Upper Airway Obstruction, Sore Throat and Dysphagia Flashcards by Marianne Gwyneth Monsalud

Most important innervations for pharynx

CN IX - glossopharyngeal nerve
CN X - vagus nerve

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Causes of acute sore throat

Infections
Foreign body
Postnasal drip
LPR

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Causes of chronic sore throat

Cancer
Allergies
Environmental irritants
Autoimmune diseases

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T/F: Group b hemolytic streptococci can cause throat infections

F
only Groups A, C, G, and F

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T/F: Sore throat can occur at _____ phase and about ____ week after

acute phase
1 week after

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Herpangina is mostly due to enteroviruses such as _______ and ____________

Coxsackieviruses
Echoviruses

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This is the most common ulcerative oropharyngeal conditions affecting 60-90% of the population

Herpes Simplex 1 (Cold Sores)

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The presentation of this throat infection are tiny fluid-filled blisters on lips/oral mucosa that are grouped in clusters

Herpes Simplex 1 (Cold Sores)

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T/F: Diagnosis of Herpes Simplex 1 (Cold Sores) is only based on clinical picture

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This throat infection occurs when you have a recrudescent viral infection

Diagnostic method of this infection:

Recurrent Herpes Simplex 1

Biopsy, viral studies

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Most common clinical presentation of Recurrent Herpes Simplex 1

Herpes Labialis

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T/F: if immunocompetent systemic antivirals against Recurrent Herpes Simplex 1 are necessary

F
NOT NECESSARY

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This throat infection has white or yellow center surrounded by erythema

This disease naturally heals within:

Aphthous ulcer

1-3 weeks

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T/F: Human Herpesvirus Lesions: Non-keratinized tissue:: Recurrent Aphthous Stomatitis:keratinized tissue

F
Herpesvirus - keratinized tissue
Aphthous - nonkeratinized tissue

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This throat infection has bilateral exudative tonsilitis, non-specific malaise, low grade fever, and cervical lymphadenopathy

Infectious mononucleosis

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Usual causative agent of infectious mononucleosis

T/F: Acute bacterial tonsillitis mimics presentation of infectious mononucleosis

Result of infectious mononucleosis on CBC and serologic testing

Epstein-Barr virus
T
CBC: atypical lymphocytosis
Serologic testing: (+) heterophile antibodies

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T/F: Infectious mononucleosis can cause complications like myocarditis, CNS involvement, and hemolytic anemia

T/F: Corticosteroids cannot be used as treatment for infectious mononucleosis

T
F- corticosteroids can be used to reduce pain and airway complications

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Clinical presentation of Candidasis:

Diagnostic modalities for Candidasis

Burning sensation, dysgeusia, sensitivity, generalized discomfort, odynophagia

KOH smear or methenamine silver; Sabouraud dextrose agar medium culture

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T/F: Leukoplakia can be a differential for Candidiasis, wherein the former has a more diffused lesions while the latter has a more localized pattern

F
Leukoplakia can be a differential, but it has MORE LOCALIZED lesions, while candidiasis has a MORE WIDESPREAD pattern

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T/F: Inhalational or topical steroid use can be a risk factor for oropharyngeal candidiasis

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(Acute/chronic) candidiasis has a clinical form of pseudomembranous (thrush) and could be erythematous/atrophic

Acute candidasis

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(Acute/chronic) candidiasis is hyperplastic (leukoplakia)

Chronic

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Most important differential diagnosis of GABHS

Viral Pharyngitis

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T/F GABHS occurs in <3yo while viral pharyngitis occurs in >3 yo

T/F: Systemic findings are severe in GABHS while

T/F: Conjunctivitis, colds, cough is present on GABHS while absent on viral pharyngitis

T/F: Erythema, sore throat, difficulty swallowing, exudates, and petechiae are severe on GABHS while mild or absent in viral pharyngitis

T/F: There is hoarseness on both GABHS and Viral pharygngitis

F - GABHS occurs in >3yo while viral pharyngitis occurs in <3 yo

F - 3Cs are present on viral pharyngitis, absent on GABHS

F- Absent in GABHS, present in viral pharyngitis

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Walsh Score for GABHS diagnosis considers the presence of the ff s/sx:

Enlarged tender cervical lymph nodes Pharyngeal exudates recent exposure to GABHS recent cough Oral temperature greater than 38.3C (CECE 38)

3 or 4 of the ff symptoms in Centor Score indicate positive predictive value for GABHS Diagnosis

Fever (hx) Anterior cervical lymphadenopathy Cough (absent) Tonsillar Exudates

Gold standard in the diagnosis of GABHS

Culture in blood agar dish with goat blood at 5%

1st line of pharmacologic management for GABHS

Oral amoxicillin or penicillin for 10 days

Drug taken for GABHS management if with penicillin allergy

Erythromycin for 10 days Azithromycin for 5 days (not first-line)

T/F: Although not the first line, Sulfonamides and tetracyclines are recommended as GABHS treatment

F they are NOT recommended due to failure of eradication

Reason why azithromycin is not a first line drug

S pyogenes develops resistance to azithromycin

Absolute indications for surgical management of GABHS

Obstructive Sleep apnea and malignancy

This throat infection has "quincy", or a collection of pus in the potential space between superior constrictor muscles and fibrous capsule of tonsil. This causes bulging in the (anterior/posterior) soft palate that pushes the tonsil (inwards/outwards)

Peritonsillar Abscess Anterior, Outwards

Triad of symptoms of peritonsillar abscess

Sore throat Odynophagia Fever

This throat infection has a positive thin but tough membrane that covers the oropharynx until the tracheobronchial tree, and it can be diagnosed by mirror examination of the pharynx

Diptheria

Tx of diptheria

toxoid, penicillin or erythromycin

Most common locations of foreign body obstruction

Tonsils Base of the tongue Vallecula

T/F: laryngopharyngeal reflux can cause post nasal drip

T/F: Erythema multiform is usually drug-induced Erythema multiforme can be due to infection by:

T Recurrent human herpesvirus 1

Clinical presentation of erythema multiforme Drugs that can induce erythema multiforme

cutaneous or oral ulcers Carbamazepine Phenytoin Quinolone Sulfonamide

Swallowing involves complex neuromuscular action that involves about ___ muscles and ___ cranial nerves

26 muscles 6 cranial nerves

Phases of swallowing and their mechanism (voluntary/involutnary/programmed)

Oral preparatory - voluntary Oral - voluntary Pharyngeal - programmed Esophageal - involuntary

Phase of swallowing that is not present in neonates and infants

Oral preparatory phase

Major muscles of mastication Main nerves for motor supply

masseter, temporalis, lateral and medial pterygoid CN V, VII, IX

T/F: in the oral transport phase, the soft plate bulges to seal oral cavity

F it's in oral preparatory phase In oral transport, the soft palate RISES to contact posterior pharyngeal wall

These two muscles contract to prevent food trapping in buccal sulcus in oral transport phase

Buccinator and labial muscles

In the pharyngeal phase: the epiglottis and aryepiglottic folds ____ The false and true vocal cords ____

epiglottis and aryepiglottic folds flaps down The false and true vocal cords snaps shut

In the pharyngeal phase, this sphincter closes to prevent nasal regurgitation

Velopharyngeal sphincter

In esophageal phase: T/F: upper 1/3 is voluntary and involuntary, while lower 2/3 is involuntary this muscle acts opposite to pharyngeal constrictors

T Cricopharyngeus muscle

T/F: Neuromuscular disorders initially present with liquid aspirations

Symptoms occurring in the initial 3-4 seconds after initiation of swallowing indicates pathology within:

oral cavity, pharynx, hypopharynx

Symptoms occurring in > 4 seconds after initiation of swallowing indicates pathology within:

esophagus

T/F: Complete otolaryngology exam is done in PE for dysphagia as chief complaint

What do you assess for checking CN involvement for patients with dysphagia?

Palate and lateral pharyngeal constrictors in response to a stimulated gag

In PE for patients with dysphagia, laryngeal excursion present during swallowing indicates:

normal condition

Phases of esophagogram

Full column Air Contrast Mucosal Relief

This phase of esophagogram evaluates esophageal peristalsis and maximally dilate esophagus to identify contour abnormalities

Full column (single contrast)

This phase of esophagogram is for evaluation of SMALL plaque-like mucosal tumors and mucosal irregularities seen in patients with ESOPHAGITIS This uses two contrasts:

Air contrast (double contrast) Effervescent agent -> barium

This phase of esophagogram makes use of thick barium without air distention, and is best for esophageal varices and some mucosal lesions

Mucosal Relief

What are the functions of modified barium swallow?

Evaluates coordination of swallow reflex with breathing determines the cause and evaluate severity of trachal aspiration

This is a protective maneuver to perform if tracheal aspirations or laryngeal penetrations occur in the natural head position

chin-tuck maneuver

This test is best for identifying pharyngeal phase dysphagia and aspiration

Flexible Endoscopic Evaluation of Swallowing with Sensory Testing

T/F: Flexible Endoscopic Evaluation of Swallowing with Sensory Testing can be used for patients with cerebral palsy, stroke, neurologic disorders, or those who have gone surgery/radiotherapy in the head and neck If true, why?

T It is used to recommend when to start feeding and what bolus consistency will be best used to mitigate aspiration

What kind of dysphagia if there is difficulty in initiating a swallow?

Oropharyngeal dysphagia

What kind of dysphagia if there the patient can swallow but the food seems to stick after swallowing?

Esophageal dysphagia

Disorder in esophageal dysphagia for solids only

Mechanical Obstruction

Disorder in esophageal dysphagia for both solids and liquids

Motility Disorder

T/F: esophageal dysphagia is associated with immediate cough, gag, and nasal regurgitation

F Oropharyngeal dysphagia

This condition involves rapidly spreading cellulitis of the submandibular, sublingual, and submental spaces, wherein the floor of the mouth is elevated pushing the tongue upwards, causing airway obstruction What is its antecedent history?

Ludwig's Angina Tooth extraction or dental infection

This disease is manifests through dysphagia for solids and liquids, regurgitation, and subsequent chest pain

Achalasia

Most common symptom and characteristic of upper airway obstruction

Stridor

What is likely the condition if the stridor was heard after feeding?

GERD

What is the condition if the stridor improves in the prone position for infant

Laryngomalacia

T/F: Epiglottitis is usually mixed bony and membranous What are the bilateral and Unilateral presentations of choanal atresia? Diagnostic modalities Management?

F - choanal atresia is usually bony and membranous Unilateral- esophageal spasm Bilateral - respiratory distress Endoscopy, CT Scan (to determine how much to widen within the area) Surgical due to combination of bony and membranous; dilatation if membranous only although difficult

What do you need to watch out for in Ludwig's Angina?

Swelling of the floor of the mouth

Epiglottitis used to be primarily due to _____ but with the advent of vaccines, _______ are now the most common causes Symptoms of epiglottitis? T/F: Soft Tissue lateral X ray is used to diagnose epiglottitis

H. influenzae; Group A and B hemolytic strep Symptoms: sudden onset and rapidly progressive high fever, drooling, painful swallowing; usually the patient is leaning forward T - to detect swelling of epiglottis

This disease causes inspiratory stridor and noisy respiration soon at birth, especially on supine position, which must resolve by 18 months What is the anatomic finding of this disease? Diagnostic modality? T/F: This disease can be managed surgically

Laryngomalacia Floppy omega shaped epiglottis Shortened aryepiglottic folds, redundant mucosa and arytenoids Awake Flexible Endoscopy T

Vocal cord paralysis can be congenital or acquired through: T/F: its symptoms depend if bilateral/unilateral and position of paralysis Diagnostic modality used: T/F: Unilateral paralysis must be urgently treated

Traumatic intubation T Flexible endoscopy F - unilateral may not need treatment

Most common area of glottic web: Presenting symptoms: Diagnostic modality used: Tx:

Anterior 2/3 Weak or hoarse voice and cough Flexible endoscopy Surgical

This disease is usually associated with genital warts in mother, and is usually among first born children. T/F: Symptoms include hoarseness in the first 5 years of life and Squamous cell carcinoma antigen in adults Diagnostic modality: Management:

Papilloma F- first 2 years of life Endoscopy Excision + adjuvant therapy

This disease is the 2nd most common cancer of the upper aerodigestive tract

Laryngeal Carcinoma (first is SCCA)

Laryngeal Carcinoma symptoms in: Glottic: Supraglottic: Subglottic: Diagnostic modality?

Glottic: Dysphonia Supraglottic: Voice, respiratory, swallowing Subglottic: stridor, dyspnea Endoscopy, CT scan, biopsy

T/F: acute croup is usually due to parainfluenza and influenzae Diagnostic sign: T/F: aerosolized racemic epinephrine is used to manage croup

T Steeple sign T

T/F long term intubation can cause laryngeal carcinoma Clinical features:

F- subglottic stenosis Dyspnea on exertion, biphasic stridor, wheezing

T/F: Rigid bronchoscopy is both diagnostic and therapeutic for conditions with foreign body

There is widened, half circle cartilages, forward ballooning of the posterior membranous wall, and forward bulging posterior wall in endoscopy on this condition This condition is best visualized/done in ______

Tracheomalacia Bronchoscopy

Upper Airway Obstruction, Sore Throat and Dysphagia Flashcards

(87 cards)