Upper Airway Diseases

Question 1

main fn of sinuses

Answer 1

filter, humidify, warm inspired air

Question 2

3 cardinal sx of rhinosinusitis

Answer 2

purulent rhinorrhea, facial pain/pressure, nasal obstruction

Question 3

differ acute, subacute, and chronic rhinosinusities

Answer 3

by timeline: acute up to 4 weeks w/ total resolution

subacute- more than 4, but less than 12 weeks w/ resolution

chronic- 12 weeks or more

Question 4

Acute rhinosinusitis causes

Answer 4

mostly viral (rhinovirus, coronavirus, influenza)

more rarely bacterial- dx after 10 days of sx or improvement and then worsening
-strep pneumo and H flu and moraxella catarrhalis most common

Question 5

Tx of ARS

Answer 5

Sx management usually

persistent/severe Sx tx w/ antibiotics

intranasal steroid

saline irrigations

Question 6

2 mechanism of ARS complication

Answer 6

loss of anatomic border or hematologic spread

Question 7

fundamental diff of CRS and ARS

Answer 7

12 weeks or more and considered more of an inflammatory disorder than infectious

Question 8

Dx of CRS

Answer 8

Sx Dx unreliable, CT is gold standard

Question 9

most common predisposing factor to CRS in adults

Answer 9

allergies, usually IgE mediated allergic rhinitis

Question 10

genetic predisposition to CRS

Answer 10

primary ciliar dyskinesia and cystic fibrosis

associated w/ higher rates of surgery

Question 11

describe primary ciliary dyskinesia

Answer 11

auto recessive, disorganized microtubules and absent dynein

chronic bronchitis, bronchiectasis, pneumonia, 50% have situs inversus,

Question 12

3 strategies for CRS Tx

Answer 12

mechanical: saline irrigations

anti inflammatory: antihistamine, oral and topical steroids

antimicrobial: based on culture results, usually S aureus, anaerobes, G-, pseudo aeruginosa

Question 13

2 systemic conditions that involve sinuses

Answer 13

granulomatosis w/ polyangitis (Wegeners)- idiopathic vasculitis in airways and kidneys

sarcoidosis

Question 14

diff b/w allergic and invasive fungal sinusitis

Answer 14

allergic: CRS subset, Tx w/ surgery and post op medical
invasive: ENT emergency, usually immunocompromised, rapid necrosis, usually rhizopus, mucor, aspergillus, Tx w. debridement and IV antifungals

Question 15

which Sx should raise concern for sinonasal tumor?

Answer 15

frequent, unexplained nosebleeds, discharge, sinus pain, unusual Sx like visual changes, tearing, neck nodes, hypoesthesia (numbness)

Question 16

pharyngitis etiologies

Answer 16

mostly viral

less common bacterial: usually group A beta hemolytic strep pyogenes

Question 17

physical exam for bacterial pharyngitis

Answer 17

swollen tonsils w/ exudate, maybe petechiae, bad breath

Question 18

Tx for bacterial pharyngitis

Answer 18

pts are contagious, penicillin first line and can prevent complications like glomerulonephritis and ARF

Question 19

Tx for infectious mono

Answer 19

rest, avoid contact sports

antivirals dont help, antibiotics for secondary bacterial infections

NO ampicillin or amoxicillin

steroids for upper airway obstruction

Question 20

associations w/ peritonsillar abscess

Answer 20

trismus (lockjaw), muffled (hot potato) voice, drooling

Question 21

key Sx of retropharyngeal abscess

Answer 21

neck stiffness, odynophagia (painful swallowing)

Question 22

complications of retropharyngeal abscess

Answer 22

mediastinitis, airway obstruction, IJV thrombosis, sepsis

Question 23

where is danger space

Answer 23

b/w alar fascia and prevertebral fascia

Question 24

Ludwigs angina

Answer 24

inflammation and cellulitis of submandibular space

life threatening, requires tracheotemy typically

Question 25

abduction vs adduction in the larynx

Answer 25

abducted for breathing, adducted for sound production and swallowing

Question 26

when is dysphonia likely other than viral laryngitis

Answer 26

more than 2 weeks and other Sx like otalgia, dysphagia, difficulty breathing

Question 27

causes of hoarseness

Answer 27

neuro injury (think recurrent laryngeal nerve) or alterations of vocal cord lining (GERD and dehydration can do this)

Question 28

most common cause of vocal fold lesions

Answer 28

phonotrauma

Question 29

common benign vocal fold lesions

Answer 29

hemorrhage, polyp, cyst, reinke's edema, granuloma

Question 30

what is the most common benign neoplasm in pediatric larynx? etiology?

Answer 30

recurrent respiratory papillomatosis, from HPV 6 and 11

Question 31

Tx of vocal fold lesions

Answer 31

combo of med Tx, speech therapy, surgery

Question 32

most common cause of unilateral vocal fold paralysis

Answer 32

iatrogenic injury

Question 33

risk factors for laryngeal carcinoma, type of cancer

Answer 33

smoking is main factor, EtOH is synergistic usually sqamous cell carcinoma

Question 34

most common location for laryngeal carcinoma

Answer 34

glottic- in vocal folds

Question 35

Sx of laryngeal carcinoma

Answer 35

most common is hoarseness dysphagia, hemoptysis, throat/ear pain, neck mass*

Question 36

diff b/w early and advanced Tx for laryngeal carcinoma

Answer 36

single modality early and combined modality w/ advanced (surgery followed by radiation)

Question 37

consequences of laryngectomy

Answer 37

cannot speak- require assistance w/ electrolarynx, esophageal speech (burping), tracheoesophageal speech need to be intubated through the tracheal incision, cannot go through the nose/mouth

Question 38

most common cause of upper airway obstruction in kids

Answer 38

adenotonsillar hypertrophy

Question 39

stridor

Answer 39

high pitch breathing from turbulent airflow, more on inspiration but can be expiratory or biphasic

Question 40

stertor

Answer 40

noise from nose, nasopharynx, oropharynx low pitched, snoring

Question 41

wheezing

Answer 41

high pitched, indicates lower airway disease, more commonly at end expiration

Question 42

signs of epiglottitis

Answer 42

thumb sign on saggital xray airway emergency

Question 43

typical bacteria of epiglottitis

Answer 43

h flu type b, strep

Question 44

tx for epiglottitis

Answer 44

secure airway, flexible intubation, tracheotemy avoid agitation

Question 45

characteristics of croup | epi, sx, risk, xray

Answer 45

common, viral, pediatric barking cough, stridor, hoarse, difficulty breathing swelling from inflammation leads to narrow airway steeple sign in frontal xray

Question 46

laryngomalacia

Answer 46

congenital presents less than 2 mos old, floppy cartilage leads to collapse and inspiratory stridor worse w/ feeding or supine

Question 47

laryngotracheal stenosis

Answer 47

narrowing of larynx or trachea SOB, inspiratory stridor, no help w/ inhaler can be progressive, often misdiagnosed as asthma or bronchitis

Question 48

risk of prolonged intubation

Answer 48

airway stenosis