Upper Airway Disorders Flashcards
what two antibodies are in sinus secretions
IgG and IgA
what type of epithelium lines the mucosal areas
psuedostratified columnar ciliated epithelium
3 cardinal symptoms of rhinosinusitis
facial pressure
nasal obstruction
purulent rhinorrhea
two main types of rhinosinusitis
acute and chronic
how long does chronic rhinosinusitis have to be
longer than 12 weeks
what is the usual pathogenic cause of acute rhinosinusitis
viral
name the three most common bacteria that cause acute rhinosinusitis
strep pneumo
haemophilus
Moraxella catrrhalis
while acute rhinosinusitis is considered to be infectious…what is chronic considered?
more inflammatory in nature
what is the gold standard for chronic sinusitis imaging
CT
what is the most common predisposing factor leading to chronic rhinosinusitis
allergies
name the two genetic predispositions to chronic sinusitis
primary ciliary dyskinesia
CF
what is mode of inheritance for primary ciliary
dyskinesia
autosomal recessive
name the four different treatment or symptom improving drugs for acute rhinosinusitis
antibiotics
steroids
saline irrigation
nasal decongestant
what is an autonomic drug used for rhinosinusitis?
phenylephrine…because it decreases edema and mucos
what is potts puffy tumor? what is it associated with?
it is a frontal bone osteomyelitis and is associated with adverse outcome of acute rhinosinusitis
what are the broad categories that can contribute to development of chronic rhinosinusitis? (5)
systemic-immuno/genetic local-obstructions/dysfunction microorganisms pollutants medications
what is rhinitis medicamentosa?
when you take too much nasal decongestant you can get chronis rhinosinusitis
name the five treatment drug options for chronic rhinosinusitis
mechanical like saline rinse and mucolytics
antihistamines
steroids..oral and topical
antibiotics
name two systemic diseases that can cause sinus blockage
granulomatosis with polyangitis (wegeners)
Sarcoidosis
what is Granulomatosis with polyangitis?
idiopathic autoimmune disorder that leads to necrotiing granulomas and can involve the upper airways
what are the two types of fungal sinusitis?
allergic and invasive
what is the treatment for allergic fungal sinusitis?
mainly surgical clearance
what bugs are usually responsible for invasive fungal sinusitis?
mucor, rhizopus, and aspergillus
what is the treatment for invasive fungal sinusitis?
surgical followed by IV antifungals
what type of person usually suffers from invasive fungal sinusitis?
an immunocompromised patient
what are three common symptoms that are signs of potential sinonasal tumors?
unexplained nosebleeds..often one sided
sinonasal discharge
sinus pain
name the common sinonasal tumor..what group suffers from this?
juvenile nasopharyngeal angiofibroma…mainly in young males
what is the most common cause of bacterial pharyngitis in adults?
group A beta hemolytic streptococcus pyogenes
is the usual cause of a sore throat bacterial or viral?
most are viral…but bacteria does have bigger presence in kids compared to adults
what is treatment for bacterial pharyngitis?
antibiotics…amoxicillin/penicillin…macrolides if allergic to penicillin
what is the structure of the EBV?
double stranded DNA virus
describe treatment for MONO
supportive care, antipyretics…NO amoxicillin or antibiotics in general unless there is secondary bacterial infection
what is a peritonsillar abscess?
an abscess between the capsule of the tonsils and the pharyngeal constrictors
name three symptoms associated with peritonsillar abscess?
trismus (lock jaw), hot potato voice (muffled voice), drooling
how do you treat a peritonsillar abscess?
drain it and give anitbiotics
what is a retropharyngeal abscess?
this is an abscess in the retropharyngeal space that is between the buccopharyngeal outpouch of the pretracheal layer and the alar fascia
what is the usual cause of the retropharyngeal abscess?
polymicrobial…can be aerobic..anaerobic and gram negative
how to treat retropharyngeal abscess?
incision and drainage then antibiotics
name the five common symptoms of a retripharyngeal abscess
fever sore throat shortness of breath neck stiffness painful swallowing
name five complications of a retropharyngeal abscess
internal jugular vein thrombosis necrotizing fascitis sepsis mediatinitis airway obstruction
describe how Ludwigs angina occurs?
usually dental in nature…inflammation and cellulitis of the submandibular space that spreads to the sublingual space
what is the most common issue encountered with ludwig angina?
tongue gets displaced due to swelling under it and will block the airway
what is the treatment for ludwigs angina?
give IV antibiotics, incision and drain, maintain airway
what are the common symptoms (4) for ludwigs angina?
shortness of breath, submandibular mass, drooling, trismus
what is the most common cause of long term dysphonia or hoarseness
iatrogenic injury to the recurrent laryngeal nerve
name three causes of neurological injury that can leads to hoarseness
neoplasm
viral neuropathy
idiopathic injury
four symptoms of unilateral vocal fold paralysis
breathy, weak dysphonia, poor cough, dysphagia
what type of imaging to use to see the recurrent laryngeal nerve?
CT scan
what is the pancoast tumor?
a tumor in the apex of the lung that can cause compression on the recurrent laryngeal and lead to hoarseness
what is the cause of most benign vocal fold lesions?
phonotrauma
what cell layers of vocal cords are usually involved in vocal cord lesions?
superficial lamina propria and epithelial cover
what is recurrent respiratory papillomatosis? how to treat it?
from the HPV 6 and 11 strands and causes lesions on the airways…often a cause of vocal cord lesions
surgery…not a cure
what age does recurrent respiratory papillomatosis affect mainly?
most common benign neoplasm in children…if get in childhood it is likely linked to mother
how does laryngeal cancer present?
hoaresness, neck masses, hemptysis, throat and ear pain, will see some masses on laryngoscopy, lymphadenopathy
how to treat early stage laryngeal cancer?
surgery or radiation therapy
how to treat late stage laryngeal cancer?
combined surgery and radiation therapy
what is a total laryngectomy?
complete disconnect of the respiratory tract and esophagus…trachea now comes out at the throat…breath through neck hole
how does tracheoesophageal speech work following a total laryngectomy?
have a fistula placed in the new trachea and it makes vibrations as air moves up and then the vibrations travel out of the mouth as speech
what is pediatric OSA? what are the signs of it?
obstructive sleep apnea
mouth breathing, snoring, snorting, gasping, dysphagia and choking signal tonsils, nasal voice signals adenoids
what four problems can kids with OSA have?
failure to thrive, learning disability, behavorial issues, ADHD
how to treat pediatric OSA?
most common cause is adenotonsillar hypertrophy so remove them
define stridor
high pitch breathing on inspiration, expiration or biphasic from narrowed trachea or larynx
define stertor
airway noise from nose or naso/oropharynx…low pitch
define wheezing
high pitched sound at end expiratory…signal lower respiration problem
with inspiratory stridor, where is the blockage?
supraglottis/glottis
with biphasic stridor where is the blockage?
subglottis
with expiratory stridor, where is the blockage?
trachea
what is epiglottitis?
bacterial infection of the epiglottis
what two organisms commonly cause epiglottitis?
haemophilus and streptococcus species
treatment for epiglottitis
secure airway, give antibiotics and steroids
what is the croup?
laryngotracheobronchitis…viral infection in pediatrics leads to inflammation and airway blockage
commonly have barking cough and stridor
what is the sign associated with epiglottitis?
thumb sign
what is the sign associated with croup?
steeple sign
what is a positional sign for epiglottitis?
they sit in a tripod position
do you have difficulty swallowing in epiglottitis and croup?
yes for epiglottitis and NO for croup
what is laryngomalacia? what age does it effect?
congenital abnormality of the laryngeal cartilage leads to collapse and inspiratory stridor
mainly infants
what is laryngotracheal stenosis
stenosis of the trachea and larynx that leads to narrowing of the airways
name the six classes of causes for laryngotracheal stenosis
idiopathic trauma neoplasms congenital collagen vascular disease chronic inflammatory disease
name a common traumatic cause of laryngotracheal stenosis
endotracheal tube placement for too long…more than 7-10 days
four symptoms of laryngotracheal stenosis
shortness of breath
inspiratory stridor
no aid with inhalers
tight throat
