Throat

Question 1

Dysphagia

Answer 1

Difficulty swallowing

Question 2

Aphagia

Answer 2

Inability or refusal to swallow

Question 3

2 types of dysphagia

Answer 3

• muscular dysfunction

- block of the esophagus

Question 4

Causes of muscular dysfunction

Answer 4

• stroke, brain, spinal cord injury
• inflammation
• Weakness (polymyositis)
• esophageal spasm
• scleroderma

Question 5

Causes of block of esophagus

Answer 5

• ulceration scars from GERD
• Inflammation
• diverticular disease
• tumors
• masses

Question 6

Alternative classification of dysphasia

Answer 6

• oropharyngeal
• esophageal
• functional (unknown cause)

Question 7

Diagnostic procedures for dysphasia

Answer 7

• barium swallow
• laryngoscopy (look at back of throat)
• manometry (internal test of esophageal pressure)
• pH monitoring (determines acid reflux)
• upper GI or esophagoscopy

Question 8

Treatment for dysphasia

Answer 8

• exercise swallowing muscles
• endoscopically or surgically remove
• dietary adjustments
• pharmacotherapy (treat GERD, treat infections, avoid/treat dry mouth)

Question 9

Pharmacist role in dysphagia

Answer 9

• drugs to adjust stomach acid/treat GERD
• encourage monitoring of weight (weekly)
• MTM to assess for dry mouth
• recommend therapies to treat dry mouth
• assist with thickened liquids

Question 10

Thin liquids

Answer 10

Water, coffee, tea, soda etc

Question 11

Nectar like liquid

Answer 11

Coats and drips off spoon

Question 12

Honey like liquids

Answer 12

Coats spoon, flows off in a ribbon

Question 13

Spoon thick liquids

Answer 13

Remains on spoon in soft mass (pudding like)

Question 14

Level 3 food standard

Answer 14

• nearly regular diet
• bite- sized
• avoid crusty, dry bread, nuts, dried fruits, raw veggies

Question 15

Level 2 food standardized

Answer 15

Foods moist, soft, cohesive
Meats ground or minced
Avoid corn bread, rice, soups, casseroles, stringy food

Question 16

Level 1 food standardized

Answer 16

Pureed and cohesive
No mixed textures
Everything pudding like

Question 17

Drugs with anticholinergic side effects

Answer 17

• antihistamines
• atropine
• antidepressants (tricyclics)
• anticholinergics (benztropine)
• antipsychotics
• urinary incontinence drugs
• diuretics
• muscle relaxants

Question 18

Laryngitis

Answer 18

Inflammation of larynx, causing voice to change

Question 19

Acute causes of laryngitis

Answer 19

• viral infection
• GERD
• irritation (allergens, smoke, pollution)
• inhaled meds
• overuse of voice

Question 20

Chronic causes of laryngitis

Answer 20

• GERD
• nerve damage
• polyps and nodules
• cancers

Question 21

Laryngitis treatment

Answer 21

• Avoid talking
• Hydrate
• Rest
• no drug proven to be of benefit (compared to risk)
• increase humidity

**professionals steroids will reduce inflammation and swelling

Question 22

Things to avoid for laryngitis

Answer 22

• talking, shouting, singing
• smoking
• dry air
• clearing throat

Question 23

Pharmacists role in laryngitis

Answer 23

• give good advice
• do not give false expectations
• make appropriate referrals (assess pain well)

Question 24

When to refer for laryngitis

Answer 24

• significant pain
• fever
• BP <100
• respiratory rate >25
• voice change >4 days, with rest
• oral lesions or visible lesions in throat
• history of inhalation damage (fire)

Question 25

T/F throat pain is a disease

Answer 25

False, symptom not disease

Question 26

Etiology of sore throat

Answer 26

- common cold - mouth breathing - flu - viral pharyngitis - group A strep - sinus drainage - inhale noxious fumes (smoking)

Question 27

Treating throat pain

Answer 27

- treat underlying bacterial infection (test for it) | - systemic analgesic (NSAIDS, APAP, NO aspirin)

Question 28

Topical products for throat pain

Answer 28

- anesthetics: benzocaine, dyclonine (numbs everything, caution with hot food, teeth grinders) - antiseptics: menthol, camphor (direct relief, decrease nasal congestion and post-nasal drip) - dosage forms: lozenges, sprays, gargles, dissolving strips

Question 29

Recommendations for sore throat

Answer 29

- drink plenty of fluids (warm, tea with honey) - gargle with warm, salt-water rinses - hard candies to increase saliva production - increase humidity - avoid irritants - rest

Question 30

When to refer for sore throat

Answer 30

- significant pain, inability to eat or drink - fever - BP <100 - respiratory rate >25 - same time onset of joint pain or rash - difficulty breathing - pain >7 days - felling of lump or swelling in throat

Question 31

Point of care testing for GAS

Answer 31

- refer tonsillar exudates | - test GAS

Question 32

T/F sleep studies are essential when apnea is suspected

Answer 32

True

Question 33

T/F you can use benzocaine in all ages

Answer 33

False, not recommended for <2 years old

Question 34

Therapies for snoring

Answer 34

- sprays - breathing strips - jaw slings (mouth breathing) - mouth guards (jaw positioning) - postural and lifestyle changes (elevate head, don’t sleep on back)

Question 35

improve snoring

Answer 35

- sufficient humidity in room - achieve optimal body weight - avoid dry mouth - protect ears of snorer - down’t sleep with people who snore - get animals out of bed - remove irritants - avoid hypnotics, alcohol

Question 36

When to refer for snoring

Answer 36

- excessive daytime sleepiness - difficulty concentrating - morning headaches - sore throat from snoring - restless sleep - gasping/choking in sleep or waking - hypertension - chest pain at night - so loud it disrupts partner

Question 37

What is the recommended questionnaire for patients to fill out in regards to snoring?

Answer 37

STOP BAND

Question 38

T/F laryngitis is painful and you can offer NSAIDS for treatment

Answer 38

False | Best therapy is to avoid talking, hydrate and rest as it only affects the voice with no pain