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ENT > Pharyngeal, throat, and neck disorders > Flashcards

Pharyngeal, throat, and neck disorders Flashcards

1
Q

What is the most important factor in flavor of food?

Taste receptor cell life span?

A

-smell or aroma of foodd is the most important factor in flavor.

Taste receptor cell lifespan in 10 days.

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2
Q

define each of the following:

  • hypogeusia
  • agusea
  • dysgeusia
  • allegeusia
  • phantogeusia
A

Hypogeusia: diminished taste to 1 or more tastants

Ageusea: absent tase

dysgeusia: persistent sweet, sour, salty, bitter, or metallic taste
allegeusia: unpleasant taste of food or drink that is usually pleasant
phantogeusia: unpleasant taste produced indigenously due to gustatory hallucination

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3
Q

Causes of taste disorders?

A

-age, infections, gastric reflux, drugs, xerostomia (dry mouth)

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4
Q

Causes of xerostomia?

A

dz, radiation, infections, drugs (anticholinergics, TCA, antihistamines), toxins

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5
Q

Tx of…

  • dysgeusia
  • burning mouth
A

Dysgeusia: difficult to treat, treat underlying problem, clonazepam (klonopin)

burning mouth: TCAs, clonazepam

*benzo’s calm the pt down so they dont notice it as much.

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6
Q

Halitosis

-PE

A

smell their breath 5-10cm away from pts mouth and rate it 0-5, 5 being unbearably strong foul odor.

next check nasal passages and score.

evaluate tongue odor using a spoon. need to scrape the tongue.

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7
Q

Etiology of halitosis from each region:

  • oral cavity
  • nasal passages
  • tonsils
A

Oral: 80-90% of time.

  • breakdown of amino acids producing sulfur and other gases
  • poor oral hygiene
  • accumulation of post nasal drip
  • dental abscess, gingivitis, unclean dentures.

Nasal passage:

  • nasal infection
  • polyps
  • FB

Tonsils:
-tonsoliths from bacteria

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8
Q

Tx of halitosis from oral source?

A
  • proper dental care and hygiene
  • cleaning of posterior tongue
  • rinsing & DEEP gargling w/ mouthwash
  • brief chewing gum
  • sufficient water intake.
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9
Q

oral candidiasis tx?

A

-diflucan is 1st choice otherwise liquid nystatin.

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10
Q

Stomatitis

-causes

A

causes:
- candida
- HSV
- VZV
- HIV **
- Recurrent aphthous stomatitis (RAS)

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11
Q

Aphthous Ulcers

-tx

A
  • Symptomatic relief:
  • -Triamcinolone acetonide in orabase gel
  • -Topical analgesics (OTC) (oragel, anbesol)

Chemical cautery w/ silver nitrate or sulfuric acid

Severe: intralesional or PO cortisone.

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12
Q

Varicella Zoster Virus

-where are these lesion located in the mouth?

A

Location:

-grouped vesicles UNILATERALLY on the hard palate, can include buccal mucosa, tongue, and gingiva

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13
Q

HIV infection of the mouth

-defined as

A

defined as painful mucocutaneous ulceration. shallow, sharply demarcated ulcers can be found on the oral mucosa.

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14
Q

Geographic tongue

  • how long does this last?
  • cause?
  • painful?
  • sx
  • tx
A

usually last one -2weeks

may be induced by viral episode

not painful or harmful it just looks very strange. They dont have any other sx and resolves on its own.

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15
Q

Xerostomia

  • definition
  • complications
  • etiologies
  • tx
A

def: dry mouth

Complications:

  • dental caries
  • gum dz
  • halitosis
  • salivary gland calculi
  • dysphagia

Etiologies:

  • autoimmune dx
  • radiation
  • medications (TCA, anticholinergics, antihistamines)

Tx:
-artificial saliva (OTC and Rx available)

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16
Q

Odynophagia

  • definition
  • tx
  • ddx
A

def: trouble swallowing in the back of your throat
tx: treat the underlying cause.

ddx:
- candida involving the esophogus
- GERD
- stomatitis

17
Q

Indirect Laryngoscopy

  • indications
  • CI
A

indications:
- Hoarsness greater than 2 weeks
- odynophagia
- voice change
- dysphagia
- hemoptysis
- FB sensation

CI

  • uncooperative pt or one with strong gag reflex
  • compromised airway (croup or epiglotitis)

*Fiber optic nasopharyngoscopy is becoming procedure of choice.

18
Q

Hoarseness etiologies

A

acute laryngitis- URI or voice misuse

chronic laryngitis

benign vocal fold lesions

malignancy involving the larynx

neurologic dysfunction (ALS or MS)

non-organic (functional) issues

systemic conditions

19
Q

Tx of:

  • acute laryngitis
  • chronic laryngitis
A

acute: less than 3wk duration, self-limited condition, voice rest and fluids.

Chronic: treat underlying etiology such as..
-toxins, gerd, chronic sinusitis, postnasal drip, chronic alcohol use, chronic vocal strain, tobacco smoke.

20
Q

Muscle tension dysphonia

-what is this?

A

imbalance of tension in muscles involved in voice production, seen in aging with atrophy of some of the supporting structure of the vocal cords.

21
Q

Polyps:

  • result from what?
  • etiologies

Nodules:

  • characteristics
  • aka
  • most common in who?
A

Polyps:
-result from chornic vocal cord irritation

-etiologies: smoking, reflux, muscle tension dysphonia

Nodules:
-characteristics: bilaterally, symmetric

  • aka screamers or singers nodes
  • MC in women and children.
22
Q

Primary Squamous cell Laryngeal Cancer

  • arise from where?
  • risk factors
  • appearance
  • benign/metastases?
A
  • arise from the mucosal surface of the larynx
  • Major risk factors are smoking and alcohol abuse
  • early lesions appear initially as white plaques (Leukoplakic)
  • metastasizes to regional lymph nodes
23
Q

Describe the stages of swallowing

A

Oral preparatory phase: CN V, VII, XII. bolus processed by mastication

Pharyngeal phase: CN V, X, XI, XII. bolus advances into esophagus by pharyngeal peristalsis

Esophageal phase: peristaltic contractions in the esophagus propel bolus down. Relaxation of the lower esophageal sphincter allows the bolus to enter the stomach.

24
Q

What are some disorders of the oral preparatory phase?

A
  • inadequate mastication
  • xerostomia
  • neurologic disorders
  • disruption of the oropharyngeal mucosa.
25
Q

Disorders of the pharyngeal phase?

A
  • neuromuscular discordination
  • obstruction within the oropharynx
  • poor compliance of the upper esophageal sphincter.
26
Q

Oropharyngeal dysphagia

  • what are some clues in the hx?
  • diagnostic tests
A

Hx clues:

  • sx occur immediately after swallowing
  • point to cervical region as to wherre the food “sticks”
  • c/o coughing, choking, drooling, changes in speech.

Dx:

  • barium studdies
  • fiberoptic endoscopic eval of swallowing
  • nasopharyngeal larygoscopy
  • manometry
27
Q

acute pharyngitis

  • MC bacterial cause
  • dx
  • tx
  • response to tx?
A

MC: Group A Strep

Dx:

  • obtain throat and nasopharyngeal specimines
  • rapid strep test/throat culture**
  • monospot (blood test)
  • influenza tests
Tx: 
Abx: 
-PCN/amoxacillin first line 
if allergic cephalosporin or macrolide 
*resistant to clindamycin. 
**NEVER USE sulfa, FQ, and tetracyclines b/c of high rates of RESISTANCE!!!

Analgesic:

  • Acetaminophen, NSAIDS, Aspirin in adults only
  • Topical: lozenges, sprays, fluids

Respones:
-within 24hrs of abx infectivity decreases by 80%, should be improved in terms of pain and fever in 48hrs..if not improving need to return to clinic.

28
Q

Tonsillopharyngitis

  • causes
  • signs and sx
  • dx
  • tx goals
A

Causes: Group A Strep or possibly EVB

Signs and Sx:

  • more severe sore throat than pharyngitis
  • diff swallowing
  • fever
  • enlarged, red tonsils with exudate
  • lymphadenopathy

Dx: same test as for pharyngitis

Tx goals:

  • reduce duration and severity of sx
  • reduce risk of acute rheumatic fever, glomerularnephritis, pediatric autoimmne neuropsychiatric disorder syndrome
  • reduce transmission to close contacts
29
Q

Peritonsillar Abscess

  • what is this?
  • signs and sx
  • PE findings
  • dx
  • tx
A

What: infection of the tonsils, complication of tonsillitis. Can present primarily or pt may be under tx for tonsillitis.

Signs and Sx:

  • sore throat
  • odynophagia
  • fever
  • trismus
  • drooling, voice changes
  • ipsilateral ear pain

PE:
-inferior and medial displacement of the tonsil and uvula

Dx:

  • needle aspiration diagnostic if purulent material obtained.
  • CT scan

Tx:

  • I&D by ENT then start on abx (sometimes IV)
  • occassionally these pts need tonsillectomy
30
Q

Diptheria

  • cause
  • spread
  • PE finding
  • dx
  • tx
A

Cause: Corynbeacterium diphtheriae

Spread: respiratory droplets or cutaneously

PE findings: grayish or white exudates and 1/3 cases pseudomembrane

Dx: culture*, test for toxin
very hard to culture

Tx: erythromycin or PCN, antitoxin
**MUST also treat contacts.

ENT (10 decks)

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