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EENT Exam 2 > Oropharynx and Larynx > Flashcards

Oropharynx and Larynx Flashcards

1
Q

Often the _____ is a component
of a Upper Respiratory Infection (URI)
syndrome

A

pharyngitis

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2
Q

VIRAL PHARYNGITIS Etiology/Pathophysiology

A

○ Many different common viruses are known etiologic agents.
■ Rhinovirus (>100 different subtypes) - About 20% of cases
■ Adenovirus - Probably nearly as common as Rhinovirus
■ Epstein-Barr Virus - causal agent of Infectious Mononucleosis
● Will be discussed separately later

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3
Q

VIRAL PHARYNGITIS Clinical presentation

A

○ Throat pain/soreness
○ Nasal congestion
○ Fever, generally low-grade
○ Nonproductive cough is
common with URI syndrome
○ Hoarse voice is possible

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4
Q

Viral Pharyngitis Physical Exam

A

○ Edema and erythema of the
oropharynx
○ Scant exudate is possible
○ May see shallow vesicles
○ In URI, nasal mucosa
■ Erythematous
■ Rhinorrhea
○ Conjunctivitis sometimes

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5
Q

VIRAL PHARYNGITIS Diagnostic Evaluation

A

Generally, considered a clinical diagnosis based on H&P
■ Lab tests should be reserved for select cases based on suspicion.
○ Rapid testing available for some viruses
■ RSV, influenza
○ If H&P suggest it could be strep throat…
■ Strep testing could be considered

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6
Q

VIRAL PHARYNGITIS Management

A

○ Rest, time, reassurance, return precautions.
○ Hydration is very important!
○ Ibuprofen > Acetaminophen
■ Aspirin is not first choice
○ Topical anesthetics (gargles, lozenges)

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7
Q

VIRAL PHARYNGITIS Management IF Herpes simplex is the pathogen

A

■ Acyclovir or Valacyclovir can help

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8
Q

VIRAL PHARYNGITIS Management IF Influenza is the pathogen

A

■ Oseltamivir (Tamiflu) can help shorten duration of illness

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9
Q

If the patient has significant URI-associated nasal congestion, eustachian
tube dysfunction can result in _____

A

subsequent sinusitis and/or otitis media

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10
Q

Some patients with influenza may later develop secondary _____, which may then require antibiotic treatment

A

bacterial pneumonia

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11
Q

A common type of viral pharyngitis known as ____ is caused by the Epstein-Barr Virus (EBV)

A

Infectious Mononucleosis
(“mono”)

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12
Q

EBV is transmitted via intimate contact with ____

A

bodily secretions, primarily
oropharyngeal secretions (“kissing disease”)

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13
Q

Infection of B lymphocytes results in a humoral and cellular response with

A

EBV

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14
Q

EBV PHARYNGITIS History

A

○ Interestingly, most are actually
asymptomatic
○ Incubation period is 1-2 months
○ Fatigue.
○ Prolonged malaise.
○ Sore throat

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15
Q

EBV PHARYNGITIS Physical Exam

A

○ Early signs
■ Fever
■ Lymphadenopathy
● Commonly b/l Post Cervical
■ Pharyngitis
○ Later signs may include…
■ Hepatomegaly
■ Splenomegaly
■ Palatal petechiae
■ Jaundice (30% of elderly patients)

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16
Q

_____ is the most common confirmatory test in the presence of signs/symptoms of EBV pharyngitis

A

A rapid heterophile agglutination test (known commonly a Monospot test)

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17
Q

EBV PHARYNGITIS Management

A

○ Antibiotic treatment is not indicated.
○ Treatment approach is mostly the same as other viral pharyngitis.
■ Rest, hydration, NSAIDs, topical anesthetics
○ Patient education that symptoms of fatigue and malaise can persist for weeks or even months
○ Patients with extreme tonsillar
enlargement may be at risk of airway
obstructions. In this case, a short course of
steroids would be appropriate.
■ Ex: Prednisone PO for 5 days

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18
Q

Patients with extreme tonsillar
enlargement due to EBV may be at risk of airway obstructions. In this case, a short course of _____ would be appropriate

A

steroids

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19
Q

acute bacterial pharyngitis caused
by Group A Beta-Hemolytic Streptococci (GABHS)

A

STREPTOCOCCAL PHARYNGITIS

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20
Q

STREPTOCOCCAL PHARYNGITIS History

A

○ Rather sudden onset of sore throat
○ Fever, often high
○ Pain and difficulty with swallowing
○ “Swollen glands” in the neck
○ Usually no cough or rhinorrhea

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21
Q

STREPTOCOCCAL PHARYNGITIS Physical Exam

A

○ Oropharyngeal erythema and edema
○ Tonsillar exudate and swelling
■ Grayish white patchy exudate
○ Tender, enlarged anterior cervical lymph
nodes
○ Febrile

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22
Q

____ commonly accompanies strep throat

A

Scarlet fever

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23
Q

Scarlet Fever on H&P

A

Scarlet fever commonly accompanies strep throat.
■ Results from pyrogenic exotoxin released by GABHS
■ Scarlatiniform rash that blanches with pressure
■ Appears on the 2nd day of illness and fades within a week
■ Followed by extensive desquamation that lasts for several weeks

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24
Q

First line medication class for Strep is ____

A

Penicillin
● Penicillin VK or Amoxicillin for 10 days
● IM Bicillin (Penicillin G benzathine) x 1 is
also effective

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25
Q

Tx for strep if allergic to penicillins

A

■ Macrolides (azithromycin, clarithromycin)
■ Cephalosporins (cefdinir)
■ Clindamycin

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26
Q

When is a tonsillectomy warranted?

A

○ Surgical removal of the tonsils is a fairly common surgical procedure in
children and teens- Performed by ENT surgeon.
○ Generally reserved for those with recurrent cases.
■ 7 episodes of throat infection in 1 year OR
■ 5 episodes each year for 2 years OR
■ 3 episodes annually for 3 years

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27
Q

DIPHTHERIA Epidemiology

A

A form of bacterial pharyngitis cause by Corynebacterium diphtheria
● Uncommon the developed nations due to widespread immunization practices;
usually seen in those who are not fully vaccinated (TDaP and Td vaccines).

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28
Q

Pathophysiology of Diptheria

A

○ Spread mostly by respiratory secretions/droplets.
○ Incubation period is 2-5 days and can stay communicable for 2-6 weeks if not
treated with antibiotics.
○ Upper respiratory bacterial colonies secrete an exotoxin and produce a thick,
tenacious gray membrane in the oropharynx

29
Q

DIPHTHERIA History

A

○ Sore throat.
○ Low-grade fever (rarely >103°F)
○ Malaise, weakness
○ Headache
○ Cervical lymphadenopathy

30
Q

DIPHTHERIA Physical Exam

A

○ Pharyngeal erythema and edema
○ Thick, gray, leathery pseudomembrane
forms in the pharynx
■ Attempts at scraping away should not
occur, but would reveal ulcerations
with bleeding (don’t do it)
○ Extensive anterior and submandibular
cervical lymphadenopathy is common
■ “Bull’s neck” appearance

31
Q

What will a DIPHTHERIA throat culture show?

A

■ Gram stain of sample will show clusters of bacilli
■ Culture should be obtained all close contacts too

32
Q

DIPHTHERIA Clinical Management

A

○ Patient should be transport to the nearest hospital.
○ Secure airway for patients with impending respiratory compromise.
○ Treatment should be initiated before confirmatory tests are completed
due to the high potential for mortality and morbidity.
○ Isolate all cases promptly and use universal and droplet precautions.
○ An antitoxin is given to anyone suspected to have diphtheria and can be
administered without confirmation from cultures

33
Q

Diptheria Patients with active disease, as well as all close contacts with suspected
exposure, should be treated with ____

A

Antibiotics
■ Erythromycin or Penicillin for 14 days

34
Q

LUDWIG ANGINA

A

Considered a deep neck infection, Ludwig
Angina is a potentially life-threating deep
cellulitis of the floor of the mouth

35
Q

the most commonly encountered deep neck infection

A

Ludwig Angina

36
Q

____ are responsible in 80% of cases of ludwig angina

A

Dental infections

37
Q

LUDWIG ANGINA History

A

○ Rapidly progressing symptoms
○ Bilateral lower facial edema around
the mandible and upper neck
■ Can be asymmetric
○ Pain

38
Q

LUDWIG ANGINA Physical Exam

A

○ Tender, indurated, warm swelling of the submental area
○ Swelling of the floor of the mouth
○ Severe trismus can occur
○ Drooling or pooling of secretions
○ Tongue is edematous and displaced
posteriorly and superiorly

39
Q

LUDWIG ANGINA Diagnostic evaluation

A

○ Should be see in Emergency
Department right away (not clinic).
○ CT of the neck with contrast STAT.
■ Ensure airway is patent before
sending for scan

40
Q

LUDWIG ANGINA Clinical management

A

○ Patient should be admitted for continued management
Broad-spectrum IV antibiotics for several days
○ If CT shows an abscess, ENT surgical
consultation is indicated

41
Q

PERITONSILLAR ABSCESS

A

● Generally result from dental infections, tonsillitis (such as strep throat),
parotitis, or complicated sinus infections.
○ Most common is progression from acute tonsillitis to cellulitis to abscess
formation in the peritonsillar soft tissue

42
Q

PERITONSILLAR ABSCESS History

A

○ Symptoms commonly began about
3-5 days prior as sore throat
○ Throat pain markedly more severe
on the affected side
○ Fever is common

43
Q

PERITONSILLAR ABSCESS Physical Exam

A

○ Pharyngeal erythema with asymmetric
tonsillar hypertrophy
■ Uvula pointed away from abscess
■ Tonsillar displacement
○ Hot potato/muffled voice

44
Q

PERITONSILLAR ABSCESS diagnostic imaging

A

○ CT of face with contrast is indicated.
■ This will show abscess
■ Delineates size, extension

45
Q

PERITONSILLAR ABSCESS Management

A

○ Monitor and assess the patient’s airway closely
○ Fluid resuscitation is often required.
○ Pain medications
○ Oral steroids
○ Empiric antibiotics should be administered for 14 days
● Clinical Management (continued)-
○ Drainage can be performed in the ED; consulting with ENT is best
○ Drainage is commonly done by needle aspiration.
○ If large and requiring I&D, patient should go to the OR with ENT

46
Q

PERITONSILLAR ABSCESS
Drainage techniques

A

○ Anesthetic Technique
then
○ Needle aspiration technique or
○ Scalpel technique (should be done by ENT provider):

47
Q

RETROPHARYNGEAL ABSCESS

A

A deep neck infection resulting in an abscess located in the deep tissues of the
throat, behind the posterior pharyngeal wall (retropharyngeal space).
● Retropharyngeal Abscess (RPA) occurs less commonly today than in the past,
likely because of widespread use of antibiotics for suppurative URIs.
○ Incidence has recently started to increase, however (unknown reasons).

48
Q

RETROPHARYNGEAL ABSCESS Mortality

A

● Mortality rate is generally low at 1-2%.
○ However, once mediastinitis occurs, mortality approaches 50%, even with
antibiotic therapy.
● Considered a medical emergency that usually requires surgical intervention

49
Q

RETROPHARYNGEAL ABSCESS History

A

○ Sore throat, can be severe
○ Fever
○ Dysphagia
○ Odynophagia
○ Neck pain
○ Neck stiffness
○ Neck swelling (in infants)
○ Poor oral intake

50
Q

RETROPHARYNGEAL ABSCESS Diagnostic Evaluation

A

○ Lateral neck XR imaging could be
obtained.
○ CT scan of the neck with contrast is the most sensitive.
■ Will reveal the abscess and show extent of involvement
○ Chest x-ray is indicated to evaluate for aspiration pneumonia or other Dx.

51
Q

RETROPHARYNGEAL ABSCESS Clinical Management

A

○ Initial focus is on protecting and monitoring the airway.
○ Once blood cultures have been taken, IV antibiotics should be started.
○ IV fluid resuscitation may be needed, especially if dehydrated.
○ Once the diagnosis has been established, ENT surgeon should be consulted right away

52
Q

EPIGLOTTITIS

A

Acute inflammation in the supraglottic region of the pharynx with inflammation of
the epiglottis, vallecula, arytenoids, and aryepiglottic folds

53
Q

EPIGLOTTITIS Physical Exam

A

○ Tripod position - Sitting up on hands,
with the tongue out and the head
forward.
○ Drooling/inability to handle secretions
○ Severe pain on gentle palpation over the
larynx or hyoid bone
○ Stridor: A late finding indicating advanced
airway obstruction
○ Cervical adenopathy is common
○ Respiratory distress

54
Q

EPIGLOTTITIS Diagnostic eval

A

○ A clinical diagnosis based on H&P.
○ DO NOT attempt direct visualization of the epiglottis!
○ Lateral neck soft-tissue radiographs are historically used.
■ Reveal classic “thumbprint” sign (seen in about 79% of cases)
○ Direct visualization of the epiglottis using nasopharyngoscopy/ laryngoscopy is
preferred and is replacing radiographic evaluation for suspected epiglottitis
(cherry red epiglottis)

55
Q

EPIGLOTTITIS Management

A

○ Avoid agitation and manipulation.
○ Airway management is the most urgent consideration.
○ Intubation may be required with little warning
○ After airway management, IV 3rd-generation cephalosporin and vancomycin.

56
Q

ACUTE LARYNGITIS

A

Simply, inflammation of the larynx
● Onset is usually rather abrupt and is usually self-limited, less than 3 weeks.
○ Commonly attributed to viruses (uncommonly bacterial)

57
Q

Can manifest in chronic forms too, where a patient may deal with a hoarse
voice for years or the rest of their life with____

A

ACUTE LARYNGITIS

58
Q

ACUTE LARYNGITIS History

A

○ Patients report vocal hoarseness or “lost my voice.”
○ Commonly associated with rather mild URI symptoms
○ Visualization of the larynx is usually not imperative or commonly performed.
■ Indirect examination of the airway with a mirror or direct examination with
a flexible nasolaryngoscope reveals erythema and edema of the vocal
folds, secretions, and irregularities of the surface contour of the vocal fold

59
Q

LARYNGOTRACHEOBRONCHITIS AKA

A

Croup

60
Q

LARYNGOTRACHEOBRONCHITIS

A

Also known as Acute Viral Laryngotracheitis and Croup, this is the most
common form of airway obstruction in young children

61
Q

Parainfluenza Virus is the most common pathogen, causing an estimated
75% of cases of ____

A

LARYNGOTRACHEOBRONCHITIS (CROUP)

62
Q

LARYNGOTRACHEOBRONCHITIS (CROUP) History

A

○ The illness generally starts with 1-3 days of low-grade fever and URI symptoms
○ “barking cough” (seal-like), hoarse voice,
inspiratory stridor, and possibly some
respiratory distress for the patient
○ Symptoms are usually worse at night
and usually increase with patient
agitation (crying or running)

63
Q

LARYNGOTRACHEOBRONCHITIS (CROUP) Diagnostic evaluation

A

○ Essentially a clinical diagnosis based on
H&P
○ Anteroposterior (AP) radiograph of the soft tissues of the neck could be obtained.
■ “Steeple sign”

64
Q

LARYNGOTRACHEOBRONCHITIS (CROUP)
Management

A

○ Mild disease does not usually require significant medical treatment.
■ Supportive measures (saline drops, acetaminophen, etc.)
■ Cool-mist humidifiers
■ Steamy bathrooms
■ Cool night air (can be especially helpful)
○ For more significant cases, which is common…
■ Can prescribe a single dose of oral dexamethasone (0.6 mg/kg to a
max of 20 mg).

65
Q

Hospitalization and nebulized epinephrine is needed in only the severe cases of

A

LARYNGOTRACHEOBRONCHITIS (CROUP)

66
Q

Bronchoscopy is generally warranted for

A

Airway foreign body

67
Q

Acute laryngitis is the most
common cause of ____

A

Hoarseness

68
Q

Besides viral laryngitis, some other causes of Hoarseness include

A

○ Voice Misuse
○ Benign vocal cord lesions
○ Vocal hemorrhage
○ Laryngopharyngeal reflux (LPR)

EENT Exam 2 (5 decks)

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