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Respiratory 1 > Upper Airway Disorders > Flashcards

Upper Airway Disorders Flashcards

1
Q

Purposes of sinuses

A 
Absorb shock
Lighten skull
Voice resonance
Filter, humidify and warm air
Immune response (IgA and IgG)
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2
Q

Type of cells in mucous membrane in sinuses

A

Pseudostratified columnar ciliated epithelium (with goblet cells)

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3
Q

Inflammation or infection of the nose and sinuses; usually involves runny nose, facial pain and nasal obstruction

A

Rhinosinusitis

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4
Q

Common symptoms of rhinosinusitis

A 
runny nose (purulent rhinorrhea)
facial pain
nasal obstruction
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5
Q

Acute vs. Chronic Rhinosinusitis

A

Acute: up to 4 weeks, then total resolution
Chronic: 12 weeks or more of signs/symptoms

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6
Q

Most common cause of ACUTE rhinosinusitis

A

Viral (Rhinovirus, influenze, coronavirus)

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7
Q

In rarer cases, what bacteria can cause acute rhinosinusitis

A

Streptococcus pneumoniae, H. Influenza, and Moraxella catarrhalis

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8
Q

Treatment of Acute Rhinosinusitis

A

Most self-limiting, so usually treat symptoms
Severe symptoms: antibiotics
Intranasal steroid (inflammation)
Saline irrigations

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9
Q

What can complicate acute sinusitis?

A

Loss of anatomic border or hematologic spread (cellulitis or abscesses)

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10
Q

Since symptom-based diagnosis of chronic rhinosinusitis is usually unreliable, how do you diagnosis it?

A

Computed tomography and nasal endoscopy (gold standard)

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11
Q

Chronic Rhino-sinusitis is __________

A

multifactorial

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12
Q

Most common predisposing factor for chronic rhinosinusitis

A

Allergies (IgE mediated)

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13
Q

genetic predisposition to chronic sinusitis and bronchiectasis; autosomal recessive; disorganized microtubules in cilia

A

Primary ciliary dyskinesia

kartegener’s syndrome: CRS, situs inversus, and bronchiectasis

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14
Q

genetic predisposition to chronic sinusitis; autosomal recessive; defective chloride transport gene; frequent aeruginosa infections

A

Cystic fibrosis

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15
Q

Treatment strategies for chronic sinusitis

A
  1. Mechanical (irrigation, mucolytics)
  2. Anti-inflammatory (antihistamine and steroids)
  3. Anti-Microbial
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16
Q

Systemic condition of sinuses; idiopathic and autoimmune process; necrotizing granulomas affecting upper and lower airways and kidneys

A

Granulomatosis with polyangitis (wegener’s)

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17
Q

Systemic condition of sinuses; chronic granulomatous disease; primarily pulmonary, although almost any organ system can be involved

A

Sarcoidosis

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18
Q

Indications for sinus surgery

A

Medical management failed
Anatomic obstruction
Need to restore proper function

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19
Q

Surgery is a definitive treatment for chronic rhinosinusitis (True or False)

A

False; does not cure it

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20
Q

Symptoms that make you worry about a sinonasal tumor

A

Frequent, unexplained nosebleeds
Sinonasal discharge
Sinus pain
Unusual symptoms (visual changes, excessive tearing, neck nodes)

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21
Q

inflammation of the pharynx; “sore throat”; 3rd most common chief complaint presented to physician; viral most common, but streptococcus pyogenes possible

A

Pharyngitis

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22
Q

Most common bacteria involved in pharyngitis

A

Group A beta hemolytic Streptococcus pyogenes

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23
Q

Physical exam findings for pharyngitis

A 
Erythema
Edema
Swollen tonsils
White tonsillar exudates (symmetrical)
Possible petechiae
Foul breath
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24
Q

Treatment for pharyngitis

A

Prompt antibiotic treatment reduces duration and symptoms

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25
Q

Why is it important to promptly treat pharyngitis with antibiotics?

A

Complications of pharyngitis involve glomerulonephritis and acute rheumatic fever

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26
Q

Common cold viruses involved in pharyngitis

A

Rhinovirus
Coronavirus
Parainfluenzae
Influenzae virus A, B, C

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27
Q

double stranded DNA virus; part of the Herpes virus family; 90% of world’s population infected; remains latent in B lymphocytes; can result in airway obstruction, meningitis and splenic rupture

A

EBV (Mono)

*also associated with Burkitt’s lymphoma, oral hairy leukoplakia (HIV), and nasopharyngeal carcinoma.

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28
Q

Treatment for Mono

A
  • Supportive, rest, antipyretics
  • Avoid contact sports (splenomegaly)
  • Steroids for airway obstruction
  • NO penicillins (can cause rash)
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29
Q

Abscess involved with trismus, hot potato/muffle voice and drooling; pain with swallowing, dehydration and fever

A

Peritonsillar abscess (PTA)

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30
Q

Treatment for peritonsillar abscess

A

Incision and drainage
Antibiotics
Tonsillectomy rarely needed

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31
Q

Symptoms of a retropharyngeal abscess

A

Painful swallowing (odynophagia)
Neck stiffness
Sore throat
Fever

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32
Q

Treatment for retropharyngeal abscesses

A

Incision and drain (I & D)

Antibiotics

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33
Q

odynophagia

A

painful swallowing

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34
Q

reduced ability to open mouth; “lock-jaw”

A

trismus

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35
Q

Most infections of deep neck spaces (retropharyngeal) are…

A

polymicrobial (aerobic, anaerobic, gram negative)

36
Q

Complications of PTA and RPA

A 
Mediastinitis
Airway obstruction
IJV thrombosis (Lemierre's)
Necrotizing Fasciitis
Sepsis
37
Q

inflammation and cellulitis of submandibular space, spreading to the sublingual space via fascial planes; tongue is forced upward and backward (airway obstruction); source is typically dental in origin.

A

Ludwig’s Angina

  • Treatment includes I & D, IV abx, and airway control
38
Q

Functions of the larynx

A

Voice production

Protect airway from aspiration/cough

Airway/breathing

Inc. intra-abdominal pressure for valsalva and defecation

39
Q

When does hoarseness indicate a referral to an otolaryngologist

A

dysphonia persists longer than 2 weeks or accompanied by other symptoms such as otalgia, dysphagia or difficulty breathing

40
Q

Common causes of hoarseness

A

Neurologic injury (recurrent laryngeal nerve injury)

Alteration of vocal fold lining (GERD, lesions, etc.)

41
Q

Symptoms of unilateral vocal fold paralysis

A

Breathy, weak dysphonia
Poor cough
Dysphagia

42
Q

The vast majority of laryngeal lesions causing hoarseness involve _____ of the vocal fold

A

Superficial Layers

superficial lamina propria and epithelial cover

43
Q

The cause of most benign vocal fold lesions is…

A

phonotrauma (vocal abuse)

44
Q

lesion that may involve the entire aerodigestive tract; most common benign neoplasms of the larynx in children

A

Recurrent respiratory papillomatosis

45
Q

Recurrent respiratory papillomatosis is usually caused by what viruses

A

HPV types 6 and 11

46
Q

HPV Vaccines

A

Only Gardasil-9 in the US as of 2017

47
Q

Treatment for vocal fold lesions

A

Combination of medical treatment, speech therapy and surgery

48
Q

> 90% of laryngeal carcinomas are

A

Squamous cell

49
Q

Largest risk factor for laryngeal carcinoma is

A

Smoking (especially in combination with alcohol)

50
Q

Laryngeal tumors are most common on

A

the vocal folds

51
Q

Symptoms of a laryngeal tumor

A 
Hoarseness (most common)
Dysphagia
Hemoptysis
Pain
Airway compromise
Neck mass
52
Q

A neck mass in an adult is considered a __________ until proven otherwise

A

cancer

53
Q

Best imaging technique(s) for determining where a laryngeal tumor is

A

PET/CT*

Laryngoscopy

54
Q

Treatment for early stage (I or II) laryngeal tumors vs. late stage (III or IV)

A 
Early stage (I or II): single modality, such as surgery or radiation
Late stage (III or IV): combined modality: surgery followed by radiation
55
Q

complete separation of the digestive and respiratory tracts; tracheal opening made in the anterior of neck; done in advanced laryngeal cancer (whole larynx is removed)

A

Total laryngectomy

56
Q

Why are head and neck cancer treatment difficult?

A

Due to the highly complex functional and aesthetic locations at which these tumors develop

57
Q

Signs and symptoms of pediatric obstructive sleep apnea (OSA)

A 
Mouth breathing
Snoring/snorting
Gasping
Dysphagia/choking
Poor sleep and attention
58
Q

Treatment for pediatric obstructive sleep apnea

A

Surgery: Adenotonsillectomy

Non-surgery: CPAP and/or weight loss

59
Q

high pitched breath sound from turbulent airflow through narrowed larynx/trachea; sign of upper airway obstruction

A

Stridor

60
Q

low pitched breath sound, nonmusical and snoring; airway noise from nose, nasopharynx and oropharynx

A

Stertor

61
Q

high pitched sound; indicating lower airway (lungs) disease; more commonly end expiratory

A

Wheezing

62
Q

Inspiratory stridor implies that the narrowing is at the level of the…

A

Supraglottic/glottis

63
Q

Expiratory stridor implies that the narrowing is at the level of the…

A

trachea

64
Q

Biphasic stridor implies that the narrowing is at the level of the…

A

subglottis

65
Q

Wheezing vs. Stridor

A

Wheezing: lower respiratory; continuous whistling sound on expiration

Stridor: upper respiratory; high pitched sound on inspiration

66
Q

“thumb sign” on an X-ray is indicative of

A

Epiglottitis (epiglottis is swollen and bulging into pharynx)

*Airway Emergency

67
Q

Epiglottitis/Supraglottitis is typically caused by what bacteria?

A
  • Hib (H. flu) type B

- Streptococcus species

68
Q

Treatment for epiglottitis/supraglottitis

A
  • Secure airway (intubation, tracheotomy)
  • IV antibiotics
  • Steroids
69
Q

common pediatric VIRAL respiratory illness (influenza, measles, RSV); barking cough, stridor, hoarseness; swelling from inflammation leads to airway narrowing

A

Croup

  • Steeple Sign on X-ray (tracheal narrowing)
70
Q

Treatment for croup

A
  • Steroids
  • Nebulized epinephrine (bronchodilation)
  • Cool mist (decrease mucous viscosity)
71
Q

Epiglottis vs. Croup

A

Epiglottis: Haemophilus Influenza B, rapid, tripod, muffled voice, thumbprint sign
Croup: Parainfluenza virus, slow, barking cough, lying back, hoarse, steeple sign

72
Q

most common cause of stridor in infants

A

Laryngomalacia (congenital softening of the tissues of the larynx above the vocal cords)

73
Q

congenital softening of the tissues of the larynx above the vocal cords; floppy cartilage leads to collapse and inspiratory stridor

A

Laryngomalacia

74
Q

Why is laryngomalacia worse when supine?

A

floppy cartilage leads will collapse with gravity

75
Q

Treatment for laryngomalacia

A

Most self-limiting

10% need surgery (supraglottoplasty)

76
Q

narrowing of the larynx or trachea; caused by trauma, chronic inflammation, neoplasms or can be congenital/idiopathic

A

laryngotracheal stenosis

77
Q

Long term intubation (>7-10 days) or too large of a tube can contribute to

A

laryngotracheal stenosis

78
Q

Symptoms of laryngotracheal stenosis

A

Shortness of breath with exertion
High pitched inspiratory stridor
No aid with inhalers
Tightness of throat

79
Q

Benefits of tracheostomy (surgically created airway) vs. laryngectomy

A

Still have full airway (larynx is not taken out); reversible

80
Q

Indications for a tracheostomy

A
  • Bypass upper airway obstruction
  • Prolonged intubation to avoid complications
  • Cure for OSA
81
Q

What benign neoplasm is associated with severe, unilateral recurrent epistaxis in young male?

A

Juvenile Nasopharyngeal Angiofibroma (JNA)

82
Q

What part of the anterior septum is responsible for 90% of anterior nosebleeds?

A

Kiesselbach’s Plexus

83
Q

What arteries are included in kiesselbach’s plexus?

A
  1. Superior Labial Artery
  2. Anterior and Posterior Ethmoidal Arteries
  3. Grater Palatine Artery
  4. Sphenopalatine Artery
84
Q

True or False? Posterior bleeds (10%) can be life threatening

A

True

85
Q

These infections are dangerous as they can cross fascial layers and spaces and lead to significant morbidity and airway obstruction.

A

Deep Neck Infections

86
Q

The tumor of apex of lung that can cause compression of subclavian artery, phrenic nerve, and also recurrent laryngeal nerve (leads to hoarseness)

A

Pancoast Tumor

Respiratory 1 (11 decks)

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