Session 10: Group Work Flashcards
What is epiglottitis?
Inflammation of the epiglottis
What is the mostly likely causative pathogen, and why do you think this girl was susceptible to it?
(Epiglottitis)
Haemophilus influenzae type B historically and she was not vaccinated against it so probably that.
Indicate which structures are involved in epiglottitis.
Can be surrounding tissues of the epiglottis as well. It is sometimes called supraglottitis.
Why do you think the girl is sitting with her head held in a sniffing position and what doe the harsh inspiratory noise suggest?
Makes it easier for her to breathe as the airway straightens.
Harsh due to swelling and narrowing of the laryngeal inlet/vocal cords.
The junior doctor who first sees the girl, considers whether to examine the patient’s throat (oral cavity and oropharynx), given the history of sore throat, and to take a set of blood tests. The registrar who is supervising the junior doctor explains that she must NOT attempt either of these things on this particular child.
Why must the doctor not attempt to further examine or take bloods from the child?
The epiglottis can shut (or vocal cords???) on examination and lead to complete airway obstruction.
Blood tests can distress the child and make symptoms worse.
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Fortunately epiglottitis is increasingly rare. What other conditions, involving the upper airway, might you consider as part of your differential in a child presenting with similar symptoms (difficulty in breathing +/- stridor)?
Peritonsillar abscess
Tonsillitis
Pharyngitis
Croup
Asthma
Laryngitis
Retropharyngeal abscess
Describe the afferent and efferent limb of the gag reflex.
Aff - CN IX
Eff - CN X
Injury to the left recurrent laryngeal nerve is suspected. Describe the route of this nerve and how it may have been injured as a result of her recent surgery.
Arises from CN X and loops around the SCA on the right and aortic arch on the left.
Ascends the tracheo-oesophageal groove.
Is in close relation to the inferior thyroid artery and innervates the intrinsic muscles of the larynx except for cricothyroid as well as sensory to the infraglottis.
Why was the patient’s cough weak?
The RLN innervates the intrinsic muscles and they are needed for adduction. If they can’t adduct fully the cough reflex can’t build up intrathoracic pressure leading to a strong cough.
Name two other particularly concerning causes of voice hoarseness.
Pancoast tumor
Thyroid cancer
What symptoms might a patient develop if the external branch of the superior laryngeal nerve were injured? Explain your answer with reference to the relevant anatomy.
Can lead to cricothyroid muscle being paralysed.
It is responsible for producing a high pitching sound. The vocal cords cant increase in length and tautness so you can get hoarseness of voice.
How would a bilateral recurrent laryngeal nerve palsy present compared to a unilateral recurrent laryngeal nerve palsy?
Explain why there is a difference in the signs and symptoms that arise.
In bilateral both vocal cords assume a paramedian position so there can’t be any compensatory action.
This can leads to complete obstruction of the airway and can be a medical emergency.
