NECK! Flashcards by Demetré Harris

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

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All cases of stridor need…

REFERAL!

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Anyone with hoarseness greater than 2 weeks should get…

Referal to ENT

ESP. If Hx of tobacco
Requires laryngoscopy

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What is the most common cause of hoarsness

Laryngitis

Usually viral

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What are the common bacterial causes of laryngitis

M. Cat

And H. Flu

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What is the tx approach to laryngitis

Vocal rest and referal to ENT

If a vocalist: steroids after laryngoscopy

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A pt presents with throat irritation, chronic cough and harness that occurs when the pt is upright

Laryngopharyngeal reflux

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What is the tx appraoch to laryngeal reflux

R/o other causes and do a laryngoscopy prior to tx

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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

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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)

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What is the complication for recurrent resp papillomatosis in smokers

Malignancy

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What are the common causes of epiglottitis

H. Flu or Viral

Common in DM (adults)

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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

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What is the tx appraoch to epiglottisis in kids

CALL ENT/ Anesthesia AND PEDS!

Intubate

Iv cultures

Cefuroxime

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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

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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

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What is the cause of vocal cysts

Vocal truama

True or pseudocysts located on inferior aspect of vocal folds
Form from mucus secreting glands

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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

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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 ?

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