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Respiratory Block > Disorders of the upper airway > Flashcards

Disorders of the upper airway Flashcards

1
Q

Why do we have sinuses?

A
  • Absorb shock
  • Contribute to facial growth
  • Resonance chamber
  • Lighten the skull
  • Increase surface area for olfaction
  • - Filter, humidify and warm inspired air to facilitate alveolar gas exchange*
  • Immunologic response (IgA and IgG in secretions)
  • Specialized neuroepithelium of roof of nose gives us olfaction
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2
Q

What are the 4 different sinuses?

A

Frontal, ethmoid, sphenoid, maxillary

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3
Q

What type of mucosa lines the surfaces of the sinuses?

A

Pseudostratified columnar ciliated epithelium

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4
Q

What is the function and some properties of respiratory cilia?

A
  • Effective in transporting, mucus, trapped inhaled particles, and bacteria
  • They are altered by chemical, thermal, mechanical, hormonal, and pH changes
  • Beat 1000x/min
  • 1-2L mucus/day
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5
Q

Definition of rhinosinusitis?

A

Inflammation or infection of the nose and sinuses. “A group of disorders characterized by inflammation of the mucosa of the paranasal sinuses

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6
Q

What are 3 cardinal symptoms of sinus infections? What are also some additional symptoms

A

3 cardinal symptoms

  • Purulent rhinorrhea
  • Facial pain/pressure
  • Nasal obstruction

Additional symptoms: fever, HA, fatigue, dental pain, cough, ear pain/pressure

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7
Q

What is the duration of an acute sinus infection?

A

Lasts up to 4 weeks, with total resolution of symptoms

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8
Q

What is duration of a subacute sinus infection

A

Persisting more than 4 weeks, but less than 12 weeks with total resolution of symptoms

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9
Q

What is the duration of a chronic sinus infection?

A

12 weeks or more of signs/symptoms

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10
Q

What is the duration of a recurrent acute sinus infection?

A

4 or more episodes per year, with resolution of symptoms between attacks

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11
Q

Characteristics of acute rhinosinusitis?

A

Lasts up to 4 weeks with possible purulent nasal drainage, nasal obstruction, facial pressure

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12
Q

What is the most common cause of acute rhinosinusitis?

A

Viral infections more so than bacterial

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13
Q

If a patient has a viral acute rhinosinusitis, what are some possible viral infections that may have caused this?

A

Rhinovirus, coronavirus, influenza, respiratory synctial virus, and parainfluenza

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14
Q

***If a patient has an acute bacterial rhinosinusitis, what are some common bacteria?

A

Streptococcus pneumoniae, haemophhilus influenzae, and Moraxella catarrhalis

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15
Q

How do you diagnose acute bacterial rhinosinusitis?

A

Clinically diagnosed after 10 days of symptoms OR initial imporvement then worsening (even if less than 10 days)
- Only happens in 0.5-2% viral cases

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16
Q

How common is staph aureus seen in bacterial acute rhinosinusitis?

A

8-11% of cases

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17
Q

There is decreased prevalaence of S.pneumoniae now than before, why is that so?

A

Widespread use of pneumococcal 7 valent vaccine

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18
Q

How do you treat acute rhinosinusitis?

A
  • Mostly self-limited, so only ***symptomatic management
  • Persistent or severe symptoms need to be trewted with 10-14 days of ***abx
  • ***Intranasal steroid may reduce time and intensity of symptoms
  • ***Saline irrigations and nasal decongestants improve symptoms
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19
Q

What are some possible complications of acute sinusitis?

A
  • Preseptal cellulitis
  • Subperiosteal abscess
  • Orbital cellulitis
  • Orbital abscess
  • Cavernus sinus thrombosis
  • Meningitis
  • Epidural abscess
  • Subdural abscess
  • Intracerebral abscess
  • Frontal bone osteomyelitis Pott’s puffy tumor
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20
Q

How is chronic rhinosunisitis classified?

A
  • 12 or more weeks
  • Considered more of an inflammatory disorder than infectious like ARS
  • Classified as CRS with nasal polyposis and CRS without nasal polyposis
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21
Q

How do you dianose chronic rhinosinusitis?

A
  • Symptom-based diagnosis may be unreliable (chronic HA and facial pressure+stopped up nose; has had “innumberable” courses of abx and 3 sinus operations by 2 different physicians
  • CT is the gold standard
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22
Q

What are predisposing factors for CRS?

A
  • Host factors: Systemic or local

- Environmental: Microorganisms, polutants (smoking), medications

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23
Q

What is the most common predisposing factor for chronic rhinosinusitis?

A
  • 20% of US population has allergies (IgE mediated)
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24
Q

Allergic rhinitis leads to:

A
  • Mucosal inflammation and hypertrophy
  • Blocking the osteriomeatal complex
  • Non aeration of sinus cavity
  • Additional inflammation
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25
Q

Are there any genetic predispositions to chronic sinusitis?

A
  1. Primary ciliary dyskinesia (PCD)
    - autosomal recessive
    - disorganized microtubules and absent dynein arms
    - Chronic sinusitis, bronchiectasis, pneumonia, otitis media, infertility, situs inversus (50%)
  2. Cystic fibrosis
    - autosomal recessive
    - Defective chloride transport gene necessary for hydration of mucus
    - Up to 50% suffer from bilateral nasal polyps and chronic sinusitis
    - Pseudomonas aeruginosa

**Both of these more commonly require sinus surgery

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26
Q

What is another name for primary ciliary dyskinesia?

A

Kartagener’s syndrome: Situs inversus, nasal polyps (sinusitis), and bronchiectasis

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27
Q

What are the strategies for treating chronic rhinosinusitis?

A
  1. Mechanical
    - Saline irrigations (increase mucociliary flow, mechanically rinse)
    - Mucolytics
  2. Anti-inflammatory
    - Antihistamines
    - Orgal corticosteroids
    - Topical steroids (improve patency of the ostiomeatal complex reduction in mucosal swelling)
  3. Antimicrobial
    - Ideally based on culture results with most common bugs to treat including: S. aureus, anaerobes, gram negative, pseudomonas aeruginosa
    - Treatment duration: 3-6 weeks
28
Q

What are the antibiotics used in treatment of CRS?

A

amoxicillin, amoxicillin-clavulanate, cepahlosporin, quinolones

29
Q

What are some systemic conditions of the sinuses?

A
  1. Granulomatosis with polyangitis
    - Idiopathic vasculitis and automimmune process
    - Necrotizing granulomas
    - Can involve upper and lower airways, kidneys
  2. Sarcoidosis
    - Chronic granulomatous disease (noncaseating); primary pulmonary, although any organ can be involved
30
Q

What are some types of fungal sinusitis?

A
  1. Allergic fungal sinusitis
    - Subset of CRS
    - Allergic mucin, eosinophils, fungal hyphae
  2. Invasive fungal sinusitis
    - ENT emergency
    - Almost exclusively immunocomprosied individuals
    - Rapid spread of necrosis; biopsy diagnostic; rhizopus , mucro, aspergillus
31
Q

How is invasive fungal sinusitis treated?

A
  • Treatment: Surgical (debride tissue); IV antifungals; revere immunocompromised state-neutropenia; diabetes)
32
Q

How is allergic fungal sinusitis treated?

A
  • Treatment is primarily surgical with postop medical treatment
33
Q

What are indications of functional endoscopic sinus surgery?

A
  • Disease refractory to medical management

- Anatomic obstruction resulting in CRS

34
Q

What are the goals of functional endoscopic sinus surgery?

A
  • Remove inflammatory mediator load (inspissated mucus)
  • Restore sinus ventilation/drainage
  • Restore mucociliary clearance system
  • Preserve functional integrity of mucosa
  • **Surgery is not a cure for chronic rhinosinusitis)
35
Q

What are some worrisome symptoms for sinus issues that may make you suspect cancer?

A
  • Nosebleeds (frequent, unexplained)
  • Sinonasal discharge
  • Sinus pain
  • Other unusual symptoms (hypoesthesia, visual changes (blurry, double vision), ecessing tearing, neck nodes
36
Q

What is the most common etiology for pharyngitis? What are some other etiologies for pharyngitis?

A

Viral infection is most common

Additional etiologies: bacterial, fungal, protozoal, abscess, epiglottis, cancer, autoimmune, laryngopharyngeal reflux, postnasal drip, exposure irritants, neuralgias, medications, trauma, foreign body

37
Q

How common is bacterial pharyngitis and what are the symptoms?

A
  • 5-10% of all sore throats in adults, 30-40% of all sore throats in children
  • 75% of all sore throats are prescribed abx
    Symptoms: severe sore throat with fever, lymphadenopathy, tonsillar exudate, absence of cough; can also have odynophagia, chills, fatigue, HA, neck stiffness, anoerexia)
38
Q

What is the most common cause of bacterial pharyngitis in adults?

A

Group A beta hemolytic Streptococcus pyogenes

39
Q

On physical exam, what might you see in someone with bacterial pharyngitis?

A
  • erythema, edema, and gray-white tonsillar exudates that symmetrically involve affected tissues
  • Petechiae may be present on soft palate
  • Tonsils are commonly swollen
  • Breath is characteristically foul
40
Q

What are the treatments for bacterial pharyngitis?

A
  • Patients are contagious
  • Prompt abx treatment reduces duration and symptoms and prevents complications
  • Penicilin or amoxicillin x10 days; macrolide or clindamycin for pcn allergic
41
Q

What are some complications of bacterial pharyngitis?

A

Post-streptococcal glomerulonephritis and acute rheumatic fever

42
Q

What are the most common viruses in pharyngitis in adults?

A

Common cold viruses: Rhinovirus, Coronavirus, Parainfluenzae
Additionally: influenza virus- A, B, C, HIV, adenovirus (conjunctivitis and pharyngitis in children), coxsackivirus, HSV

43
Q

What are some characteristics of herpangina in viral pharyngitis?

A

vesicular, ulcerative, coxsackievirus, seen in children

44
Q

What are some characteristics of HSV 1 and 2 in viral pharyngitis?

A

vesicles, shallow ulcers, chronic in immunocompromised

45
Q

What type of virus is EBV?

A

double stranded DNA virus in herpesviridae family

46
Q

EBV affects approximately how much of the world’s population?

A

90%

47
Q

EBV remains latent in what type of cells, is replicated in what type of cells, and is transmitted by what?

A
  • Remains in latent in B-lymphocytes
  • Intermittently replicates in oropharngeal epihtelial cells
  • Trasmitted via saliva
48
Q

Incubation of infectious mononucleosis through EBV takes how long?

A

3-7 weeks; with malaise fevers and chills. This is then followed by sore throat, fever, lymphadenopathy, anorexia and various immune responses in adolescents

49
Q

Monospot test for infectious mononucelosis is positive after how long after infection?

A

70-90% positive beginning 2-3 weeks after sore throat

50
Q

What are some complications of infectious mononucleosis?

A

Secondary bacterial infection, upper airway obstruction, meningitis, splenic rupture

51
Q

What is the treatment for infectious mononucleosis?

A
  • supportive care, rest, antipyretics, and analgesics
  • avoid contact sports (splenomegaly)
  • Antivirals are not beneficial, antibiotics only for secondary bacterial infections
  • NO AMPICILLIN OR AMOXICILLIN ->maculopapular rash in 95%
  • steroids for impending upper airway obstruction, severe hemolytic anemia, severe thrombocytopenia, or persistent severe disease
  • Other airway interventions are rarely necessary
52
Q

Peritonsllar abscess are located where?

A

Between the capsule of the tonsils and pharyngeal constrictors

53
Q

Peritonsillar abscesses are associated with what symptoms?

A

More often: trismus, hot potatoe voice/muffled voice, and drooling
Also: Pain with swallowing, dehydration, fever

54
Q

Treatment for peritonsillar abscesses?

A

Incision and drainage, abx, tonsillectomy rarely needed

55
Q

Complications of peritonsillar abscesses if left untreated?

A

airway obstruction, necrotizing mediasinitis, carotid artery aneurysm, IJ thrombosis (lemierre’s syndrome)

56
Q

Where is the retropharyngeal space located?

A

buccopharyngeal fascia anteriorly, deep cervica fascia posterior, and carotid sheaths laterally. It extends superiorly to the base of the skull and inferiorly to the mediastium

57
Q

Symptoms of retropharygneal abscess?

A

sore throat, fever, neck stiffness, odynophagia, shortness of breath

58
Q

What types of bacteria are involved with retropharyngeal abscess?

A

usually polymicrobial: aerobic, anaerobic, gram negative.

59
Q

What types of individuals are most likely to have retropharyngeal abscesses?

A

Mostly in children from bacterial URI/lyphadenitis

60
Q

Treatment for retropharyngeal abscesses?

A

Incision and drainage, abx

61
Q

What are some complications of retropharyngeal abscesses?

A

Mediastinitis, airway obstruction, internal jugular vein thrombosis (lemierre’s), necrotizing fasciitis, sepsis

62
Q

What is ludwig’s angina?

A

Inflammation and cellulitis of the submandibular space, spreading to the sublingual space via fascial planes. The floor of the mouth becomes indurated, and the tongue is forced upward and backward, obstruction

63
Q

What is the main source of ludwig’s angina?

A

dental origin

64
Q

What are symptoms of ludwig’s angina?

A

drooling, trismus, pain, dysphagia, submandibular mass, and dyspnea or airway compromised caused by displacement of the tongue

65
Q

Is ludwig’s angina life threatening?

A

Yes, it requires airway control, typically tracheotomy, IV avx, and I&D

66
Q

What type of bacteria are involved with ludwig’s angina?

A

Mixed flora, aerobes, anaerobes (strep, staph, bacteroides)

Respiratory Block (2 decks)

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