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Small Animal Medicine II > Oropharynx > Flashcards

Oropharynx Flashcards

1
Q

What are 3 signs that point to oral dz?

A

Halitosis
Ptyalism (sometimes with blood)
Prehension difficulty

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2
Q

If you suspect oral dz, but none is seen what should you consider next?

A

Neuromuscular dz

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3
Q

What is CUPS?

A

Canine ulcerative periodontal stomatitis

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4
Q

What is FOPS?

A

Feline orofacial pain syndrome, similar to trigeminal neuralgia in humans

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5
Q

What are two drugs that might be used to help alleviate the pain from FOPS?

A

Gabapentin
Phenobarb

NOTE: NSAIDs not very helpful

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6
Q

What is tonsillitis/pharyngitis?

A

Inflammation of the tonsils of pharynx

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7
Q

Whata re two major presenting signs you see with tonsillitis/pharyngitis?

A

Anorexia

Odynophagia (pain swallowing food)

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8
Q

What is odynophagia?

A

Pain when swallowing food

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9
Q

What is crucial when considering the signs of tonsillitis/pharyngitis?

A

Vaccination hx, thinking rabies

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10
Q

What are two clinical findings associated with tonsillitis/pharyngitis?

A

Enlarged tonsils

FB

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11
Q

When examining oropharynx for tonsillitis/pharyngitis, what samples should you take?

A

Cytology or biopsy of tonsils, especially if bleeding or ulcerated

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12
Q

What is tonsillitis/pharyngitis most commonly secondary to?

A

Respiratory dz

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13
Q

What are 3 common etiologies of tonsillitis/pharyngitis?

A

Viral (most common)
Bacterial (rare and secondary)
Nasopharyngeal polyps

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14
Q

What 5 things would you do to gain a dx of tonsillitis/pharyngitis?

A

Viral isolation (Idexx PCR) **for sure do in cats
Imaging (CT specifically)
Endoscopy (can use to look above soft palate)
Cytology
Biopsy

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15
Q

What are 4 steps to treating tonsillitis/pharyngitis?

A

Find and treat underlying cause
Remove FB
Abx
Symptomatic (analgesia, soft foods)

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16
Q

What nasopharyngeal dz might you see?

A

Stenosis/tumors

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17
Q

What are 2 diagnostic approaches to nasopharyngeal dz?

A

CT

Felxible endoscopy

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18
Q

What can you do to intervene in cases of nasopharyngeal stents/tumors?

A

Interventions- stents

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19
Q

What age of cat typically gets nasopharyngeal polyps?

A

Young cats, 1-6yoa

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20
Q

What a re the clinical signs of nasopharyngeal polyps?

A

Upper respiratory signs and dysphagia

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21
Q

What is dysphagia?

A

Difficult or painful swallowing

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22
Q

What are the 4 phases of swallowing?

A

Oral
Pharyngeal
Cricopharyngeal
Oesophageal

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23
Q

What is the normal oral phase of swallowing?

A

Grabbing food, bolus formation, bolus passed in aboral direction and pushed into oropharynx.

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24
Q

What are 5 signs of abnormal oral phase of swallowing?

A 
Tilting or throwing the head back to swallow
Difficult prehending
Food/water drops
Salivation
Food is held in the cheeks
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25
Q

What is the goal of the pharyngeal phase of swallowing?

A

To prevent aspiration while moving food into the esophagus.

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26
Q

What is the normal pharyngeal phase of swallowing?

A

Contractions propel bolus from the oropharynx to the laryngopharynx, the soft palate is elevated and the larynx is elevated against the epiglottis

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27
Q

What two phases of swallowing are difficult to distinguish from one another?

A

The pharyngeal phase and the cricopharyngeal phase

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28
Q

If a patient develops laryngeal paralysis, what do they become predisposed to?

A

Aspiration

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29
Q

What are 4 signs of abnormal pharyngeal phase of swallowing?

A

Coughing
Retching
Gagging
Food goes back into the mouth

NOTE: Worse while drinking
NOTE: Nasal discharge is actually reflux of food into the nasopharynx

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30
Q

What is the normal cricopharyngeal phase?

A

Cricopharyngeal muscle relaxes and the pharyngeoesophageal sphincter opens

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31
Q

What are 4 signs of abnormal cricopharyngeal phase?

A

Repeated efforts to swallow
Coughing
Retching
Gagging

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32
Q

What happens in the esophageal phase of swallowing?

A

Peristaltic wave is generated in the pharynx and propagated through the esophagus to carry bolus to the stomach

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33
Q

What is the conformation of the oropharyngeal structures to allow airflow?

A

Soft palate is down
Epiglottis is open
Pharyngeal muscles relax
Pharyngeosophageal sphincter is closed

34
Q

When diagnosing dysphagia, what 3 things are you looking for in your history?

A

Vaccine status (rabies)
Trauma, weakness of concurrent dz
Differentiate oral from pharyngeal/cricopharyngeal dysphagia

35
Q

When performing a clinical exam on a dysphagic animal, what is one thing you might do that can help you differentiate anorexia from dysphagia?

A

See for yourself by offering water and different food items

36
Q

On top of your general physical exam, what are 4 other things you would perform to help diagnose dysphagia?

A

Palpate masticatory muscles
Neuro exam (gag reflex)
Mouth inspection (sedate/GA)
Videofluoroscopy

37
Q

What is the diagnostic approach for dysphagia?

A

If cannot eat or prehend/eats with pain = Oral dysphagia

If tries to eat/no pain/difficult drinking/respoiratory signs = Pharyngeal/cricopharyngeal dysphagia

38
Q

What are 3 Ddxs for dysphagia?

A

Infection
Myopathy/myositis
Neuropathy

39
Q

What 3 things would you do to rule out infection?

A

CBC
Culture (rarely beneficial)
Viral isolation/serology

40
Q

What screening test would you run to rule out myopathy/myositis?

A

CK

41
Q

What 2 endocrine dzs would you screen for if you suspect a neuropathy?

A

HypoT

Addison’s (typical and atypical)

42
Q

What are 3 diagnostics you can do to determine cause of oral dysphagia?

A

RADs - FB, fxs
FNA - Abscess
FNA, biopsy - Neoplasias

43
Q

What diagnostics would you use to determine a cricopharyngeal achalasia?

A

Fluoroscopy (barium swallow)

44
Q

What is a cricopharyngeal achalasia?

A

A bar of muscle tissue which causes a physical restriction

45
Q

What diagnostics would you use to determine a mass or FB?

A

Pharyngeal endoscopy

46
Q

What 3 diagnostics would you use to determine a retropharyngeal neoplasia/abscess/lymphadenopathy?

A

US
FNA
Biopsy

47
Q

What diagnostics would you use to rule out secondary pneumonia?

A

Thoracic RADs

NOTE: Should do this whenever you have stridor or respiratory issues

48
Q

What diagnostics would you use to determine myasthenia gravis?

A

Screening test is ACTH Ab titer

NOTE: Corticosteroids can interfere with this test, wean off a couple weeks ahead of test

49
Q

How do you treat dysphagia?

A

Usually symptomatic treatment

Specifically identify and treat underlying cause

NOTE: Cricopharyngeal achalasia tx is myotomy, only thing with a specific treatment

50
Q

What are 5 common differentials for a cervical mass?

A 
Pharyngeal stick injury
Sialocoele
Thyroid carcinoma
Lymphadenopathy
Insect sting/bite
51
Q

What are 4 infrequent causes for a cervical mass?

A

Salivary gland neoplasia (usually in severe pain and odynophagia)
Hematoma
Calcinosis circumscripta
Sialadenitis/salivary gland necrosis

52
Q

What are 4 things you would investigate in your patient’s history with a cervical mass?

A

Duration
Owner description
Change over time
Location

53
Q

If the cervical mass increases and decreases in size, what 2 things should be at the top of your ddx?

A

Sialocoel

Salivary gland hyperplasia

54
Q

If the cervical mass is painful, what 2 things should be on your ddx?

A

Neoplasia

Salivary gland necrosis

55
Q

If you have a lymphadenopathy, what might you want to be looking for?

A

Oral neoplasia

56
Q

What is the typical signalment of e pharyngeal stick injury?

A

A young playful puppy

57
Q

What are 5 clinical signs do you expect to see with a pharyngeal stick injury?

A 
Dull
Bloody saliva
Terrible halitosis
Pain opening mouth
Anorexia
58
Q

With a pharyngeal stick injury, what do you typically see on RADs?

A

Emphysema around the cervical area

NOTE: Can also track into mediastinum and also go under the skin

59
Q

How do you manage a pharyngeal stick injury?

A

Explore all tracts
Establish drainage
Don’t rely on abx

60
Q

What do you need to be early on in your treatment of a pharyngeal stick injury?

A

Fairly aggressive to make sure you don’t manifest complications later

61
Q

Where can rostral pharyngeal FBs migrate to?

A

Retrobulbar (can cause abcesses)

Temporal/masseteric (facial sinus)

62
Q

Why are wooden FBs difficult to spot of RADs?

A

They’re usually radiolucent

63
Q

What is surprising about sewing needles?

A

They’re inert, and COULD be left alone, but the thread is irritating. Also, needles can migrate if in muscles.

64
Q

If you have a lateral pharyngeal FB, whay do you need multiple views?

A

Because difficult to localize where the exact location is.

65
Q

What 3 things might you see on a RAD of a cervial FB patient that suggest esophageal involvement?

A

SQ emphysema
Dyspnoea
Pneumomediastinum

66
Q

What is a sialocele?

A

A soft painless swelling

67
Q

What causes a sialocele?

A

A defect in the polystomatic sublingual gland

68
Q

What should you be careful of when sampling or draining a sialocele?

A

Easy to contaminate and it becomes an abscess

69
Q

What is the quality of the fluid drained from a sialocele?

A

“tenacious” honey coloured fluid

70
Q

How do you confirm a sialocele?

A

“Drip test”

71
Q

Why would you juts go in surgically instead of continuing diagnostics with a sialocele?

A

Because they can easily become infected

72
Q

Where would you palpate if you suspected a thyroid carcinoma?

A

Mid-cervical with deep palpation

73
Q

What would you palpate if you suspected a thyroid carcinoma?

A

A firm mass ventrolateral to the larynx

74
Q

What are 2 clinical signs you would see with a thyroid carcinoma?

A

Coughing/respiratory signs

Regurgitation

75
Q

What imaging is most helpful with a thyroid carcinoma?

A

CT contrast

76
Q

What do you need to remember when taking a biopsy of a thyroid carcinoma?

A

They will bleed a lot so make sure you have blood on hand

77
Q

What is the signalment for a patient with idiopathic sialadenitis?

A

Young terriers (JRT)

78
Q

What 3 things would you see with idiopathic sialadenitis?

A

Extreme pain
Tortoise movement (sign of odynophagia)
Hypersalivation (more severe at night)

79
Q

Why is idiopathic sialadenitis phenobarbitone responsive?

A

One clinical sign may be temporal lobe epilepsy

80
Q

What can salivary gland hyperplasia or metaplasia progress to?

A

Salivary gland necrosis

81
Q

What is the underlying etiology of salivary gland hyper-/metaplasia?

A

Esophageal dz (vagal nerve abnormality)

82
Q

How do you treat salivary gland hyper-/metaplasia?

A

Multimodal analgesia

Small Animal Medicine II (8 decks)

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