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Small Animal Medicine II > Oropharynx > Flashcards

Oropharynx Flashcards

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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
What is the goal of the pharyngeal phase of swallowing?
To prevent aspiration while moving food into the esophagus.
26
What is the normal pharyngeal phase of swallowing?
Contractions propel bolus from the oropharynx to the laryngopharynx, the soft palate is elevated and the larynx is elevated against the epiglottis
27
What two phases of swallowing are difficult to distinguish from one another?
The pharyngeal phase and the cricopharyngeal phase
28
If a patient develops laryngeal paralysis, what do they become predisposed to?
Aspiration
29
What are 4 signs of abnormal pharyngeal phase of swallowing?
Coughing Retching Gagging Food goes back into the mouth NOTE: Worse while drinking NOTE: Nasal discharge is actually reflux of food into the nasopharynx
30
What is the normal cricopharyngeal phase?
Cricopharyngeal muscle relaxes and the pharyngeoesophageal sphincter opens
31
What are 4 signs of abnormal cricopharyngeal phase?
Repeated efforts to swallow Coughing Retching Gagging
32
What happens in the esophageal phase of swallowing?
Peristaltic wave is generated in the pharynx and propagated through the esophagus to carry bolus to the stomach
33
What is the conformation of the oropharyngeal structures to allow airflow?
Soft palate is down Epiglottis is open Pharyngeal muscles relax Pharyngeosophageal sphincter is closed
34
When diagnosing dysphagia, what 3 things are you looking for in your history?
Vaccine status (rabies) Trauma, weakness of concurrent dz Differentiate oral from pharyngeal/cricopharyngeal dysphagia
35
When performing a clinical exam on a dysphagic animal, what is one thing you might do that can help you differentiate anorexia from dysphagia?
See for yourself by offering water and different food items
36
On top of your general physical exam, what are 4 other things you would perform to help diagnose dysphagia?
Palpate masticatory muscles Neuro exam (gag reflex) Mouth inspection (sedate/GA) Videofluoroscopy
37
What is the diagnostic approach for dysphagia?
If cannot eat or prehend/eats with pain = Oral dysphagia | If tries to eat/no pain/difficult drinking/respoiratory signs = Pharyngeal/cricopharyngeal dysphagia
38
What are 3 Ddxs for dysphagia?
Infection Myopathy/myositis Neuropathy
39
What 3 things would you do to rule out infection?
CBC Culture (rarely beneficial) Viral isolation/serology
40
What screening test would you run to rule out myopathy/myositis?
CK
41
What 2 endocrine dzs would you screen for if you suspect a neuropathy?
HypoT | Addison's (typical and atypical)
42
What are 3 diagnostics you can do to determine cause of oral dysphagia?
RADs - FB, fxs FNA - Abscess FNA, biopsy - Neoplasias
43
What diagnostics would you use to determine a cricopharyngeal achalasia?
Fluoroscopy (barium swallow)
44
What is a cricopharyngeal achalasia?
A bar of muscle tissue which causes a physical restriction
45
What diagnostics would you use to determine a mass or FB?
Pharyngeal endoscopy
46
What 3 diagnostics would you use to determine a retropharyngeal neoplasia/abscess/lymphadenopathy?
US FNA Biopsy
47
What diagnostics would you use to rule out secondary pneumonia?
Thoracic RADs NOTE: Should do this whenever you have stridor or respiratory issues
48
What diagnostics would you use to determine myasthenia gravis?
Screening test is ACTH Ab titer NOTE: Corticosteroids can interfere with this test, wean off a couple weeks ahead of test
49
How do you treat dysphagia?
Usually symptomatic treatment Specifically identify and treat underlying cause NOTE: Cricopharyngeal achalasia tx is myotomy, only thing with a specific treatment
50
What are 5 common differentials for a cervical mass?
``` Pharyngeal stick injury Sialocoele Thyroid carcinoma Lymphadenopathy Insect sting/bite ```
51
What are 4 infrequent causes for a cervical mass?
Salivary gland neoplasia (usually in severe pain and odynophagia) Hematoma Calcinosis circumscripta Sialadenitis/salivary gland necrosis
52
What are 4 things you would investigate in your patient's history with a cervical mass?
Duration Owner description Change over time Location
53
If the cervical mass increases and decreases in size, what 2 things should be at the top of your ddx?
Sialocoel | Salivary gland hyperplasia
54
If the cervical mass is painful, what 2 things should be on your ddx?
Neoplasia | Salivary gland necrosis
55
If you have a lymphadenopathy, what might you want to be looking for?
Oral neoplasia
56
What is the typical signalment of e pharyngeal stick injury?
A young playful puppy
57
What are 5 clinical signs do you expect to see with a pharyngeal stick injury?
``` Dull Bloody saliva Terrible halitosis Pain opening mouth Anorexia ```
58
With a pharyngeal stick injury, what do you typically see on RADs?
Emphysema around the cervical area NOTE: Can also track into mediastinum and also go under the skin
59
How do you manage a pharyngeal stick injury?
Explore all tracts Establish drainage Don't rely on abx
60
What do you need to be early on in your treatment of a pharyngeal stick injury?
Fairly aggressive to make sure you don't manifest complications later
61
Where can rostral pharyngeal FBs migrate to?
Retrobulbar (can cause abcesses) | Temporal/masseteric (facial sinus)
62
Why are wooden FBs difficult to spot of RADs?
They're usually radiolucent
63
What is surprising about sewing needles?
They're inert, and COULD be left alone, but the thread is irritating. Also, needles can migrate if in muscles.
64
If you have a lateral pharyngeal FB, whay do you need multiple views?
Because difficult to localize where the exact location is.
65
What 3 things might you see on a RAD of a cervial FB patient that suggest esophageal involvement?
SQ emphysema Dyspnoea Pneumomediastinum
66
What is a sialocele?
A soft painless swelling
67
What causes a sialocele?
A defect in the polystomatic sublingual gland
68
What should you be careful of when sampling or draining a sialocele?
Easy to contaminate and it becomes an abscess
69
What is the quality of the fluid drained from a sialocele?
"tenacious" honey coloured fluid
70
How do you confirm a sialocele?
"Drip test"
71
Why would you juts go in surgically instead of continuing diagnostics with a sialocele?
Because they can easily become infected
72
Where would you palpate if you suspected a thyroid carcinoma?
Mid-cervical with deep palpation
73
What would you palpate if you suspected a thyroid carcinoma?
A firm mass ventrolateral to the larynx
74
What are 2 clinical signs you would see with a thyroid carcinoma?
Coughing/respiratory signs | Regurgitation
75
What imaging is most helpful with a thyroid carcinoma?
CT contrast
76
What do you need to remember when taking a biopsy of a thyroid carcinoma?
They will bleed a lot so make sure you have blood on hand
77
What is the signalment for a patient with idiopathic sialadenitis?
Young terriers (JRT)
78
What 3 things would you see with idiopathic sialadenitis?
Extreme pain Tortoise movement (sign of odynophagia) Hypersalivation (more severe at night)
79
Why is idiopathic sialadenitis phenobarbitone responsive?
One clinical sign may be temporal lobe epilepsy
80
What can salivary gland hyperplasia or metaplasia progress to?
Salivary gland necrosis
81
What is the underlying etiology of salivary gland hyper-/metaplasia?
Esophageal dz (vagal nerve abnormality)
82
How do you treat salivary gland hyper-/metaplasia?
Multimodal analgesia

Small Animal Medicine II (8 decks)

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