulitis of the epiglottis and surrounding tissue that can lead to airway compromise

MC in DM and kids (2-5 y/o)

49
Q

Epiglottitis (supraglottitis)

cause

A

viral or bacterial

50
Q

Epiglottitis (supraglottitis)

S/S

A

4 D’s
- Drooling
- Dysphagia
- Dyspnea
- Dysphonia (hot potato voice)

Tripod position

f/c

51
Q

Epiglottitis (supraglottitis)

Dx

A

THUMB PRINT SIGN - lateral x-rays soft tissue

Laryngoscopy - ENT + anesthesia = spasm and airway compromise

52
Q

Epiglottitis (supraglottitis)

Tx

A

Keep the patient comfortable!
DO NOT use a tongue depressor

respiratory distress, = intubate and secure the airway!

ADMIT
IV abx - cephalosporins
IV steroids - dexamethasone
Close airway obsevation
Continuous pulse ox
prep intubate

53
Q

Vocal Cord Nodules

A

Smooth, PAIRED lesions at the junction of the anterior 1/3 and posterior 2/3

due to vocal abuse/ overuse

common cause of hoarsness

54
Q

Vocal Cord Nodules - TX

A

Modification of voice habits (most resolve)

Referral to speech therapy

Do not resolve = surgery ?

55
Q

Vocal Fold Polyps

A

UNILATERAL masses within the superficial lamina propria

Typically larger than nodules

due to vocal trauma (resolution of cord hemorrhage)

56
Q

Vocal Fold Polyps - TX

A

Vocal rest, steroids for small polyps
Excision- larger polyps

57
Q

Vocal Fold Cysts

A

Traumatic lesions from mucus-secreting glands on the inferior aspect of vocal folds

vary in size and degree of symptoms

58
Q

Vocal Fold Cysts - tx

A

rarely resolve completely - often scar (permenant dysphonia)

Surgical intervention to prevent scarring by preserving the mucosal layer

59
Q

Recurrent Respiratory Papillomatosis

A

benign, rare malign

symptomatic and causes hoarness

MC in kids

60
Q

Recurrent Respiratory Papillomatosis
cause

A

HPV type 6 & 11

61
Q

Recurrent Respiratory Papillomatosis

Tx

A

Failure to tx= distal spread and airway compromise

Tx: repeated laser vaporizations or resections

Severe cases = airway compromise in adults and may require treatment every 6 weeks

62
Q

Polypoid Corditis

loss of …

A

elastin fibers and loosening of intracellular junctions within the lamina propria

= swelling of superficial lamina (REINKE EDEMA)

63
Q

Polypoid Corditis strong assoc. w/

A

SMOKING

vocal abuse, chemicals, hypothyroid

64
Q

Polypoid Corditis Tx

A

Surgical resection if stridor or airway obstruction

65
Q

Vocal Cord Paralysis

A

lesion or damage to either the vagus or recurrent laryngeal nerve (RLN)

breathy dysphonia or effortful voicing

66
Q

Vocal Cord Paralysis - diff types

A

Unilateral recurrent laryngeal nerve injury

Unilateral Vagus damage/lesions

BILATERAL fold paralysis = Medical Emergency!

67
Q

Vocal Cord Paralysis

Dx

A

CT/MRI with contrast of brain and brainstem

Direct visualization with laryngoscope

68
Q

Vocal Cord Paralysis

Tx

A

create safe airway with normal vocal ability

Vocal cord injections with ProLaryn (dermal filler)

Vocal cord prosthesis - Thyroplasty (Montgomery Implant)

69
Q

Laryngeal Leukoplakia

A

Commonly associated with hoarseness in smokers

Histology = mild, moderate or severe dysplasia

35-60% with severe dysplasia = squamous cell carcinoma

70
Q

Laryngeal Leukoplakia - tx

A

Proton Pump Inhibitors, regular surveillance, resection and/or radiation

Smoking cessation (mild/mod)

71
Q

Squamous Cell Carcinoma of the Larynx

A

MC malign of larynx

Occurs almost exclusively in smokers

MEN, 50-70 y/o

Associated with HPV 16 and 18

72
Q

Squamous Cell Carcinoma of the Larynx

S/S

A

Change in voice quality (new/persist hoarsness >2 weeks in smoker)

neck mass

throat/ear pain

73
Q

Squamous Cell Carcinoma of the Larynx

Dx

A

Laryngoscopy with BIOPSY

Lung function and exercise tolerance should be evaluated prior to surgery due to risk of aspiration following procedure for resection

74
Q

Squamous Cell Carcinoma of the Larynx

Staging

A

TNM - tumor, node, metastasis

75
Q

Squamous Cell Carcinoma of the Larynx

Tx goals

A

Cure
Preserve swallowing and voice
Avoid permanent Tracheostoma

76
Q

Squamous Cell Carcinoma of the Larynx

Modalities

A

Radiation
Chemo
Surgical resectino
Long term f/u

77
Q

Laryngectomy

A

Removal of the larynx (voice box)

78
Q

Laryngectomy - after

A

patients can eat by mouth

Permanent stoma – safest airway

Speech?
Tracheoesophageal Puncture + Prosthesis
Electrolarynx (robot voice from smokers commercial)

ICM Unit 3 HEENT (6 decks)

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