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ENT > [END OF ROUND] LARYNGOLOGY REVISION > Flashcards

[END OF ROUND] LARYNGOLOGY REVISION Flashcards

1
Q

C/P: Hoarseness of voice, biphasic stridor, cough & expectoration, fibrosis & formation of a web between the VF, bilateral nasal obstruction & mucoid discharge. When examined via indirect laryngoscope, bilateral symmetrical granulations & crustations were observed in the subglottic region. Upon obtaining a biopsy, fibroblasts, Russel bodies & mikluiczcells were seen.

1.DIAGNOSIS?
2.TTT?

A
  1. (larygno) Scleroma
    2- severe stridor—> tracheostomy
    -thin web–>MLS
    -thick web–>Laryngofissure + apply free skin graft
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2
Q

C/P: history of smoking, hoarseness of voice, slightly raised white patches above mucosa of the VF, VF are freely mobile however.

1.DIAGNOSIS?
2.TTT?

A

1.Leukoplakia
2. -Avoid/control PDFs
-MLS
-Careful follow up

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3
Q

C/P: history of under going surgery under anesthesia, followed up change of voice & discomfort in the throat.

a pink granular mass is seen on the vocal processes of the arytenoids

1.DIAGNOSIS?
2.TTT?

A
  1. Intubation granuloma
  2. MLS
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4
Q

C/P: child 5-8y, fever, biphasic stridor, hoarse cry, croupy cough + thick viscid sputum & dyspnea.

mucosa of the larynx is congested & edematous. Steeple sign is seen on x-ray

1.DIAGNOSIS?
2.TTT?

A
  1. Croup (acute laryngo-tracheo-bronchitis)
  2. secure the airway (tracheostomy is preferred), oxygen, ABs & Mucolytic, Steroids, steam inhalation & humidification
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5
Q

C/P: hoarse voice, dry congested throat, dry irritative cough.

diffuse symmetrical bilateral congestion+ thickening of mucosa of VF, localized hyperkeratosis/nodules/polyps

1.DIAGNOSIS?
2.TTT?

A
  1. Chronic nonspecific laryngitis
  2. Control PDFs, steam inhalation, ABs+ Mucolytic, voice therapy, MLS
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6
Q

C/P: child, episode of common cold followed by fever (38-39) hoarseness of voice, croupy metallic cough, dyspnea that rapidly progresses into stridor

VF are bilaterally symmetrically congested with viscid secretions in between & a narrowed larynx

1.DIAGNOSIS?
2.TTT?

A
  1. Acute nonspecific laryngitis in children.
  2. secure airway (endotracheal tube/tracheostomy), oxygen, ABs+ Mucolytics, steroids, steam inhalation + humidification
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7
Q

C/P: adult, history of smoking & common cold followed by hoarseness of voice, dry cough that progresses into wet cough with viscid sputum.

VF are symmetrically bilaterally congested with viscid secretions in between.

1.DIAGNOSIS?
2.TTT?

A
  1. Acute nonspecific laryngitis in adults.
  2. Voice rest, ABs+ Mucolytics, steam inhalation
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8
Q

C/P: adult, complaining of dysphonia.

unilateral single whitish warty-like mamillated swellings on VF, no recurrence when removed

1.DIAGNOSIS?
2.TTT?

A
  1. Single papilloma
  2. MLS
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9
Q

C/P: child 5-15y, history of HPV infection, dysphonia & stridor

multiple sessile warty-like pinkish granulations on larynx

1.DIAGNOSIS?
2.TTT?

A

1.Multiple papillomatosis
2. Repeated MLS, Tracheostomy (LOW), estrogen/interferon,tetracyclines

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10
Q

C/P: adult complaining of dysphonia
unilateral single whitish warty like mamillated swelling on VF

1.DIAGNOSIS?
2.TTT?

A
  1. Single papillomatosis
  2. MLS
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11
Q

C/P: adult male >40y, with history of smoking & alcoholism complaining of hoarseness of voice, stridor, throat discomfort, dysphagia, referred otalgia, foeter oris, cough & expectoration that is sometimes blood stained.
broadened larynx, tenderness, absent laryngeal click.

cauliflower mass is seen growing on VF.

1.DIAGNOSIS?
2.INVESTIGATIONS?

A
  1. Cancer larynx
  2. -General exam (CBC, ESR,
    ECG…)
    -Radiological= CT scan,
    Barium swallow, Plain X-ray
    -Endoscopy
    -*Biopsy to confirm diagnosis
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12
Q

Glottic tumors TTT (2)

A
  1. Cordectomy (Laser MLS/ Conventional laryngectomy)
  2. Partial VERTICAL laryngofissure
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13
Q

Supraglottic tumors TTT (4)

A
  1. Partial HORIZONTAL laryngectomy
    2.Total laryngectomy (late cases)
  2. Radical neck dissection
  3. Elective neck dissection
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14
Q

Subglottic tumors TTT

A

Total laryngectomy & radiotherapy

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15
Q

Indications of Irradiation in cases of cancer larynx (4)

A
  1. T1 glottic or supraglottic tumors
  2. Surgery is CI
  3. Inoperable cases
    4.Non resectable LNs
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16
Q

Voice rehabilitation after total laryngectomy in cases of cancer larynx is done by (3)

A
  1. Esophageal speech
  2. Artificial larynx
    3.Tracheo-esophageal valve
17
Q

Palliative TTT in cases of cancer larynx is done by (5)

A

1-Tracheostomy (laryngeal obstruction)
2.Gastrostomy (dysphagia)
3. Palliative excision (of fungating tumors)
4. Chemotherapy (MTX)
5.Antibiotics + Analgesics

18
Q

C/P: mild dysphonia that improves with time, dyspnea only on exertion.
with indirect laryngoscopy, VC is seen in paramedian position, one VC is shorter and thinner than the other, the arytenoids have fallen forward

1.DIAGNOSIS?
2.TTT?

A
  1. Unilateral RLN paralysis
  2. -wait 6-12 months for spontaneous recovery
    -Vocal fold augmentation
    -Thyroplasty
19
Q

C/P: marked dysphonia that improves with time, dyspnea only on exertion, aspiration that improves with time with indirect laryngoscopy, VC is seen in cadaveric position

1.DIAGNOSIS?
2.TTT?

A
  1. Unilateral RLN & SLN paralysis
  2. wait 6-12 months for spontaneous recovery
    -Vocal fold augmentation
    -Thyroplasty
20
Q

Investigations of unilateral VF paralysis (4)

A
  1. Radiological= Chest X-ray, CT, MRI, Thyroid scans
  2. Laboratory (ESR, Syphilis, TB, virology)
  3. Direct laryngoscopy
  4. other Endoscopy=
    -Nasopharyngoscopy,
    -Esophagoscopy
    -Biopsy
21
Q

C/P: history of thyroidectomy operation followed by sudden onset stridor, voice is not bad, no aspiration

VF in paramedian position

1.DIAGNOSIS?
2.TTT?

A
  1. Bilateral RLN (Abductor) paralysis
  2. TTT of cause
  3. Follow up 6-12 months for spontaneous recover
  4. Tracheostomy (severe obstruction)
  5. Surgery for VF lateralization (improves respiration at the expense of phonation)
    -Laser cordectomy
    -Laser cordotomy
    -Arytenoidectomy
22
Q

C/P: Aphonia, severe aspiration, no stridor

1.DIAGNOSIS?
2.TTT?

A
  1. Bilateral RLN & SLN (adductor) paralysis
  2. Glottic closure & permanent tracheostomy with speaking valve
    (NO SPONTANEOUS RECOVERY)
23
Q

C/P: child, sudden attack of coughing, choking, dyspnea & cyanosis, burning feeling in chest.

dullness heard on chest. percussion.

with chest x-ray, narrow intercostal spaces, low copula, lung collapse & mediastinum shift towards collapsed lung is seen.

1.DIAGNOSIS?
2.TTT?

A
  1. FB inhalation with complete obstruction
  2. Removal via bronchoscopy
    ⤷if failed: open thoracic surgery
    & bronchotomy
  3. Antibiotics, bronchodilators, expectorants
24
Q

C/P: child, sudden attack of coughing, choking, dyspnea & cyanosis, burning feeling in chest.

hyper-resonance is heard on chest percussion

with chest x-ray, widened intercostal spaces, high copula, inflated lung with mediastinum shift away from inflated lung is seen

1.DIAGNOSIS?
2.TTT?

A
  1. FB inhalation with incomplete obstruction
  2. Removal via bronchoscopy
    ⤷if failed: open thoracic surgery
    + bronchotomy
  3. Antibiotics, bronchodilators, expectorants
25
Q

Investigations of FB inhalation

A

1- Bronchoscopy (GOLD STD)
2. Chest X-ray; AP & lateral view

26
Q

C/P: 3-8y , repeated attacks URTI, BILATERAL nasal obstruction, mouth breather, snoring, sleep apnea, lack of concentration in class, diminished hearing, postnasal discharge, Pigeon chest

1.DIAGNOSIS?
2.TTT?
3.INVESTIGATIONS?

A
  1. Adenoid hypertrophy
  2. Adenoidectomy (+/- tonsillectomy)
  3. Nasopharyngeal X-ray
    -Pure tone audiometry &
    tympanometry
27
Q

C/P: Fever (39-40), headache, malaise, sore throat, dysphagia, otalgia, foeter oris, rapid full pulse (proportionate), enlarged tender LNs, on examination: edematous enlarged congested tonsils with pus in crypts

1.DIAGNOSIS?
2.TTT?
3.INVESTIGATIONS?

A
  1. Acute tonsillitis
  2. Medical TTT= Penicillin for 10d (Erythromycin if penicillin allergy), Analgesics, Antipyretics, bed rest
  3. C&S, CBC= leukocytosis+ Neutrophils
28
Q

C/P: FAHM, insomnia, repeated attack of sore throat & dysphagia, change of voice , fetor oris, expelling of fetid debris, neck swelling, cervical lymphadenitis, enlarged jugulodigastric LNs, congested anterior pillar, irregular surface of tonsils, tonsils unequal in size

1.DIAGNOSIS?
2.TTT?

A
  1. Chronic tonsillitis
  2. Tonsillectomy
29
Q

C/P: child 2-5y, FAHM, severe sore throat, dysphagia, UNILATERAL neck swelling, BULLNECK APPEARANCE
weak v rapid pulse (disproportionate), albuminuria, grayish white pseudomembrane on tonsils that is adherent and leads to bleeding on removal

1.DIAGNOSIS?

A
  1. Diphtheria
30
Q

C/P: hoarse croupy cough, inspiratory stridor, pyrexia, weak rapid pulse, grayish white pseudomembrane that bleeds when separated

1.DIAGNOSIS?

A
  1. Laryngeal diphtheria
31
Q

C/P: Severe pain, referred otalgia, fetor oris, unilateral tender cervical LNs, unilateral membrane in pharynx when removed leaves behind a deep irregular crater like inlaid ulcer

1.DIAGNOSIS?
2.TTT?

A
  1. Vincent’s Angina
  2. H2O2
    -Penicillin or Erythromycin +
    Metronidazole
32
Q

C/P: child, symptoms of acute tonsilitis+ red rash all over trunk & limbs, circumoral pallor & red smooth tongue

1.DIAGNOSIS?
2.TTT?
3.INVESTIGATIONS?

A
  1. Scarlet fever
  2. Antibiotics= Penicillin for 10d (erythromycin if allergic)
    -Antipyretics
    -Analgesics
    -Bed rest, fluids, etc
  3. CBC= Leukocytosis
    -Dick’s test
    -Chultz-Chartton test
33
Q

C/P: diabetic patient, severe dysphagia, sore throat, fever, white milky patches on tongue, palate, tonsils, pharynx

1.DIAGNOSIS?
2.TTT?
3.INVESTIGATIONS

A
  1. Moniliasis
  2. -Stop Abs
    -Antifungal drops= Mycostatin,
    Daktarin gel
    -Alkaline stringent gargle
    -good diet & vitamins
    3.Throat swab & film examination
34
Q

C/P: 50y woman, difficulty in swallowing solid food for the last 3 years, non-tender swelling in the right upper neck, koilonychia, glossitis, angular stomatitis, splenomegaly, anemia, achlorhydria

1.DIAGNOSIS?
2.TTT?
3.INVESTIGATIONS?

A
  1. Plummer Vinson $
  2. nutrition for anemia & vit
    deficiency
    -repeated dilatation of stricture
    -follow up for malignancy
  3. Endoscopy (DIAGNOSTIC)
    -biopsy to exclude malignancy
35
Q

C/P: dysphagia for years, double swallowing, regurgitation of undigested food, nocturnal cough, repeated chest infections, swelling in LEFT side of neck following meals

1.DIAGNOSIS?
2.TTT?
3.INVESTIGATIONS?

A
  1. Pharyngeal pouch (zinker’s diverticulum)
  2. mild=> cricopharyngeal
    myotomy
    -well formed pouch=> diverticulotomy + cricopharyngeal myotomy
  3. Barium swallow & endoscopy
36
Q

C/P: severe FAHM, severe pain below mandible, dysphagia, trismus, dysphonia, early respiratory obstruction
external neck swelling in below the jaw, protruded tongue, trismus

1.DIAGNOSIS?
2.TTT?
3.INVESTIGATIONS?

A
  1. Ludwig’s angina
  2. Abscess drainage, EXTERNAL incision (midline/horse shoe incision)
    -Abs, Antipyretics, Analgesics
    -Tracheostomy (done early due to rapid progression)
37
Q

C/P: adult, frequent attack of acute tonsilitis, pain, dysphagia, drooling of saliva, referred otalgia, hot potato voice, trismus, torticollis, fetor oris
fever (40-41) w/ proportionate rapid pulse, tonsils pushed downwards & medially, displaced uvula, enlarged jugulodigastric LNs

1.DIAGNOSIS?
2.TTT?
3.INVESTIGATIONS?

A
  1. Quinzy
    2.Abs + drainage, INTERNAL +Tracheostomy
    3.Syringe aspiration
38
Q

C/P: recurrent severe epistaxis, anemia, bilateral nasal obstruction (started off as unilateral), nose broadening, mass in nasal cavity & nasopharynx, proptosis, swollen cheek, bilateral OME & CHL, soft palate pushed downward

A
  1. Angiofibroma
  2. surgical excision after preoperative embolization
    3.CT nose, angiography, MRI & MRA, pure tone audiometry & tympanometry
39
Q
A

ENT (3 decks)

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