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HEENT > Oropharynx and Larynx - Exam 4 > Flashcards

Oropharynx and Larynx - Exam 4 Flashcards

1
Q

What are the 6 components of the oropharynx?

A

The middle part of the throat behind the mouth.
The back 1/3 of the tongue.
The soft palate & uvula.
The side and back walls of the throat.
The tonsils.

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1
Q

What are the 6 components of the larynx?

A
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2
Q

_____ is one of the MC complaints in primary care. _____ is viral. Highest in _____ months

A

sore throat (acute pharyngitis)

50% are viral

highest in winter months

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3
Q

_____ is the MC bacterial pathogen cause of acute pharyngitis

A

Group A strep

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4
Q

Sore throat - Not severe
Coryzal symptoms
Fever - rare
PE - little to no findings
No adenopathy or pharyngeal exudates

What am I?

A

viral pharyngitis: respiratory viruses

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5
Q

Sore throat - More severe
Fever
Myalgia, headache, cough

What am I?

A

viral pharyngitis: influenza

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6
Q

Sore throat
Fever
Post-auricular adenopathy
Myalgias
conjunctivitis

What am I?

A

Viral pharyngitis: Adenovirus

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7
Q

If conjunctivitis is present, it is almost always _____

A

adenovirus

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8
Q

**Pharyngeal inflammation and exudate
Vesicles and shallow ulcers on hard palate and tongue

What am I?
What is the tx?

A

HSV Infection

Acyclovir / Valacyclovir (Valtrex)

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9
Q

“Mouth blisters”
Small vesicles on soft palate and uvula that rupture to form shallow white ulcers

What am I?
**Mouth ulcers are almost always _____

A

Coxsackievirus - Herpangina (Hand, foot and mouth dz)

Viral!!!

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10
Q

Pharyngitis
Pharyngeal exudate: White - purple
Fever
Fatigue: persistent and severe
Generalized lymphadenopathy: posterior cervical
splenomegaly
HA
Maculopapular, urticarial, or petechial rash

What am I?
What does the rise commonly arise after?
What is the pt education?

A

Epstein-Barr Virus (mononucleosis)

Can arise with ampicillin/amoxicilin

Avoid contact sports for 4 weeks
Risk of splenic rupture
Can use oral Prednisone taper if tonsillar swelling is significant
Antivirals and Steroids not recommended in regular treatment; does not reduce duration

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11
Q

What are some diagnostic/screening tools that you can order for viral pharyngitis?

A

Rapid antigen detection test (rapid strep screen)

monospot

serum EBV specific antibodies

NP swab

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12
Q

What is important to remember about the monospot test?

A

Can have false negatives in early course

Not reactive on young children less than 4 years of age - high false negative

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13
Q

What are the mono lab values? **What is the value that sets it apart?

A

Lymphocytosis
**Atypical lymphocytosis
Total WBC 12000-18000
Elevated Liver Function Tests

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14
Q

**What organism is strep throat caused by?

A

strep pyogenes

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15
Q

Fever over 38C (100.4F)
Sore Throat
odynophagia
Malaise
Nausea, Vomiting
Tender anterior cervical lymphadenopathy
Pharynx, soft palate, tonsils erythematous and edematous
Tonsillar exudate
Palatal petechiae
Hoarseness, cough, coryza not suggestive of this illness
History of exposure

What am I?
What is the MC organism?
What is the highlighted s/s?

A

GABHS- strep throat

Strep pyogenes

Hoarseness, cough, coryza not suggestive of this illness

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16
Q

Which dz presents with a sandpaper rash that blanches and resembles a sunburn. What are an additional 2 important symptoms to note?

A

Strep throat

palatal petechiae

strawberry tongue

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17
Q

Rapid Antigen Detection Strep test first line testing is first line for ______. How accurate is it?

A

Strep throat- GABHS

90-99% accurate
Can have false negatives

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18
Q

What is the Centor criteria? What dz is it associated with? What do the result indicate? **If _____ is present need to think viral

A

Tonsillar exudates
Tender anterior cervical lymphadenopathy
Fever
Absence of cough

strep throat

greater than or equal to 3 need to strep test the patient, less than 3 do not need to strep test

cough present think viral!!!

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19
Q

What is the first line tx for strep throat? What is second line?

A

Pen VK
Pen G benzathine (Bicillin) IM as a single dose
Amoxicillin

second:
Augmentin
Erythromycin
Clindamycin
Azithromycin (Zithromax)

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20
Q

What is the first line tx for strep throat for a pt with a mild PCN allergy? What about for a severe PCN allergy?

A

Cephalexin (Keflex)/ Cefdinir / Cephalosporins
Penicillin allergic reaction of rash

Azithromycin / Clindamycin
Anaphylaxis reaction

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21
Q

What are the pt education points for strep throat?

A

Have pt change toothbrush after 24 hours

Not contagious any longer after 24 hours of treatment

Strep will “go away” on it’s own without antibiotics
However, a patient will remain contagious for 2-3 weeks after symptoms abate

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22
Q

_____ is a common strep throat complication in children

A

Otitis media

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23
Q

Strep throat secondary antibody formation because of cross-reactivity may result in _____ and ______

A

rheumatic fever

valvular heart disease

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24
strep throat antigen-antibody complexes may lead to acute _______
poststreptococcal glomerulonephritis
25
When do Rheumatic fever and glomerulonephritis typically appear? _____ will be elevated after recent strep infection
2 - 3 weeks after streptococcal illness Antistreptolysin O (ASO) titer
26
What is the correct throat swab procedure?
rub swab over posterior pharynx and bilateral tonsillar pillars AVOID: tongue, teeth and gums
27
What are some differences between strep throat and viral pharyngitis?
28
What is a peritonsillar abscess? Complication of _____. Also called ______.
Forms between one of your tonsils and the wall of your throat tonsillitis quinsy
29
What organisms are MC for a peritonsillar abscess?
Often polymicrobial **Streptococcus pyogenes (group A strep) **Staph aureus Respiratory anaerobes
30
Severe sore throat (usually unilateral) Fever Muffled voice - “hot potato” voice Drooling Odynophagia Trismus muscle spasms Neck swelling and pain Referred ear pain Fatigue, irritability, decreased oral intake deviation of the uvula to the opposite side What am I? What are the highlighted s/s?
peritonsillar abscess Hot potato voice Deviation of the uvula to the opposite side
31
**How do you confirm the dx of a peritonsilar abscess? What is the imaging of choice?
Diagnosis confirmed by aspiration of pus from abscess. CT with IV contrast but not necessary to make dx
32
What is the management for a peritonsillar abscess?
airway is the first priority!! consult ENT Needle aspiration or I&D IV Ampicillin-sulbactam (Unasyn) or Clindamycin Add Vancomycin if patient doesn’t respond promptly can switch to oral once improvement is noted. Augmentin or clinda
33
What structures does a retropharyngeal abscess come between? What is a typical patient?
Occurs between the prevertebral fascia and the constrictor muscles more common in children after a upper respiratory infection
34
The deep cervical fascial spaces are normally bound together by ______ and intercommunicate to varied degrees Deep neck space infections are typically ______ and represent the normal resident flora of the contiguous mucosal surfaces from which the infection originated. _____, ____ and _____ may share common organisms.
loose connective tissue polymicrobial oral cavity, upper respiratory tract, and certain parts of the ears
35
Neck swelling / mass / lymphadenopathy Spiking fever Neck pain, stiff neck Odynophagia Dysphagia Anorexia Malaise Irritability What am I? What is the dx tool of choice?
Retropharyngeal Abscess CT neck with IV contrast (imaging of choice)
36
What is the tx for retropharyngeal abscess? When should you see improvement?
maintain airway IV antibiotics Ampicillin / Sulbactam (Unasyn) or Ceftriaxone plus Metronidazole or Clindamycin plus Levofloxacin Surgical drainage of abscess with ultrasound guided needle aspiration or open drainage 24 - 48 hours: Consider new antibiotics and / or surgery if not
37
______ is the MC cause of hoarseness. And is inflammation of the larynx. Name 3 non-infectious causes
Acute Laryngitis Vocal strain / cysts Vocal cord polyps Reflux
38
Hoarseness Typically preceded by viral URI Exudative tonsillopharyngitis with fever and anterior cervical lymphadenopathy What am I? What are 3 common organisms?
Acute Laryngitis Group A Streptococcus or C. diphtheriae M. catarrhalis
39
What is the tx for viral acute laryngitis? bacterial?
viral: voice rest and hydration bacterial: PCN or erythromycin
40
What should you give actors/singers for acute laryngitis?
Can be given oral steroids or erythromycin to help speed up recovery for performances
41
**What should you do if laryngitis (hoarseness) lasting > 2 weeks in the absence of URI symptoms?
specifically in a pt who uses tobacco or drinks alcohol requires ENT or otolaryngology referral
42
Resulting in hoarseness, barky, seal-type cough, respiratory distress, and inspiratory stridor. Relatively common in what age children?
Laryngotracheobronchitis - Croup common infection in children peak age is 3 months to 3 years
43
What is the infection of the upper airways - larynx, trachea, and upper levels of bronchial tree and edema of the airways? What is the MC viruses?
Laryngotracheobronchitis - Croup **Parainfluenza - 75%, specifically 1 and 3 Adenovirus RSV
44
_____ is the source of 3-4% of Laryngotracheobronchitis - Croup?
Mycoplasma pneumoniae
45
Prodromal URI symptoms for 1-2 days Barking, "Seal-Like" cough Inspiratory Stridor fever possible symptoms worse at night respiratory distress Then followed by the characteristic cough, which indicates progression in distress: accessory muscles of the chest wall What am I? What should you tell the parents?
croup have the kid go outside the cold air helps to constrict
46
Stridor results from obstruction to airflow during both _____ and ______ Most marked on _____
inspiration and expiration inspiration
47
What is "steeple sign" associated with? what is it actually?
Soft tissue x-ray of the neck Subglottic narrowing imaging and labs are generally NOT needed
48
The tx of croup depends on ______. What is considered mild? What is the tx?
depends on severity! mild: No stridor at rest Barky cough Hoarse cry No /mild chest wall retractions tx: supportive care and exposure to cold air **also instruct parents to watch for difficulty breathing, stridor at rest, worsening course, prolonged symptoms >7 day**
49
What is considered mild croup but brought into the office? What is the tx?
Mild (managed outpatient) If brought into outpatient setting, can do dexamethasone (decadron) single dose (.15 to .6 mg/kg) Or oral Prednisolone 1mg/kg single dose *Minimal handling of child, make sure they are comfortable **Crying and anxiety make children take short, rapid breaths, which aggravate narrowing of the airway
50
What is considered moderate croup? severe? What is the tx?
Moderate: Stridor at rest Mild to moderate retractions severe: Stridor at rest Marked retractions with agitations Lethargy, cyanosis both should be evaluated at the ER!!!! Dexamethasone Nebulized Epinephrine Supportive care including humidified air or oxygen, antipyretics, fluid intake, nebulized saline need to observe for 3-4 hours after rx intervention and additional epi should be given if s/s persist
51
_____ is cellulitis of the supraglottis and surrounding structures. Is it an emergency? **What organism is it caused by? How do you prevent it?
Epiglottitis YES!! airway emergency in children **Haemophilus influenzae type B Vaccinate!!!!
52
Acutely with dysphagia, drooling, and distress Classic “tripod” position Sudden onset of High fever Anxious, restless, irritable Stridor Can present with Toxic appearance Rapidly sore throat Odynophagia out of proportion to oropharyngeal findings What am I? How do you confirm dx? What are the typical findings? What is the first priority?
Epiglottitis laryngoscopy that confirms cherry red and swollen epiglottis Maintenance of airway is mainstay of treatment!!!!! Need to maintain airway before anything else!!!
53
When do you need to order an xray on a pt with epiglottitis? **What will you commonly find?
Radiographs are NOT necessary to make the diagnosis, only order if the pt is stable and want to differentiate from croup **thumbprint sign** on lateral neck radiograph
54
What is the tx for epiglottitis? When should you start tx?
tx: Ceftriaxone plus Vancomycin first line OR Ceftriaxone plus Clindamycin also accepted as first line start tx with empiric IV antibiotic treatment should begin AFTER blood and epiglottic cultures are obtained
55
______ is the MC neck space infection. Describe it. What does it typically arise from? What is important to note?
Ludwig's angina Bilateral Cellulitis of the sublingual, submandibular, and submental spaces Arises from infected or recently extracted tooth ⅔ of the time **Aggressive and spreads rapidly** can potentially cause airway obstruction
56
What is the tx for epiglottitis if the pt has a severe PCN allergy?
can use Vancomycin plus fluoroquinolone
57
What are the 4 main descriptive characteristics of Ludwig's Angina?
1. Begins in floor of mouth with a “woody” or brawny cellulitis (skin has a hard, firm texture or feel) 2. Rapidly spreading without involvement of lymph nodes 3. Sublingual and submaxillary spaces are involved 4. Bilateral
58
Dysphagia, odynophagia Edema and erythema of the sublingual region Tongue displaced up and back Marked neck pain and swelling Fever, chills, malaise Dysarthria Disturbance of speech Drooling, stiff neck tender , symmetric, and “woody” induration (known as “bull neck”) What am I? Why is this an emergency?
Ludwig’s Angina Deep neck abscesses are emergencies b/c they can rapidly compromise the airway
59
Why is the tongue displacement in Ludwig's angina potentially fatal? _____ is the MC cause of death
tongue displacement up and back. Potential airway obstruction Asphyxiation - most common cause of death
60
What is the tx for Ludgwig's Angina?
61
______ are usually benign and occur from vocal abuse. What is the tx?
Vocal cord nodules Voice habit modification +/- surgical excision
62
_____ are caused by vocal abuse, smoking and chemical irritants. What is the tx?
Vocal cord polyps Tx: Lifestyle change Inhaled steroid spray Removal
63
_____ is the MC tumor of the larynx. What are 2 risk factors? What is the s/s? What is the tx?
Squamous cell carcinoma smokers and alcohol use hoarseness!! tx: Surgery Radiation and / or chemotherapy
64
vocal cords are _____ when someone is speaking and _____ when not speaking
closed when speaking open when NOT speaking
65
Lesion or damage to the _____ or _____ nerve leads to vocal cord paralysis
recurrent laryngeal nerve vagus nerve
66
_______ is the MC cause of unilateral vocal cord paralysis. What is second MC? What is the dx TOC?
Iatrogenic idiopathic CT or MRI
67
voice hoarse and breathy equal _____ vocal cord paralysis Inspiratory stridor Voice limited intensity, but good quality dyspnea on exertion equal _____ vocal cord paralysis
unilateral bilateral
68
What are some causes of bilateral vocal cord paralysis?
Thyroid surgery Esophageal cancer Ventricular shunt malformation
69
How do you dx vocal cord paralysis?
Laryngoscopy, bronchoscopy, esophagoscopy CT of head, neck and chest need to determine the cause!!!
70
_______ vocal cord paralysis may resolve spontaneously. How long could it take?
Unilateral may take up to a year
71
How do you grade hypertrophic tonsils? What is the range?
based on where the tonsils are compared to the pillars Grade 0-4
72
When is a tonsillectomy recommended?
Recurrent throat infection ≥ 3 episodes in each of 3 years, ≥ 5 episodes in each of 2 years, or ≥ 7 episodes in 1 year Each episode characterized by at least ONE of the following Oral temp ≥ 101℉ (38.3℃) Enlarged (> 2 cm) or tender anterior cervical lymph nodes Tonsillar exudate Positive culture for group A beta-hemolytic Streptococcus or obstructive sleep apnea
73
_____ are soft aggregates of bacterial and cellular debris that form in the tonsillar crypts (crevices). What can they indicate?
Tonsilloliths: AKA tonsil stones can indicate need to get sx
74
Which of the following s/s are not generally seen in strep throat? Nausea /vomiting Fever Cough/congestion
cough
75
A 12 y/o patient presents to the office with a sore throat. Mom states pt has had a fever of 101F as well but is not coughing or congested. You notice tender cervical lymph nodes that are enlarged, as well as tonsillar exudate. What is your next step? Rapid strep screen and culture Immediately treat Do nothing and say it’s viral
rapid strep screen and culture
76
What is the imaging modality of choice for a retropharyngeal abscess?
CT with contract
77
What is the most common pathogen associated with croup?
Parainfluenza virus 1 and 3
78
A 1 year old child presents to the clinic with a barking cough. The mom stated it started in the middle of the night. The mom describes the cough as “seal like.” Mom states she also has a low grade fever and mild runny nose. She denies any trouble breathing. She brings him to the office for evaluation and the patient coughs, which sounds like a seal bark. What is you treatment for this patient?
steroids IM
79
A 3 year old male presents to the clinic with a severely sore throat. Mom states he has to sit in a specific way in order to not have trouble breathing. On PE, you notice the patient is drooling and looks to be in pain. You later learn in the encounter the patient is on a delayed vaccine schedule. What is your diagnosis?
epiglottitis
80
Which nerves are damaged in vocal cord paralysis?
CN X and recurrent laryngeal nerve
81
What is the most common type of cancer that causes malignant tumors of the larynx?
squamous cell
82
Are vocal cord polyps concerning for malignancy? What is their MC cause?
polyps are benign overuse
83

HEENT (12 decks)

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