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13 ENT > Adult Stridor > Flashcards

Adult Stridor Flashcards

(47 cards)

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1
Q

the larynx begins its descent into its final position between the age of ___

A

18-24 mos

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2
Q

the foregut is the origin of the ___

A

larynx, trachea, and esophagus

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3
Q

____: sole abductor
___: major adductor and modules tone and volume

A

posterior cricoarytenoids: sole abductor

lateral cricoarytenoids: adducts vocal folds and modulates tone and volume

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4
Q

cricothyroid muscle: ___ nerve

all other intrinsic laryngeal muscles: __ nerve

A

cricothyroid: superior laryngeal nerve

all other laryngeal muscles: recurrent laryngeal nerve

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5
Q

blood supply of the larynx

A

superior thyroid artery -> superior laryngeal artery ->cricothyroid artery (laryngeal cartilage)

inferior thyroid artery -> inferior laryngeal arteries

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6
Q

voice production

A

thyroarytenoid lowers the pitch
cricothyroid + thyroarytenoid raises the pitch
cricothyroid makes falsetto

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7
Q

aberrations in the microanatomy of the vocal fold causes __

A

dysphonia, aphonia with or without airway compromise

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8
Q

microanatomy of the vocal fold

A

reinke’s space/ superficial lamina propria: acellular and gelatinous

intermediate and deep lamina propria: elastin and collagen

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9
Q

bernoulli’s principle

A

read it girl

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10
Q

cough reflex

A
  • inspiratory phase
  • intrathoracic pressure exceeds extrathoracic pressure + expiratory muscle contraction
  • opening of the glottis
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11
Q

protective functions of the cough reflex

A
  • clean the tracheobronchial tree

- maintain patency of lower airways

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12
Q

most common cause of acute laryngopharyngitis

A

infectious (viral)

  • rhinovirus most common
  • coronavirus and parainfluenza
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13
Q

pathophysio of acute laryngopharyngitis

A
  • inflammatory mediators -> edema and hyperemia of laryngopharyngeal mucosa
  • inability to phonate, swallow, breathe properly and pain
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14
Q

death from influenza a is from ___

A

bacterial pneumonia (s aureus or gbs)

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15
Q

clinical course of influenza type a

A
  • abrupt onset of fever, headache, myalgia

- symptoms resolve in 3-5 days

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16
Q

treatment for influenza type a

A

antiviral with m2 ion channel blockers: amantadine

neuraminidase inhibitors: zanamivir, oseltamivir

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17
Q

cause of bacterial acute laryngopharyngitis

A

gabhs transmitter by aerosolized microdroplets

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18
Q

clinical course of bacterial al

A
  • contagious during acute illness until 1 week after

- resolution in 3-7 days

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19
Q

treatment for bacterial al

Study These Flashcards
A
  • antibiotic within 24-48 hours of symptom onset
  • penicillin or amoxicillin for 10 days
  • clindamycin is an acceptable alternative
20
Q

types of chronic laryngopharyngitis

Study These Flashcards
A
  • chronic bacterial
  • chronic fungal (blastomyces, histoplasma, coccidioides, paracoccidioides, cryptococcus)
  • chronic mycobacterial laryngitis (myobacterium leprae)
21
Q

what is chronic mycobacterial laryngitis

Study These Flashcards
A
  • m leprae transmitted via aerosolized droplet
  • dx: tissue biopsy and tissue staining
  • tx: multidrug therapy
22
Q

most common symptoms of laryngeal tb

Study These Flashcards
A

hoarseness with or without

  • odynophagia
  • dysphagia, cough, otalgia, and/or stridor
23
Q

lesions of laryngeal tb are more commonly found in ___

Study These Flashcards
A

glottis and anterior glottis

24
Q

diagnosis and treatment of laryngeal tb

Study These Flashcards
A
  • direct laryngoscopy with biopsy
  • histopathologic examination is required
  • tx: extrapulmonary tb
25
cause of recurrent respiratory papillomatosis
hpv 6 and 11 (11 more aggressive) hpv 16 and 18 = more malignancy
26
childhood vs adulthood rrp
childhood: hoarseness and stridor, grape like structures, more anterior adulthood: solitary or carpet
27
gold standard for diagnosing rrp
direct laryngoscopy with tissue biopsy
28
treatment for rrp
- carbon dioxide laser or laryngeal microdebrider!!! - cryotherapy, irradiation, photodynamic therapy - vaccines (gardasil) - indole 3 carbinol - intralesional cidofovir
29
what are vocal fold nodules
- benign mid-membranous lesions - symmetrical, hour glass closure - minimally reduced mucosal wave - tx: voice therapy
30
what is vocal fold cyst
- blocked mucus gland or congenital - unilateral - hourglass pattern - tx: excision only
31
what is vocal fold polyp
- exophytic or pedunculated (gelatinous material) | - videostroboscopy: hourglass closure, normal or minimal reduction of mucosal wave
32
what is fibrous mass
- accumulation of fibrous fluid - hourglass closure - tx: surgical only
33
what is a reactive lesion
- in the submucosa - response to a contralateral vocal fold lesion - hourglass closure - tx: voice rest and therapy
34
what is a polypoid corditis (reinke's edema)
- gelatinous like fluid - asymmteric - always bilateral - most common cause: tobacco abuse
35
what is sulcus vocalis
- from severe abnormality of lamina propria | - replacement of extracellular matrix proteins of lamina propria = furrowing of vf ligament
36
white plaques of questionable risk having excluded other known causes, no increased risk for cancer
leukoplakia of true vocal cords
37
t/f there is a clear association between smoking and excessive alcohol and development of malignancy in the upper aerodigestive tract
true
38
treatment for laryngeal squamous cell carcinoma
radiotherapy, conservation laryngectomy, total laryngectomy with/without radiotherapy
39
gold standard for diagnosis of laryngeal squaca
direct laryngoscopy with biopsy
40
causes of reflux laryngitis
- acidic injury | - bile and pepsin: doesn't respond to antacid therapy
41
diagnosis for reflux laryngitis
rigid laryngeal endoscopy or flexible laryngeal endoscopy + clinical history - posterior pachyderma and erythema of arytenoids
42
treatment for reflux laryngitis
acid neutralization, dietary and hebavioral changes, adequate hydration - h2 receptor antagonists, ppi, mucosal protectants, hydration
43
most common inciting event that can cause chronic aspiration
cerebrovascular accidents, especially brainstem with bilateral cranial nerve deficits
44
most common cause for chronic aspiration in pedia
severe neurologic dysfunction
45
diagnosis of chronic aspiration
- indirect mirror exam - fiberoptic nasopharyngoscopy - esophagoscopy - pulmonary function tests (for functional reserve) - functional endoscopic evaluation of swallowing (for dysphagia)
46
treatment for chronic aspiration
- enteral feeding (alternative routes) - parenteral hyperalimentation - surgery: tracheostomy!!, vocal cord medialization, laryngectomy
47
functions of tracheostomy
- provide comfortable airway - facilitate pulmonary toilet in patients with copious secretions - reduce pulmonary dead space

13 ENT (18 decks)

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