Goljan 17: Upper Airway Disorders

Question 1

What is the diagnosis? Baby turns blue when breast feeding, cannot breathe through nose

Answer 1

Choanal Atresia Can be unilateral or bilateral or membranous septum between nose and pharynx

Question 2

In a child with nasal polyps, what diagnosis do you want to rule out?

Answer 2

Sweat test for cystic fibrosis Nasal polyps: Noncancerous often associated with CF due to thickness of secretions Nasal smear shows numerous eosinophils Most often seen in adults with IgE mediated allergies

Question 3

What is the diagnosis? Airway obstruction causes CO2 retention (respiratory acidosis) leading to hypoxemia; PaO2 down, O2 sat down, PaCO2 up Complications include pulmonary HTN and right ventricular hypertrophy and secondary polycythemia (RBC hyperplasia due to hypoxemia)

Answer 3

Obstructive Sleep Apnea Obesity is the most common cause Tonsillar hypertrophy is another cause

Question 4

What is the diagnosis? Fever Nasal congestion with or without purulent discharge Pain over the affected sinuses Painful teeth, cough from postnasal discharge, periorbital cellulitis

Answer 4

Sinusitis inflammation of the mucous membranes lining one or more of the paranasal sinuses; most often in the maxillary sinus in adults (ethmoid in children); Causes include URIs, deviated nasal septum, allergic rhinitis, barotrauma, cigarette smoking –strep pneumonaie Diagnose with CT scan

Question 5

What is the diagnosis? Squamous cell carcinoma, nonkeratinizing squamous carcinoma, or undifferentiated cancer; Increased in Chinese and African populations Causal relationship with EBV

Answer 5

Nasopharyngeal carcinoma Most common malignant tumor of the nasopharynx

Question 6

What are the risk factors for laryngeal carcinoma?

Answer 6

Cigarette smoking Alcohol use HPV 6 and 11 Majority on true vocal cords and are keratinizing SCC Presents with persistent hoarseness and cervical lymphadenopathy