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ENT Flashcards > Laryngology > Flashcards

Laryngology Flashcards

1
Q

What is the only laryngeal aBductor?

A

Posterior cricoiarytenoid (PCA)

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2
Q

What muscle makes up the vocal FOLD body (vocalis)

A

Thyroarytenoid - deep to vocal ligament!

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3
Q

Vocal cord layers from superficial to deep?

A

Squamous epithelium, superficial lamina propria, vocal ligament (intermediate and deep lamina propria), thyroarytenoid

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4
Q

Components of stroboscopy grading (7)?

A

Mucosal wave, vibration, vertical phase, phase symmetry, regularity, adynamic segments, closure.

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5
Q

What is jitter and shimmer?

A

Jitter: Cycle to cycle variation in pitch/frequency
Shimmer: Cycle to cycle variatoin in amplitude

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6
Q

What are the components of the GRBAS scale?

A

Grade (overall severity)), Roughness, Breathiness, Asthenia, Strain

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7
Q

What hormone reduces LES pressure?

A

Glucagon

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8
Q

What is released by chief cells in the stomach and can cause refractory GERD?

A

Pepsin

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9
Q

What are the principle aDductors of the vocal cords?

A

Lateral cricoarytenoids (adduct and internally rotate arytenoid cartilage) and thyroarytenoid

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10
Q

What muscle is this and what is it innervated by?

A

Cricoarytenoid - External branch of superior laryngeal nerve

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11
Q

Which laser is preferred for respiratory papillomatosis?

A

-CO2 laser is main stay (and consider intralesional Cidofovir or Bevacizumab)
-BUT consider KTP laser for recurrent cases (less thermal damage to surrounding tissues)

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12
Q

Features of relapsing polychondritis?

A

Autoantibodies against type II collagen
Often have laryngeal dysfunction (cricoarytenoid joint especially affected) –> Hoarse, pain, cough, obstruction
Other sites: ears, nose, joints
Diagnosis: Clinical
TX: Steroids, immunomodulators

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13
Q

Site of:
Zenker’s Diverticulum
Killian-Jameson Diverticulum
Laimer Diverticulum?

A

Zenker: Between inferior constrictor and cricopharyngeas (Killian’s triangle)
Killian-Jameson: Between Oblique and Transverse cricopharyngeas fibers
Laimer: Between Cricopharyngeus and superior esophageal wall circular muscles

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14
Q

Esophageal Achalasia Features?

A

Degeneration of Aurbach’s plexus, failure of LES to relax
Bird’s beak on esophagram
TX: Botox or myotomy, can consider CCBs or nitrates to decrease LES pressure too.

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15
Q

CREST Syndrome (+ esophagram features)

A

Calcinosis, Raynaud’s, esophgeal dismotility, sclerodactyly, telangiectasia
Esophagram: dilated DISTAL esophagus, normal UES and LES
TX: Reflux regimen, CCBs (for Reynaud’s), can consider steroids

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16
Q

Diffuse esophageal spasm features?

A

Hih pressure non paristaltic contractions
Corkscrew esophaagus
Manometry: disorganized contractions
TX: Nitrates, Ca Channel Blockers

17
Q

What histopath changes occur to vocal cords as they age?

A

INCREASE in collagen I and III,
DECREASE in Elastin
(i.e. VC stiffen with age)

18
Q

What is laser an acronym for?

A

Light Amplification by Stimulated Emission of Radiation

19
Q

Action of the cricothyroid muscle?

A

Increases length and tension of the vocal cord. Innervated by external branch of SLN.

20
Q

Failure of what pharyngeal arch leads to a non recurrent RLN?

A

Failure of 4th pharyngeal ARCH (leads to a retroesophageal subclavian artery) –> non recurrent RLN

21
Q

Sarcoidosis - what does it affect, histopath and TX?

A

Supraglottic thickening (i.. e. epiglottis), histopath shows NON necrotizing granulomas (non caseating) –> intralesional steroids
Other SX: Bilateral hilar lymphadenopathy, anterior uveitis, facial rash
AA women age 20-40

22
Q

Wegener’s - what does it affect, hisopath and TX?

A

Subglottis, Necrotizing granulomas, Steroids…

23
Q

ABductor spasmodic dysphonia:
Which muscle is affected?
How to diagnose?
TX?

A

-Posterior cricoarytenoid (only aBductor)
-Count 60-69 or “Harry’s Happy Hat” –> Breathiness (with consonents)
-Botox to PCA

24
Q

ADductor spasmodic dysphonia:
Which muscle is affected?
How to diagnose?
TX?

A

-Thyroarytenoid or lateral cricoarytenoid
-Count 80-89 or “We eat eggs every easter) –> strain and breaks with vowels
-Botox to thyroarytenoid

25
Q

SX of Parkinsons, specifically laryngeal signs and TX?

A

Low tone, soft/weak monotone voice, slurred, vocal tremor
Other: Tremor, shuffled gate, bradykinesia (mask like face)
TX: Lee Silverman Voice TX (helps with soft/weak voice

26
Q

What do the following L EMG findings indicate?
Fibrillation potentials w/decreased activity?
Polyphasic action potentials?
Fatiguing?
Decreased frequency?
Decreased amplitude?

A

Fibrillation potentials w/decreased activity - Denervation (Fibrillation = FAIL)
Polyphasic action potentials - Reinnervation
Fatiguing - Myasthenia Gravis
Decreased frequency - Neuropathy (nerve cant get signal over to muscle as frequently)
Decreased amplitude - Myopathy (muscle isn’t working as well)
Do 1-6 months after injury

27
Q

Vocal Tremor Features and TX

A

-Tremoring persists even with whispering
-Often have other tremors (hands, feet)
-TX: Beta blocker (primidone is 1st line), Botox to thyroartenoid (not first line)

28
Q

What provides sensory to the subglottis? Supraglottis and glottis?

A

Subglottis: RLN
Supraglottis and Glottis: SLN

29
Q

What is characteristic on LEMG for vocal cord paresis?

A

Large-amplitude polyphasic MUPs (due to the differing latencies of normal versus injured neurons) with incomplete recruitment.

30
Q

What drugs increase LES pressure? Decrease?

A

INCREASE: Gastrin, Vasopressin,
DECREASE: Nitrates, CCBs, Glucagon, alcohol, chocolate, sedatives, nicotine

31
Q

What does Dual PH probe test?

A

Tests LES and UES, allow differentiation between GERD and LPR, can be combined with impedance testing (can determine direction of flow and if reflux is acidic or not)
DeMeester score > 14.7 = abnormal

32
Q

Polymyositis and Dermatomyositis Features, DX, TX?

A

PM: Idiopathic inflammation of striated muscle
DM: Variant with rashes, higher risk of malignancy
Associated with hiatal hernia, malignancies, vasculitis
SX: Hip/shoulder weakness, aspiration, upper 1/3 esophagus dysmotility, periorbital heliotrop rash (DM).
DX: EMG, muscle biopsy, increased CPK, LDH, liver enzymes
TX: Anti reflux, steroids, immunosuppressives

33
Q

Mallory Weiss Syndrome VS Boerhave Syndrome?

A

MW: Incomplete tear from emesis (alcoholics), usually self limiting
Boerhaave: Rupture of ALL 3 layers of esophagus, severe SX (tachycardia, ches pain, subq emphysema, crunchy over heart (Hamman)

34
Q

What is the most common benign and malignant esophageal tumor (and risk factor)?

A

Benign: Leiomyoma from muscularis
Malignant: Adenocarcinoma, main risk = Barrett’s

35
Q

How do vocal cords lengthening/shortening affect pitch?

A

Lengthen/tense = INCREASED pitch
Shorten/relax = DECREASED pitch

ENT Flashcards (12 decks)

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