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Medicine I: HEENT > Disorders of the Larynx and Upper Trachea > Flashcards

Disorders of the Larynx and Upper Trachea Flashcards

1
Q

Dysphonia

A

any change in voice, most cases resolve with out tx w/in a month

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2
Q

Hoarseness

A

difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or quality of the voice may change.

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3
Q

Stridor

A

noisy breathing caused by airflow through a narrow airway (implies airway obstruction)

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4
Q

Congenital Disorders

A

laryngomalacia
tracheomalacia
subglottic stenosis

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5
Q

Infectious Disorders

A 
epiglottitis
laryngotracheobronchitis (croup)
membranous tracheitis
TB
syphilis
fungal infections
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6
Q

Neoplastic Disorders

A

laryngeal carcinoma

recurrent respiratory papillomatosis

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7
Q

Traumatic Disorders

A

can occur with or with out open neck injury

signs and symptoms:
dyspnea/stridor
dysphonia/aphonia
cough/hemoptysis
neck pain dysphagia/odynophagia
tenderness of larynx
subcutaneous emphysema
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8
Q

What is the “thumbprint sign”?

A

acute epiglotitis

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9
Q

What is the “steeple sign”?

A

croup

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10
Q

What are the typical signs and symptoms of glottis cancer?

A 
hoarseness and voice change
respiratory difficulty
throat pain
otalgia (ear pain)
cough, hemoptysis
dysphagea
weight loss
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11
Q

Laryngeal Neoplasm:

A

males more common

> 90% SCCA

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12
Q

Tx of a laryngeal neoplasm:

A

radiation- good for smaller cancer (>85% cure rate), maybe be used in combo with surgery

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13
Q

GERD

A

acid from the stomach in the larynx or esophagus

symptoms:
dysphagia
dysphonia
chronic throat clearing
excessive throat mucus
voice fatigue
globus
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14
Q

Tx of GERD:

A

modify diet and lifestyle
H2 blockers
proton pump inhibitor
anti reflux inhibitor

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15
Q

Voice Abuse:

A

contact ulcer of larynx or nodules

symptoms:
hoarseness
neck pain on exertion

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16
Q

Tx of voice abuse:

A

ENT referral

  • voice therapy
  • voice rest
  • microlaryngoscopy
  • rarely excision of lesion
17
Q

What are the types of stridor?

A

inspiratory- supraglottic
expiratory- trachea or distal airway (wheezing as in asthma)
biphasic- glottic or subglottic

18
Q

How do we dx GERD?

A

clinically with flexible laryngoscopy

gold standard is 24 hr double pH probe monitor

19
Q

How do we diagnose laryngeal trauma?

A

neck CT- look for fracture of laryngeal cartilages

20
Q

How do we tx laryngeal trauma?

A

if airway is unstable plan for tracheostomy

if no fx: voice rest, humidified O2, steroids
if fracture: consult

21
Q

Laryngomalacia

A

stridor- usually insiratory, occuring several weeks after birth
MOST COMMON CONGENITAL ANOMALY CAUSING AIRWAY OBSTRUCTION

immature laryngeal cartilage
spontaneous resolution, tracheotomy if not/laser surgery

22
Q

Tracheomalacia

A

Immature tracheal rings
trachea collapses on exhalation

young children with multiple bouts of pneumonia

23
Q

Tx for tracheomalacia:

A

observation
CPAP
possible tracheostomy

24
Q

Subglottic Stenosis:

A

congenital or acquired
prolonged intubation

prevention with proper sized endotracheal tube, avoid prolonged intubation, tracheotomy

25
Q

Acute epiglottitis:

A

rapidly progressing acute laryngitis
etiology: H influenza B (less common with vaccine)
MEDICAL EMERGENCY- fatal with in hours

26
Q

Signs and symptoms of epiglottitis:

A

sore throat with rapid progression to dysphagia, refusal of feeds, “hot potato” voice

prefer to be upright slightly leaning forward (“flower sniffing position”)

DO NOT USE TONGUE BLADE

27
Q

Tx of epiglottitis:

A

ENT consult
blood culture if adult
OR for oral intubation, direct laryngoscopy, possible tracheostomy (if unable to intubate)

broad spectrum abx (IV) if : h. influenza, staph, strep

28
Q

Acute Laryngotracheobronchitis:

A

CROUP

infection of lower respiratory passage way
viral in etiology, most likely para influenza

29
Q

Symptoms of Croup:

A

barking cough, fever

30
Q

Tx of Croup:

A

hospitalize and observe
steroids, racemic epinephrine
consider broad spectrum abx
when in doubt intubate

31
Q

Membranous tracheitis

A

Atypical croup

staph aureus, strep pneumo

symptoms similar to croup but with a higher fever

32
Q

Tx of membranous tracheitis:

A

broad spectrum abx

pts do not respond to epinephrine

33
Q

Risk Factors for Laryngeal Carcinoma:

A

smoking and alcohol (HUGE FACTORS)

AA/whites > asian/latino
HPV
GERD

34
Q

YOU CAN ONLY RADIATE AND AREA ONCE!

A

KNOW THAT

35
Q

What is the most common benign neoplasm of the larynx?

A

recurrent respiratory papillomatosis (a/w hpv 6 & 11)

36
Q

Tx of recurrent respiratory papillpmatosis?

A

excision w/ cold instruments or laser, intralesional cidofovir, intralesional bevacizumab (avastin)

Medicine I: HEENT (13 decks)

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