Pharyngeal, throat, and neck disorders Flashcards Preview

ENT > Pharyngeal, throat, and neck disorders > Flashcards

Flashcards in Pharyngeal, throat, and neck disorders Deck (30)
Loading flashcards...
1

What is the most important factor in flavor of food?

Taste receptor cell life span?

-smell or aroma of foodd is the most important factor in flavor.

Taste receptor cell lifespan in 10 days.

2

define each of the following:
-hypogeusia
-agusea
-dysgeusia
-allegeusia
-phantogeusia

Hypogeusia: diminished taste to 1 or more tastants

Ageusea: absent tase

dysgeusia: persistent sweet, sour, salty, bitter, or metallic taste

allegeusia: unpleasant taste of food or drink that is usually pleasant

phantogeusia: unpleasant taste produced indigenously due to gustatory hallucination

3

Causes of taste disorders?

-age, infections, gastric reflux, drugs, xerostomia (dry mouth)

4

Causes of xerostomia?

dz, radiation, infections, drugs (anticholinergics, TCA, antihistamines), toxins

5

Tx of...
-dysgeusia
-burning mouth

Dysgeusia: difficult to treat, treat underlying problem, clonazepam (klonopin)

burning mouth: TCAs, clonazepam

*benzo's calm the pt down so they dont notice it as much.

6

Halitosis
-PE

smell their breath 5-10cm away from pts mouth and rate it 0-5, 5 being unbearably strong foul odor.

next check nasal passages and score.

evaluate tongue odor using a spoon. need to scrape the tongue.

7

Etiology of halitosis from each region:
-oral cavity
-nasal passages
-tonsils

Oral: 80-90% of time.
-breakdown of amino acids producing sulfur and other gases
-poor oral hygiene
-accumulation of post nasal drip
-dental abscess, gingivitis, unclean dentures.

Nasal passage:
-nasal infection
-polyps
-FB

Tonsils:
-tonsoliths from bacteria

8

Tx of halitosis from oral source?

-proper dental care and hygiene
-cleaning of posterior tongue
-rinsing & DEEP gargling w/ mouthwash
-brief chewing gum
-sufficient water intake.

9

oral candidiasis tx?

-diflucan is 1st choice otherwise liquid nystatin.

10

Stomatitis
-causes

causes:
-candida
-HSV
-VZV
-HIV **
-Recurrent aphthous stomatitis (RAS)

11

Aphthous Ulcers
-tx

-Symptomatic relief:
--Triamcinolone acetonide in orabase gel
--Topical analgesics (OTC) (oragel, anbesol)

Chemical cautery w/ silver nitrate or sulfuric acid

Severe: intralesional or PO cortisone.

12

Varicella Zoster Virus
-where are these lesion located in the mouth?

Location:
-grouped vesicles UNILATERALLY on the hard palate, can include buccal mucosa, tongue, and gingiva

13

HIV infection of the mouth
-defined as

defined as painful mucocutaneous ulceration. shallow, sharply demarcated ulcers can be found on the oral mucosa.

14

Geographic tongue
-how long does this last?
-cause?
-painful?
-sx
-tx

usually last one -2weeks

may be induced by viral episode

not painful or harmful it just looks very strange. They dont have any other sx and resolves on its own.

15

Xerostomia
-definition
-complications
-etiologies
-tx

def: dry mouth

Complications:
-dental caries
-gum dz
-halitosis
-salivary gland calculi
-dysphagia

Etiologies:
-autoimmune dx
-radiation
-medications (TCA, anticholinergics, antihistamines)

Tx:
-artificial saliva (OTC and Rx available)

16

Odynophagia
-definition
-tx
-ddx

def: trouble swallowing in the back of your throat

tx: treat the underlying cause.

ddx:
-candida involving the esophogus
-GERD
-stomatitis

17

Indirect Laryngoscopy
-indications
-CI

indications:
-Hoarsness greater than 2 weeks
-odynophagia
-voice change
-dysphagia
-hemoptysis
-FB sensation

CI
-uncooperative pt or one with strong gag reflex
-compromised airway (croup or epiglotitis)

*Fiber optic nasopharyngoscopy is becoming procedure of choice.

18

Hoarseness etiologies

acute laryngitis- URI or voice misuse

chronic laryngitis

benign vocal fold lesions

malignancy involving the larynx

neurologic dysfunction (ALS or MS)

non-organic (functional) issues

systemic conditions

19

Tx of:
-acute laryngitis
-chronic laryngitis

acute: less than 3wk duration, self-limited condition, voice rest and fluids.

Chronic: treat underlying etiology such as..
-toxins, gerd, chronic sinusitis, postnasal drip, chronic alcohol use, chronic vocal strain, tobacco smoke.

20

Muscle tension dysphonia
-what is this?

imbalance of tension in muscles involved in voice production, seen in aging with atrophy of some of the supporting structure of the vocal cords.

21

Polyps:
-result from what?
-etiologies


Nodules:
-characteristics
-aka
-most common in who?

Polyps:
-result from chornic vocal cord irritation

-etiologies: smoking, reflux, muscle tension dysphonia

Nodules:
-characteristics: bilaterally, symmetric

-aka screamers or singers nodes

-MC in women and children.

22

Primary Squamous cell Laryngeal Cancer
-arise from where?
-risk factors
-appearance
-benign/metastases?

-arise from the mucosal surface of the larynx

-Major risk factors are smoking and alcohol abuse

-early lesions appear initially as white plaques (Leukoplakic)

-metastasizes to regional lymph nodes

23

Describe the stages of swallowing

Oral preparatory phase: CN V, VII, XII. bolus processed by mastication

Pharyngeal phase: CN V, X, XI, XII. bolus advances into esophagus by pharyngeal peristalsis

Esophageal phase: peristaltic contractions in the esophagus propel bolus down. Relaxation of the lower esophageal sphincter allows the bolus to enter the stomach.

24

What are some disorders of the oral preparatory phase?

-inadequate mastication
-xerostomia
-neurologic disorders
-disruption of the oropharyngeal mucosa.

25

Disorders of the pharyngeal phase?

-neuromuscular discordination
-obstruction within the oropharynx
-poor compliance of the upper esophageal sphincter.

26

Oropharyngeal dysphagia
-what are some clues in the hx?
-diagnostic tests

Hx clues:
-sx occur immediately after swallowing
-point to cervical region as to wherre the food "sticks"
-c/o coughing, choking, drooling, changes in speech.

Dx:
-barium studdies
-fiberoptic endoscopic eval of swallowing
-nasopharyngeal larygoscopy
-manometry

27

acute pharyngitis
-MC bacterial cause
-dx
-tx
-response to tx?

MC: Group A Strep

Dx:
-obtain throat and nasopharyngeal specimines
-rapid strep test/throat culture**
-monospot (blood test)
-influenza tests

Tx:
Abx:
-PCN/amoxacillin first line
if allergic cephalosporin or macrolide
*resistant to clindamycin.
**NEVER USE sulfa, FQ, and tetracyclines b/c of high rates of RESISTANCE!!!

Analgesic:
-Acetaminophen, NSAIDS, Aspirin in adults only
-Topical: lozenges, sprays, fluids

Respones:
-within 24hrs of abx infectivity decreases by 80%, should be improved in terms of pain and fever in 48hrs..if not improving need to return to clinic.

28

Tonsillopharyngitis
-causes
-signs and sx
-dx
-tx goals

Causes: Group A Strep or possibly EVB

Signs and Sx:
-more severe sore throat than pharyngitis
-diff swallowing
-fever
-enlarged, red tonsils with exudate
-lymphadenopathy

Dx: same test as for pharyngitis

Tx goals:
-reduce duration and severity of sx
-reduce risk of acute rheumatic fever, glomerularnephritis, pediatric autoimmne neuropsychiatric disorder syndrome
-reduce transmission to close contacts

29

Peritonsillar Abscess
-what is this?
-signs and sx
-PE findings
-dx
-tx

What: infection of the tonsils, complication of tonsillitis. Can present primarily or pt may be under tx for tonsillitis.

Signs and Sx:
-sore throat
-odynophagia
-fever
-trismus
-drooling, voice changes
-ipsilateral ear pain

PE:
-inferior and medial displacement of the tonsil and uvula

Dx:
-needle aspiration diagnostic if purulent material obtained.
-CT scan

Tx:
-I&D by ENT then start on abx (sometimes IV)
-occassionally these pts need tonsillectomy

30

Diptheria
-cause
- spread
-PE finding
-dx
-tx

Cause: Corynbeacterium diphtheriae

Spread: respiratory droplets or cutaneously

PE findings: grayish or white exudates and 1/3 cases pseudomembrane

Dx: culture*, test for toxin
*very hard to culture*

Tx: erythromycin or PCN, antitoxin
**MUST also treat contacts.