Lecture 22- Larynx and the airway cases

Question 1

Key features of illness

Answer 1

• Antivaxxer parents
• Harsh respiratory noise- stridor
• Sore throat
• Lethargic
• Sitting in still ‘sniffing’ position
• Dribbling
• Breathing rapidly
• 39.5- pyrexia
  
  • Think infection

Question 2

What is epiglottitis

Answer 2

• Inflammation of the epiglottitis and supraglottis regions
• Narrowing of laryngeal inlet through inflammation of the epiglottitis
• Usually rare due to Hib vaccination

Question 3

What would be your differential diagnosis in a patient presenting with similar signs and symptoms (epiglottitis)?

Answer 3

• Croup
• Foreign body in airways
• Laryngeal oedema
• Retropharyngeal abscess

Question 4

1. Common cause of epiglottitis

Answer 4

Haemophilus influenza type B

Question 5

Pseudomonas aeruginosa related to which H+N infections

Answer 5

Otitis externa

Question 6

Why do you think the girl sitting with her head held in a sniffing position and what does the hard inspiratory noise suggest?​

Answer 6

• Head tilt chin lift
• Holds the airway more patent
• Maintain airway
• Stridor= airway obstruction in the upper respiratory tract

Question 7

label

Answer 7

A- epiglottis

B- aryepiglottic folds

C- false vocal cords- vestibular fold

D- true vocal cords- vocal folds

Question 8

where is the supra glottic region found

Answer 8

coloured in yellow

Question 9

why mus thte doctor not further examine or take bloods from the girl

Answer 9

Distress can decrease the patency of the airway – exacerbate inflammation

• Deterioration causing complete airway obstruction

Question 10

how would you treat epiglottitis

Answer 10

first: laryngoscopy and endotracheal intubation
then: give IV Abx

Question 11

order of the structures the endotracheal tube will have to pass to reach the trachea

Answer 11

1. oral cavity
2. posterior third of the tongue
3. epiglottis and aryepiglottic fold
4. supraglottis (laryngeal vestibule)
5. false vocal cords
6. true vocal cords
7. infraglottis
8. trachea

Question 12

what is is this

Answer 12

1 Oropharyngeal airway

Question 13

what is is this

Answer 13

2 Nasopharyngeal airway

Question 14

what is this

Answer 14

3 Laryngeal mask- supraglottic airway

Question 15

what is this

Answer 15

Endotracheal tube

Question 16

key features

Answer 16

• Key features
  
  • Thyroid operation
  • Hoarseness of voice
  • Cough
  • Gag reflex is weak
  • Left vocal fold in a paramedian position (should be more abducted)

Question 17

why have these symptoms developed

Answer 17

• Left recurrent laryngeal nerve palsy (branch of vagus nerve)
  
  • Which supplies the left side of the larynx
• Caused by damage in thyroid surgery- local structures (runs in the tracheooesophageal groove)

Question 18

1. Explain why the women’s cough was weak?

Answer 18

1. • Lack of forcible adduction of the vocal chords (unable to fully raise intrathoracic pressure)
   • Due to weakness in left vocal chord (need to adduct together)

Question 19

1. What symptoms might pt develop if the external branch of the superior laryngeal nerve were injured?

Answer 19

• External branch of superior laryngeal nerve innervates the cricothyroid muscle
• When it contracts it tilts the thyroid cartilage forward and downwards, increasing tension in the vocal chords- achieve higher pitch
• Struggle to produce higher pitched sounds

Question 20

nervous supply to the larynx

Answer 20

Superior laryngeal nerve

• Sensory= supra glottic and true vocal cords (internal laryngeal nerve)
• Motor= cricothyroid (high pitched noises)= external laryngeal

Recurrent laryngeal is motor and sensory to every muscle except the infraglottis