Upper Airway Obstruction, Sore Throat and Dysphagia Flashcards
Most important innervations for pharynx
CN IX - glossopharyngeal nerve
CN X - vagus nerve
Causes of acute sore throat
Infections
Foreign body
Postnasal drip
LPR
Causes of chronic sore throat
Cancer
Allergies
Environmental irritants
Autoimmune diseases
T/F: Group b hemolytic streptococci can cause throat infections
F
only Groups A, C, G, and F
T/F: Sore throat can occur at _____ phase and about ____ week after
acute phase
1 week after
Herpangina is mostly due to enteroviruses such as _______ and ____________
Coxsackieviruses
Echoviruses
This is the most common ulcerative oropharyngeal conditions affecting 60-90% of the population
Herpes Simplex 1 (Cold Sores)
The presentation of this throat infection are tiny fluid-filled blisters on lips/oral mucosa that are grouped in clusters
Herpes Simplex 1 (Cold Sores)
T/F: Diagnosis of Herpes Simplex 1 (Cold Sores) is only based on clinical picture
T
This throat infection occurs when you have a recrudescent viral infection
Diagnostic method of this infection:
Recurrent Herpes Simplex 1
Biopsy, viral studies
Most common clinical presentation of Recurrent Herpes Simplex 1
Herpes Labialis
T/F: if immunocompetent systemic antivirals against Recurrent Herpes Simplex 1 are necessary
F
NOT NECESSARY
This throat infection has white or yellow center surrounded by erythema
This disease naturally heals within:
Aphthous ulcer
1-3 weeks
T/F: Human Herpesvirus Lesions: Non-keratinized tissue:: Recurrent Aphthous Stomatitis:keratinized tissue
F
Herpesvirus - keratinized tissue
Aphthous - nonkeratinized tissue
This throat infection has bilateral exudative tonsilitis, non-specific malaise, low grade fever, and cervical lymphadenopathy
Infectious mononucleosis
Usual causative agent of infectious mononucleosis
T/F: Acute bacterial tonsillitis mimics presentation of infectious mononucleosis
Result of infectious mononucleosis on CBC and serologic testing
Epstein-Barr virus
T
CBC: atypical lymphocytosis
Serologic testing: (+) heterophile antibodies
T/F: Infectious mononucleosis can cause complications like myocarditis, CNS involvement, and hemolytic anemia
T/F: Corticosteroids cannot be used as treatment for infectious mononucleosis
T
F- corticosteroids can be used to reduce pain and airway complications
Clinical presentation of Candidasis:
Diagnostic modalities for Candidasis
Burning sensation, dysgeusia, sensitivity, generalized discomfort, odynophagia
KOH smear or methenamine silver; Sabouraud dextrose agar medium culture
T/F: Leukoplakia can be a differential for Candidiasis, wherein the former has a more diffused lesions while the latter has a more localized pattern
F
Leukoplakia can be a differential, but it has MORE LOCALIZED lesions, while candidiasis has a MORE WIDESPREAD pattern
T/F: Inhalational or topical steroid use can be a risk factor for oropharyngeal candidiasis
T
(Acute/chronic) candidiasis has a clinical form of pseudomembranous (thrush) and could be erythematous/atrophic
Acute candidasis
(Acute/chronic) candidiasis is hyperplastic (leukoplakia)
Chronic
Most important differential diagnosis of GABHS
Viral Pharyngitis
T/F GABHS occurs in <3yo while viral pharyngitis occurs in >3 yo
T/F: Systemic findings are severe in GABHS while
T/F: Conjunctivitis, colds, cough is present on GABHS while absent on viral pharyngitis
T/F: Erythema, sore throat, difficulty swallowing, exudates, and petechiae are severe on GABHS while mild or absent in viral pharyngitis
T/F: There is hoarseness on both GABHS and Viral pharygngitis
F - GABHS occurs in >3yo while viral pharyngitis occurs in <3 yo
T
F - 3Cs are present on viral pharyngitis, absent on GABHS
T
F- Absent in GABHS, present in viral pharyngitis
Walsh Score for GABHS diagnosis considers the presence of the ff s/sx:
Enlarged tender cervical lymph nodes
Pharyngeal exudates
recent exposure to GABHS
recent cough
Oral temperature greater than 38.3C
(CECE 38)
3 or 4 of the ff symptoms in Centor Score indicate positive predictive value for GABHS Diagnosis
Fever (hx)
Anterior cervical lymphadenopathy
Cough (absent)
Tonsillar Exudates
Gold standard in the diagnosis of GABHS
Culture in blood agar dish with goat blood at 5%
1st line of pharmacologic management for GABHS
Oral amoxicillin or penicillin for 10 days
Drug taken for GABHS management if with penicillin allergy
Erythromycin for 10 days
Azithromycin for 5 days (not first-line)
T/F: Although not the first line, Sulfonamides and tetracyclines are recommended as GABHS treatment
F
they are NOT recommended due to failure of eradication
Reason why azithromycin is not a first line drug
S pyogenes develops resistance to azithromycin
Absolute indications for surgical management of GABHS
Obstructive Sleep apnea and malignancy
This throat infection has “quincy”, or a collection of pus in the potential space between superior constrictor muscles and fibrous capsule of tonsil.
This causes bulging in the (anterior/posterior) soft palate that pushes the tonsil (inwards/outwards)
Peritonsillar Abscess
Anterior, Outwards
Triad of symptoms of peritonsillar abscess
Sore throat
Odynophagia
Fever
This throat infection has a positive thin but tough membrane that covers the oropharynx until the tracheobronchial tree, and it can be diagnosed by mirror examination of the pharynx
Diptheria
Tx of diptheria
toxoid, penicillin or erythromycin
Most common locations of foreign body obstruction
Tonsils
Base of the tongue
Vallecula
T/F: laryngopharyngeal reflux can cause post nasal drip
T
T/F: Erythema multiform is usually drug-induced
Erythema multiforme can be due to infection by:
T
Recurrent human herpesvirus 1
Clinical presentation of erythema multiforme
Drugs that can induce erythema multiforme
cutaneous or oral ulcers
Carbamazepine
Phenytoin
Quinolone
Sulfonamide
Swallowing involves complex neuromuscular action that involves about ___ muscles and ___ cranial nerves
26 muscles
6 cranial nerves
Phases of swallowing and their mechanism (voluntary/involutnary/programmed)
Oral preparatory - voluntary
Oral - voluntary
Pharyngeal - programmed
Esophageal - involuntary
Phase of swallowing that is not present in neonates and infants
Oral preparatory phase
Major muscles of mastication
Main nerves for motor supply
masseter, temporalis, lateral and medial pterygoid
CN V, VII, IX
T/F: in the oral transport phase, the soft plate bulges to seal oral cavity
F
it’s in oral preparatory phase
In oral transport, the soft palate RISES to contact posterior pharyngeal wall
These two muscles contract to prevent food trapping in buccal sulcus in oral transport phase
Buccinator and labial muscles
In the pharyngeal phase:
the epiglottis and aryepiglottic folds ____
The false and true vocal cords ____
epiglottis and aryepiglottic folds flaps down
The false and true vocal cords snaps shut
In the pharyngeal phase, this sphincter closes to prevent nasal regurgitation
Velopharyngeal sphincter
In esophageal phase:
T/F: upper 1/3 is voluntary and involuntary, while lower 2/3 is involuntary
this muscle acts opposite to pharyngeal constrictors
T
Cricopharyngeus muscle
T/F: Neuromuscular disorders initially present with liquid aspirations
T
Symptoms occurring in the initial 3-4 seconds after initiation of swallowing indicates pathology within:
oral cavity, pharynx, hypopharynx
Symptoms occurring in > 4 seconds after initiation of swallowing indicates pathology within:
esophagus
T/F: Complete otolaryngology exam is done in PE for dysphagia as chief complaint
T
What do you assess for checking CN involvement for patients with dysphagia?
Palate and lateral pharyngeal constrictors in response to a stimulated gag
In PE for patients with dysphagia, laryngeal excursion present during swallowing indicates:
normal condition
Phases of esophagogram
Full column
Air Contrast
Mucosal Relief
This phase of esophagogram evaluates esophageal peristalsis and maximally dilate esophagus to identify contour abnormalities
Full column (single contrast)
This phase of esophagogram is for evaluation of SMALL plaque-like mucosal tumors and mucosal irregularities seen in patients with ESOPHAGITIS
This uses two contrasts:
Air contrast
(double contrast)
Effervescent agent -> barium
This phase of esophagogram makes use of thick barium without air distention, and is best for esophageal varices and some mucosal lesions
Mucosal Relief
What are the functions of modified barium swallow?
Evaluates coordination of swallow reflex with breathing
determines the cause and evaluate severity of trachal aspiration
This is a protective maneuver to perform if tracheal aspirations or laryngeal penetrations occur in the natural head position
chin-tuck maneuver
This test is best for identifying pharyngeal phase dysphagia and aspiration
Flexible Endoscopic Evaluation of Swallowing with Sensory Testing
T/F: Flexible Endoscopic Evaluation of Swallowing with Sensory Testing can be used for patients with cerebral palsy, stroke, neurologic disorders, or those who have gone surgery/radiotherapy in the head and neck
If true, why?
T
It is used to recommend when to start feeding and what bolus consistency will be best used to mitigate aspiration
What kind of dysphagia if there is difficulty in initiating a swallow?
Oropharyngeal dysphagia
What kind of dysphagia if there the patient can swallow but the food seems to stick after swallowing?
Esophageal dysphagia
Disorder in esophageal dysphagia for solids only
Mechanical Obstruction
Disorder in esophageal dysphagia for both solids and liquids
Motility Disorder
T/F: esophageal dysphagia is associated with immediate cough, gag, and nasal regurgitation
F
Oropharyngeal dysphagia
This condition involves rapidly spreading cellulitis of the submandibular, sublingual, and submental spaces, wherein the floor of the mouth is elevated pushing the tongue upwards, causing airway obstruction
What is its antecedent history?
Ludwig’s Angina
Tooth extraction or dental infection
This disease is manifests through dysphagia for solids and liquids, regurgitation, and subsequent chest pain
Achalasia
Most common symptom and characteristic of upper airway obstruction
Stridor
What is likely the condition if the stridor was heard after feeding?
GERD
What is the condition if the stridor improves in the prone position for infant
Laryngomalacia
T/F: Epiglottitis is usually mixed bony and membranous
What are the bilateral and Unilateral presentations of choanal atresia?
Diagnostic modalities
Management?
F - choanal atresia is usually bony and membranous
Unilateral- esophageal spasm
Bilateral - respiratory distress
Endoscopy, CT Scan (to determine how much to widen within the area)
Surgical due to combination of bony and membranous; dilatation if membranous only although difficult
What do you need to watch out for in Ludwig’s Angina?
Swelling of the floor of the mouth
Epiglottitis used to be primarily due to _____ but with the advent of vaccines, _______ are now the most common causes
Symptoms of epiglottitis?
T/F: Soft Tissue lateral X ray is used to diagnose epiglottitis
H. influenzae; Group A and B hemolytic strep
Symptoms: sudden onset and rapidly progressive high fever, drooling, painful swallowing; usually the patient is leaning forward
T - to detect swelling of epiglottis
This disease causes inspiratory stridor and noisy respiration soon at birth, especially on supine position, which must resolve by 18 months
What is the anatomic finding of this disease?
Diagnostic modality?
T/F: This disease can be managed surgically
Laryngomalacia
Floppy omega shaped epiglottis
Shortened aryepiglottic folds, redundant mucosa and arytenoids
Awake Flexible Endoscopy
T
Vocal cord paralysis can be congenital or acquired through:
T/F: its symptoms depend if bilateral/unilateral and position of paralysis
Diagnostic modality used:
T/F: Unilateral paralysis must be urgently treated
Traumatic intubation
T
Flexible endoscopy
F - unilateral may not need treatment
Most common area of glottic web:
Presenting symptoms:
Diagnostic modality used:
Tx:
Anterior 2/3
Weak or hoarse voice and cough
Flexible endoscopy
Surgical
This disease is usually associated with genital warts in mother, and is usually among first born children.
T/F: Symptoms include hoarseness in the first 5 years of life and Squamous cell carcinoma antigen in adults
Diagnostic modality:
Management:
Papilloma
F- first 2 years of life
Endoscopy
Excision + adjuvant therapy
This disease is the 2nd most common cancer of the upper aerodigestive tract
Laryngeal Carcinoma (first is SCCA)
Laryngeal Carcinoma symptoms in:
Glottic:
Supraglottic:
Subglottic:
Diagnostic modality?
Glottic: Dysphonia
Supraglottic: Voice, respiratory, swallowing
Subglottic: stridor, dyspnea
Endoscopy, CT scan, biopsy
T/F: acute croup is usually due to parainfluenza and influenzae
Diagnostic sign:
T/F: aerosolized racemic epinephrine is used to manage croup
T
Steeple sign
T
T/F long term intubation can cause laryngeal carcinoma
Clinical features:
F- subglottic stenosis
Dyspnea on exertion, biphasic stridor, wheezing
T/F: Rigid bronchoscopy is both diagnostic and therapeutic for conditions with foreign body
T
There is widened, half circle cartilages, forward ballooning of the posterior membranous wall, and forward bulging posterior wall in endoscopy on this condition
This condition is best visualized/done in ______
Tracheomalacia
Bronchoscopy
