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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
Q

strep throat antigen-antibody complexes may lead to acute _______

A

poststreptococcal glomerulonephritis

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25
Q

When do Rheumatic fever and glomerulonephritis typically appear? _____ will be elevated after recent strep infection

A

2 - 3 weeks after streptococcal illness

Antistreptolysin O (ASO) titer

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26
Q

What is the correct throat swab procedure?

A

rub swab over posterior pharynx and bilateral tonsillar pillars

AVOID: tongue, teeth and gums

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27
Q

What are some differences between strep throat and viral pharyngitis?

A
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28
Q

What is a peritonsillar abscess? Complication of _____. Also called ______.

A

Forms between one of your tonsils and the wall of your throat

tonsillitis

quinsy

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29
Q

What organisms are MC for a peritonsillar abscess?

A

Often polymicrobial
**Streptococcus pyogenes (group A strep)
**Staph aureus
Respiratory anaerobes

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30
Q

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?

A

peritonsillar abscess

Hot potato voice
Deviation of the uvula to the opposite side

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31
Q

**How do you confirm the dx of a peritonsilar abscess? What is the imaging of choice?

A

Diagnosis confirmed by aspiration of pus from abscess.

CT with IV contrast but not necessary to make dx

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32
Q

What is the management for a peritonsillar abscess?

A

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

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33
Q

What structures does a retropharyngeal abscess come between? What is a typical patient?

A

Occurs between the prevertebral fascia and the constrictor muscles

more common in children after a upper respiratory infection

34
Q

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.

A

loose connective tissue

polymicrobial

oral cavity, upper respiratory tract, and certain parts of the ears

35
Q

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?

A

Retropharyngeal Abscess

CT neck with IV contrast (imaging of choice)

36
Q

What is the tx for retropharyngeal abscess? When should you see improvement?

A

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
Q

______ is the MC cause of hoarseness. And is inflammation of the larynx. Name 3 non-infectious causes

A

Acute Laryngitis

Vocal strain / cysts
Vocal cord polyps
Reflux

38
Q

Hoarseness
Typically preceded by viral URI
Exudative tonsillopharyngitis with fever and anterior cervical lymphadenopathy

What am I?
What are 3 common organisms?

A

Acute Laryngitis

Group A Streptococcus or C. diphtheriae
M. catarrhalis

39
Q

What is the tx for viral acute laryngitis? bacterial?

A

viral: voice rest and hydration

bacterial: PCN or erythromycin

40
Q

What should you give actors/singers for acute laryngitis?

A

Can be given oral steroids or erythromycin to help speed up recovery for performances

41
Q

**What should you do if laryngitis (hoarseness) lasting > 2 weeks in the absence of URI symptoms?

A

specifically in a pt who uses tobacco or drinks alcohol requires ENT or otolaryngology referral

42
Q

Resulting in hoarseness, barky, seal-type cough, respiratory distress, and inspiratory stridor. Relatively common in what age children?

A

Laryngotracheobronchitis - Croup

common infection in children peak age is 3 months to 3 years

43
Q

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?

A

Laryngotracheobronchitis - Croup

**Parainfluenza - 75%, specifically 1 and 3
Adenovirus
RSV

44
Q

_____ is the source of 3-4% of Laryngotracheobronchitis - Croup?

A

Mycoplasma pneumoniae

45
Q

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?

A

croup

have the kid go outside the cold air helps to constrict

46
Q

Stridor results from obstruction to airflow during both _____ and ______
Most marked on _____

A

inspiration and expiration

inspiration

47
Q

What is “steeple sign” associated with? what is it actually?

A

Soft tissue x-ray of the neck
Subglottic narrowing

imaging and labs are generally NOT needed

48
Q

The tx of croup depends on ______. What is considered mild? What is the tx?

A

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
Q

What is considered mild croup but brought into the office? What is the tx?

A

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
Q

What is considered moderate croup? severe? What is the tx?

A

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
Q

_____ is cellulitis of the supraglottis and surrounding structures. Is it an emergency? **What organism is it caused by? How do you prevent it?

A

Epiglottitis

YES!! airway emergency in children

**Haemophilus influenzae type B

Vaccinate!!!!

52
Q

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?

A

Epiglottitis

laryngoscopy that confirms cherry red and swollen epiglottis

Maintenance of airway is mainstay of treatment!!!!! Need to maintain airway before anything else!!!

53
Q

When do you need to order an xray on a pt with epiglottitis? **What will you commonly find?

A

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
Q

What is the tx for epiglottitis? When should you start tx?

A

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
Q

______ is the MC neck space infection. Describe it. What does it typically arise from? What is important to note?

A

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
Q

What is the tx for epiglottitis if the pt has a severe PCN allergy?

A

can use Vancomycin plus fluoroquinolone

57
Q

What are the 4 main descriptive characteristics of Ludwig’s Angina?

A
  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
Q

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?

A

Ludwig’s Angina

Deep neck abscesses are emergencies b/c they can rapidly compromise the airway

59
Q

Why is the tongue displacement in Ludwig’s angina potentially fatal? _____ is the MC cause of death

A

tongue displacement up and back. Potential airway obstruction

Asphyxiation - most common cause of death

60
Q

What is the tx for Ludgwig’s Angina?

A
61
Q

______ are usually benign and occur from vocal abuse. What is the tx?

A

Vocal cord nodules

Voice habit modification
+/- surgical excision

62
Q

_____ are caused by vocal abuse, smoking and chemical irritants. What is the tx?

A

Vocal cord polyps

Tx:
Lifestyle change
Inhaled steroid spray
Removal

63
Q

_____ is the MC tumor of the larynx. What are 2 risk factors? What is the s/s? What is the tx?

A

Squamous cell carcinoma

smokers and alcohol use

hoarseness!!

tx:
Surgery
Radiation and / or chemotherapy

64
Q

vocal cords are _____ when someone is speaking and _____ when not speaking

A

closed when speaking

open when NOT speaking

65
Q

Lesion or damage to the _____ or _____ nerve leads to vocal cord paralysis

A

recurrent laryngeal nerve

vagus nerve

66
Q

_______ is the MC cause of unilateral vocal cord paralysis. What is second MC? What is the dx TOC?

A

Iatrogenic

idiopathic

CT or MRI

67
Q

voice hoarse and breathy equal _____ vocal cord paralysis

Inspiratory stridor
Voice limited intensity, but good quality
dyspnea on exertion equal _____ vocal cord paralysis

A

unilateral

bilateral

68
Q

What are some causes of bilateral vocal cord paralysis?

A

Thyroid surgery
Esophageal cancer
Ventricular shunt malformation

69
Q

How do you dx vocal cord paralysis?

A

Laryngoscopy, bronchoscopy, esophagoscopy
CT of head, neck and chest

need to determine the cause!!!

70
Q

_______ vocal cord paralysis may resolve spontaneously. How long could it take?

A

Unilateral

may take up to a year

71
Q

How do you grade hypertrophic tonsils? What is the range?

A

based on where the tonsils are compared to the pillars

Grade 0-4

72
Q

When is a tonsillectomy recommended?

A

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
Q

_____ are soft aggregates of bacterial and cellular debris that form in the tonsillar crypts (crevices). What can they indicate?

A

Tonsilloliths: AKA tonsil stones

can indicate need to get sx

74
Q

Which of the following s/s are not generally seen in strep throat?

Nausea /vomiting
Fever
Cough/congestion

A

cough

75
Q

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

A

rapid strep screen and culture

76
Q

What is the imaging modality of choice for a retropharyngeal abscess?

A

CT with contract

77
Q

What is the most common pathogen associated with croup?

A

Parainfluenza virus 1 and 3

78
Q

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?

A

steroids IM

79
Q

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?

A

epiglottitis

80
Q

Which nerves are damaged in vocal cord paralysis?

A

CN X and recurrent laryngeal nerve

81
Q

What is the most common type of cancer that causes malignant tumors of the larynx?

A

squamous cell

82
Q

Are vocal cord polyps concerning for malignancy? What is their MC cause?

A

polyps are benign

overuse

83
Q
A

HEENT (12 decks)

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