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ENT-HNS > Upper Airway Obstruction, Sore Throat and Dysphagia > Flashcards

Upper Airway Obstruction, Sore Throat and Dysphagia Flashcards

1
Q

Most important innervations for pharynx

A

CN IX - glossopharyngeal nerve
CN X - vagus nerve

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2
Q

Causes of acute sore throat

A

Infections
Foreign body
Postnasal drip
LPR

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3
Q

Causes of chronic sore throat

A

Cancer
Allergies
Environmental irritants
Autoimmune diseases

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4
Q

T/F: Group b hemolytic streptococci can cause throat infections

A

F
only Groups A, C, G, and F

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5
Q

T/F: Sore throat can occur at _____ phase and about ____ week after

A

acute phase
1 week after

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6
Q

Herpangina is mostly due to enteroviruses such as _______ and ____________

A

Coxsackieviruses
Echoviruses

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7
Q

This is the most common ulcerative oropharyngeal conditions affecting 60-90% of the population

A

Herpes Simplex 1 (Cold Sores)

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8
Q

The presentation of this throat infection are tiny fluid-filled blisters on lips/oral mucosa that are grouped in clusters

A

Herpes Simplex 1 (Cold Sores)

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9
Q

T/F: Diagnosis of Herpes Simplex 1 (Cold Sores) is only based on clinical picture

A

T

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10
Q

This throat infection occurs when you have a recrudescent viral infection

Diagnostic method of this infection:

A

Recurrent Herpes Simplex 1

Biopsy, viral studies

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11
Q

Most common clinical presentation of Recurrent Herpes Simplex 1

A

Herpes Labialis

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12
Q

T/F: if immunocompetent systemic antivirals against Recurrent Herpes Simplex 1 are necessary

A

F
NOT NECESSARY

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13
Q

This throat infection has white or yellow center surrounded by erythema

This disease naturally heals within:

A

Aphthous ulcer

1-3 weeks

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14
Q

T/F: Human Herpesvirus Lesions: Non-keratinized tissue:: Recurrent Aphthous Stomatitis:keratinized tissue

A

F
Herpesvirus - keratinized tissue
Aphthous - nonkeratinized tissue

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15
Q

This throat infection has bilateral exudative tonsilitis, non-specific malaise, low grade fever, and cervical lymphadenopathy

A

Infectious mononucleosis

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16
Q

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

A

Epstein-Barr virus
T
CBC: atypical lymphocytosis
Serologic testing: (+) heterophile antibodies

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16
Q

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

A

T
F- corticosteroids can be used to reduce pain and airway complications

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17
Q

Clinical presentation of Candidasis:

Diagnostic modalities for Candidasis

A

Burning sensation, dysgeusia, sensitivity, generalized discomfort, odynophagia

KOH smear or methenamine silver; Sabouraud dextrose agar medium culture

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18
Q

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

A

F
Leukoplakia can be a differential, but it has MORE LOCALIZED lesions, while candidiasis has a MORE WIDESPREAD pattern

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19
Q

T/F: Inhalational or topical steroid use can be a risk factor for oropharyngeal candidiasis

A

T

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20
Q

(Acute/chronic) candidiasis has a clinical form of pseudomembranous (thrush) and could be erythematous/atrophic

A

Acute candidasis

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21
Q

(Acute/chronic) candidiasis is hyperplastic (leukoplakia)

A

Chronic

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22
Q

Most important differential diagnosis of GABHS

A

Viral Pharyngitis

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23
Q

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

A

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

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24
Q

Walsh Score for GABHS diagnosis considers the presence of the ff s/sx:

A

Enlarged tender cervical lymph nodes
Pharyngeal exudates
recent exposure to GABHS
recent cough
Oral temperature greater than 38.3C

(CECE 38)

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25
Q

3 or 4 of the ff symptoms in Centor Score indicate positive predictive value for GABHS Diagnosis

A

Fever (hx)
Anterior cervical lymphadenopathy
Cough (absent)
Tonsillar Exudates

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26
Q

Gold standard in the diagnosis of GABHS

A

Culture in blood agar dish with goat blood at 5%

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27
Q

1st line of pharmacologic management for GABHS

A

Oral amoxicillin or penicillin for 10 days

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28
Q

Drug taken for GABHS management if with penicillin allergy

A

Erythromycin for 10 days
Azithromycin for 5 days (not first-line)

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29
Q

T/F: Although not the first line, Sulfonamides and tetracyclines are recommended as GABHS treatment

A

F
they are NOT recommended due to failure of eradication

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30
Q

Reason why azithromycin is not a first line drug

A

S pyogenes develops resistance to azithromycin

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31
Q

Absolute indications for surgical management of GABHS

A

Obstructive Sleep apnea and malignancy

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32
Q

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)

A

Peritonsillar Abscess
Anterior, Outwards

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33
Q

Triad of symptoms of peritonsillar abscess

A

Sore throat
Odynophagia
Fever

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34
Q

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

A

Diptheria

35
Q

Tx of diptheria

A

toxoid, penicillin or erythromycin

36
Q

Most common locations of foreign body obstruction

A

Tonsils
Base of the tongue
Vallecula

37
Q

T/F: laryngopharyngeal reflux can cause post nasal drip

A

T

38
Q

T/F: Erythema multiform is usually drug-induced

Erythema multiforme can be due to infection by:

A

T

Recurrent human herpesvirus 1

39
Q

Clinical presentation of erythema multiforme

Drugs that can induce erythema multiforme

A

cutaneous or oral ulcers

Carbamazepine
Phenytoin
Quinolone
Sulfonamide

40
Q

Swallowing involves complex neuromuscular action that involves about ___ muscles and ___ cranial nerves

A

26 muscles
6 cranial nerves

41
Q

Phases of swallowing and their mechanism (voluntary/involutnary/programmed)

A

Oral preparatory - voluntary
Oral - voluntary
Pharyngeal - programmed
Esophageal - involuntary

42
Q

Phase of swallowing that is not present in neonates and infants

A

Oral preparatory phase

43
Q

Major muscles of mastication

Main nerves for motor supply

A

masseter, temporalis, lateral and medial pterygoid

CN V, VII, IX

44
Q

T/F: in the oral transport phase, the soft plate bulges to seal oral cavity

A

F
it’s in oral preparatory phase

In oral transport, the soft palate RISES to contact posterior pharyngeal wall

45
Q

These two muscles contract to prevent food trapping in buccal sulcus in oral transport phase

A

Buccinator and labial muscles

46
Q

In the pharyngeal phase:
the epiglottis and aryepiglottic folds ____
The false and true vocal cords ____

A

epiglottis and aryepiglottic folds flaps down
The false and true vocal cords snaps shut

47
Q

In the pharyngeal phase, this sphincter closes to prevent nasal regurgitation

A

Velopharyngeal sphincter

48
Q

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

A

T
Cricopharyngeus muscle

49
Q

T/F: Neuromuscular disorders initially present with liquid aspirations

A

T

50
Q

Symptoms occurring in the initial 3-4 seconds after initiation of swallowing indicates pathology within:

A

oral cavity, pharynx, hypopharynx

51
Q

Symptoms occurring in > 4 seconds after initiation of swallowing indicates pathology within:

A

esophagus

52
Q

T/F: Complete otolaryngology exam is done in PE for dysphagia as chief complaint

A

T

53
Q

What do you assess for checking CN involvement for patients with dysphagia?

A

Palate and lateral pharyngeal constrictors in response to a stimulated gag

54
Q

In PE for patients with dysphagia, laryngeal excursion present during swallowing indicates:

A

normal condition

55
Q

Phases of esophagogram

A

Full column
Air Contrast
Mucosal Relief

56
Q

This phase of esophagogram evaluates esophageal peristalsis and maximally dilate esophagus to identify contour abnormalities

A

Full column (single contrast)

57
Q

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:

A

Air contrast
(double contrast)

Effervescent agent -> barium

58
Q

This phase of esophagogram makes use of thick barium without air distention, and is best for esophageal varices and some mucosal lesions

A

Mucosal Relief

59
Q

What are the functions of modified barium swallow?

A

Evaluates coordination of swallow reflex with breathing
determines the cause and evaluate severity of trachal aspiration

60
Q

This is a protective maneuver to perform if tracheal aspirations or laryngeal penetrations occur in the natural head position

A

chin-tuck maneuver

61
Q

This test is best for identifying pharyngeal phase dysphagia and aspiration

A

Flexible Endoscopic Evaluation of Swallowing with Sensory Testing

62
Q

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?

A

T

It is used to recommend when to start feeding and what bolus consistency will be best used to mitigate aspiration

63
Q

What kind of dysphagia if there is difficulty in initiating a swallow?

A

Oropharyngeal dysphagia

64
Q

What kind of dysphagia if there the patient can swallow but the food seems to stick after swallowing?

A

Esophageal dysphagia

65
Q

Disorder in esophageal dysphagia for solids only

A

Mechanical Obstruction

66
Q

Disorder in esophageal dysphagia for both solids and liquids

A

Motility Disorder

67
Q

T/F: esophageal dysphagia is associated with immediate cough, gag, and nasal regurgitation

A

F
Oropharyngeal dysphagia

68
Q

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?

A

Ludwig’s Angina

Tooth extraction or dental infection

69
Q

This disease is manifests through dysphagia for solids and liquids, regurgitation, and subsequent chest pain

A

Achalasia

70
Q

Most common symptom and characteristic of upper airway obstruction

A

Stridor

71
Q

What is likely the condition if the stridor was heard after feeding?

A

GERD

72
Q

What is the condition if the stridor improves in the prone position for infant

A

Laryngomalacia

73
Q

T/F: Epiglottitis is usually mixed bony and membranous

What are the bilateral and Unilateral presentations of choanal atresia?

Diagnostic modalities

Management?

A

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

74
Q

What do you need to watch out for in Ludwig’s Angina?

A

Swelling of the floor of the mouth

75
Q

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

A

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

76
Q

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

A

Laryngomalacia

Floppy omega shaped epiglottis
Shortened aryepiglottic folds, redundant mucosa and arytenoids

Awake Flexible Endoscopy

T

77
Q

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

A

Traumatic intubation

T

Flexible endoscopy

F - unilateral may not need treatment

78
Q

Most common area of glottic web:

Presenting symptoms:

Diagnostic modality used:

Tx:

A

Anterior 2/3

Weak or hoarse voice and cough

Flexible endoscopy

Surgical

79
Q

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:

A

Papilloma

F- first 2 years of life

Endoscopy

Excision + adjuvant therapy

80
Q

This disease is the 2nd most common cancer of the upper aerodigestive tract

A

Laryngeal Carcinoma (first is SCCA)

81
Q

Laryngeal Carcinoma symptoms in:
Glottic:
Supraglottic:
Subglottic:

Diagnostic modality?

A

Glottic: Dysphonia
Supraglottic: Voice, respiratory, swallowing
Subglottic: stridor, dyspnea

Endoscopy, CT scan, biopsy

82
Q

T/F: acute croup is usually due to parainfluenza and influenzae

Diagnostic sign:

T/F: aerosolized racemic epinephrine is used to manage croup

A

T
Steeple sign
T

83
Q

T/F long term intubation can cause laryngeal carcinoma

Clinical features:

A

F- subglottic stenosis

Dyspnea on exertion, biphasic stridor, wheezing

84
Q

T/F: Rigid bronchoscopy is both diagnostic and therapeutic for conditions with foreign body

A

T

85
Q

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 ______

A

Tracheomalacia
Bronchoscopy

86
Q
A

ENT-HNS (8 decks)

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