NECK! Flashcards
Describe the dif. Between breathy and hatch dysphonia
Breathy- vocal cords don’t touch
-Unilateral vocal fold paralysis
Harsh- stiff cords w/ irregular vibration
-Laryngitis or malignancy
Rough/low pitched- Edematous cords
All cases of stridor need…
REFERAL!
Anyone with hoarseness greater than 2 weeks should get…
Referal to ENT
ESP. If Hx of tobacco
Requires laryngoscopy
What is the most common cause of hoarsness
Laryngitis
Usually viral
What are the common bacterial causes of laryngitis
M. Cat
And H. Flu
What is the tx approach to laryngitis
Vocal rest and referal to ENT
If a vocalist: steroids after laryngoscopy
A pt presents with throat irritation, chronic cough and harness that occurs when the pt is upright
Laryngopharyngeal reflux
What is the tx appraoch to laryngeal reflux
R/o other causes and do a laryngoscopy prior to tx
A pt presents with hoarnsess over week. To months With stridor (kids) and papillomas seen on laryngoscopy
Think?
Recurrent resp. Papillomatosis
2/2 HPV 6 and 11
More common in children and often aquired in utero or in the birth canal
What is the tx for papillomatosis
Surgical excision
With either lasers of cold knife!
(MAIN STAY)
DO NO DO A TRACH!!
Rx: Cidofovir (Intralesional injection)
What is the complication for recurrent resp papillomatosis in smokers
Malignancy
What are the common causes of epiglottitis
H. Flu or Viral
Common in DM (adults)
What is the tx approach for epiglottisis in adults
IV ABX
Ceftizoxime 1-2 g q 8-12 hrs
Cefuroxime 750-1500 mg q 8 hrs
IV dexamethasone
4-10 mg bolus, then 4 mg q 6 hrs
Once s/s improve then oral ABX x 10 days
What is the tx appraoch to epiglottisis in kids
CALL ENT/ Anesthesia AND PEDS!
Intubate
Iv cultures
Cefuroxime
What is the treatment for smooth paired lesions of the vocal chords
There are nodules
Tx: modify voice habits
Refer to speech therapist
If refractory then surgical excision
You find unilateral mass on the lamina propria of the vocal chords?
What is this and what is the tx
These are polyps
If small: vocal rest and steroids
If large: SRGY
What is the cause of vocal cysts
Vocal truama
True or pseudocysts located on inferior aspect of vocal folds
Form from mucus secreting glands
A pt presents with hoarsness and decreased modal pitch
And is a smoker which has led to the loss of elastin fibers of the the vocal chords
Think
Polypoid corditis
What is the tx approach to polypoid corditis
Inspect with laryngoscopy
(Swelling of the lamina propria aka Reinke edema)
Tx: STOP SMOKING
SRGU only if pt has stopped smoking or if there is airway obstruction
What is the tx for contact ulcers/ granulomas common after extubation
Fluticasone BID
What is the most common S/s of SCC of the larynx
Hoarsness + smoking
With pain when swelling
What is the most common malignancy of the larynx
SCC
HPV esp. in smokers
If larygectomy is considered
Who should CA of the larynx be referred to
Cardio
What is the tx approach to SCC of the larynx
Earl : radiation and partial larygectomy
LATE: Chemo + SRGY PRN
Then voice rehab, and prosethic vocal chords
STOP SMOKING!
What is the common cause of vocal chord paralysis (unilateral)
Iatrogenic
Or recurrent laryngeal nerve truama
(Sometimes vagus nerve truama)
What are the common causes of bilateral vocal fold paralysis
SURGRY, CA
What are the tx options for unilateral vocal chord paralysis
DIet mod and Pulm toilet
Can have injections of gel foam/ fat
If permanent then SRGRY or Teflon injection
What is the treatment for bilateral vocal chord paralysis
REFER
For surgery - trach
What is the most common deep neck infection
Ludwigs angina
What are the agents in Ludwigs Angina
Sterp, Steph, FUSIFORM
DM: Klebsiella
A pt presetns wtih neck swelling and tongue is displaced up and back
Think
Ludwigs angina
What is the w/u for Ludwig’s angina
CRT with CON
Or CT with MRI if severe HA
Can Dx Lemiers Sydrome
If pulmonary infiltrates present with neck infection
Think?
Lemieres syndrome or IV drug use
What are the ABX for Ludwig’s angina
PCN + metronidazole
Ampicillin-sulbactam
Clindamycin
Cephalosporins
If a pt has a neck abcess plus bleeding
Think
Bleeding means carotid or IJV involvement
Neck exploration necessary
If a pt presetns with Lemieres syndrome
What is the tx?
Aka thrombophlebitis of the IJV
Treat w/ ABX for Fusobacterium !
No anticoagulants
What is the main Stay of therapy for cervical lymphadenopathy ?
FNA
What is the criteria for FNA of a lymph node
Node >1.5 cm
Persistent node
Node with necrotic center and no infectious cause
Continued enlargement of node
**Especially if Hx of smoking, alcohol use, prior cancer
What is scrofula
What the nodes drain onto the skin
2/2 TB or mycobatreia
What is the W/u for TB and Non TB Lymphadenitis
FNA and Bx
PCR if presentation is tuberculous but other tests inconclusive
IS snoring without OSA a medical problem ?
NO
What should you R.o in a pt with snoring
OSA (daytime somnolence)
And Obstructive causes ( refer to ent for scope)
What is the threshold for Tracheotomy
Respiratory failure needing prolonged mech. vent.
What foreign body in the esophagus is an emergency
Batteries !
A soft slow growing painless neck mass that is NOT midline and does NOT move with swallowing?
Think
Branchial Cleft Cyst
most common congeintal mass of the lateral neck
What is the W/u and Tx for a Branchial cleft cyst
Contrast Ct or MRI
Tx: complete excistion
Prevent CA
What is the most common midline congenital neck mass
Thyroglobulin duct cyst
