Ent

Front 1

Peritonsillar Abscess Etiology;

Back 1

Usually Group A Hemolytic Streptococcus
also Anaerobic microorganisms (bacteroides)

Front 2

Peritonsillar Abscess S/Sx;

Back 2

Painful (severe) swallowing, febrile & toxic pt, head tilts toward the side of the abscess, marked trismus, tonsil displaced medially, soft palate erythematous & swollen, uvula is edematous & displaced, drooling from inability to swallow, "hot potato" voice.

Front 3

Peritonsillar Abscess tx;

Back 3

Aimed at tx of infection & relief of sx, IV ABX, Decadron (Steriod), surgical drainage, Analgesics, Tonsillectomy.

Front 4

Indications for tonsillectomy;

Back 4

Hx of Peritonsillar Abscess, hx of airway obstruction (sleep apnea) secondary to tonsil hypertrophy, 4-5 episodes of strep pharyngitis in 1yr, chronic sore throat, w/adenopathy for 6 months that is unresponsive to tx.

Front 5

Adenopathy

Back 5

Swelling and morbid change in lymph nodes; glandular disease.

Front 6

Laryngotracheobronchitis (Croup) Definition;

Back 6

Viral infection causes inflammation & narrowing of the subglottic airway causing obstruction of the subglottic airway & the larynx.

Front 7

Laryngotracheobronchitis (Croup) Etiology;

Back 7

Viral inf. & inflammation of the larynx, vocal cords, subglottic part of larynx & nearby structures.
There is inflammation of the vocal cords & trachea w/tracheal & bronchial wall edema, causing narrowing & obstruction to airflow.

Front 8

Laryngotracheobronchitis (Croup)
Where is maximal narrowing?

Back 8

The subglottic region

Front 9

What virus usually causes Laryngotracheobronchitis (Croup)?

Back 9

Para-influenza virus
(also measles, herpes simplex & adenovirus)

Front 10

Laryngotracheobronchitis (Croup) S/Sx;

Back 10

Peaks at 2yrs, barking cough, hoarseness, stridor on inhalation (indicates emergancy),

Front 11

Laryngotracheobronchitis (Croup) Xrays;

Back 11

Seen on AP film of neck as "steeple sign".
A lateral film should be taken to R/O D/Dx w/inspiratory stridor, particularly epiglottis.

Front 12

What does stridor indicate?

Back 12

Blockage to airway.
Airway is blocked at least 70%
Could be forigne body.

Front 13

What labs would you order for suspected Laryngotracheobronchitis (Croup)?

Back 13

CBC - marked leukocytosis, w/increased PMNs.

Front 14

Laryngotracheobronchitis (Croup) D/Dx;

Back 14

Epiglottitis, Congenital subglottic Stenosis, Subglottic hemangioma, airway foreign body, Esophageal foreign body, Epiglottis.

Front 15

What should be the first thing thought of when a pt presents with Subglottic Airway Narrowing?

Back 15

Epiglottitis-25% of epiglottitis pts have subglottic airway narrowing.
(espectially in non-izz child HIB)

Front 16

Laryngotracheobronchitis (Croup) Tx;

Back 16

Relieve obstruction, R/O other causes, Prevention of hypoxia & hypercarbia, Supportive tx. (Decadron 0.6mg/kg to 10m, Nebulizer w/epi.

Front 17

Epiglottitis Definition;

Back 17

Disorder caused by inflammation of the cartilage that covers the trachea.

Front 18

Epiglottitis Etiology;

Back 18

Haemophilus influenzae group b (Hib)

Front 19

Epiglottitis S/Sx;

Back 19

High fever, sore throat, Drooling, tripos position, Beefy red swollen stiff epiglottis that can obstruct breathing, respiratory distress increases rapidly as epiglottis swells, Dysphagia, dysphonia (hot potato voice), distress.

Front 20

What is the biggest worry w/Epiglottitis?

Back 20

Spasm may cause the airway to close abruptly.
Putting anything into the mouth could cause spasm.
Death follows withing minutes of laryngeal spasm.

Front 21

Epiglottitis tx;

Back 21

Equipment for an emergency tracheostomy should be available during exam.

Front 22

Epiglottitis Xray;

Back 22

Thumbprint sign seen on lateral X-ray.
If you think you have time for X-ray.

Front 23

Epiglottitis S/Sx 4 D's;

Back 23

Dysphagia
Dysphonia (hot potato voice)
Drooling
Distress

Front 24

Laryngitis Definition;

Back 24

Inflammation of the larynx.

Front 25

Laryngitis Etiology;

Back 25

Most common cause is viral URI, Bronchitis, Pneumonia, Influenza, Pertussis, Measles, Diphtheria.
Excessive use of voice, Allergic reactions, Inhaling irritating substance (cigarette smoke)

Front 26

Laryngitis S/Sx;

Back 26

Hoarseness (Most prominent sx)
Apnonia, tickling, rawness & urge to clear throat, symptoms vary w/severity of inflammation.
(fever, malaise, dysphagia)

Front 27

Aphonia

Back 27

Loss of voice.

Front 28

Laryngitis Tx;

Back 28

No specific tx for viral Laryngitis.
Tx of acute or chronic bronchitis may relieve laryngitis.

Front 29

What are benign neoplasms?

Back 29

May affect any part of the larynx.
Removal restores the voice, the functional integrity of the laryngeal sphincter, & airway.

Front 30

Benign Neoplasms Etiology;

Back 30

Juvenile papillomas, Hemangiomas, Fibromas, Chaondromas, Myxomas, Neurofibromas.

Front 31

Vocal Cord Paralysis Etiology;

Back 31

Result from; CNS lesions, Intracranial neoplasms, Vascular accidents, Demyelinating dzs, Neoplasms at base of skull, Trauma of the neck, Aortic aneurysm, Mitral stenosis, CA of Thyroid, esophagus, lung or medial structures, Thyroidectomy, Neurotoxins (lead), Neurotoxic inf. (diphtheria), C-spine injury, surger, or viral illness.

Front 32

Vocal Cord Paralysis S/Sx;

Back 32

Loss of vocal cord abduction or adduction. May affect phonation, respiration & deglutition & aspiration of fluids & food into trachea, paralyzed cord (2-3mm lateral to the midline may move w/phonation but not inspiration.

Front 33

deglutition

Back 33

The act of swallowing.

Front 34

Unilateral Vocal Cord Paralysis S/Sx;

Back 34

The airway is usually not obrtructid because the normal cord abducts sufficiently, the voice is hoarse and breathy.

Front 35

Bilateral Vocal Cord Paralysis S/Sx;

Back 35

Airway is inadequate, resulting in stridor & dyspnea w/ moderate exertion.
Both cords lie generally w/in 2-3mm of the midline, & the voice is of limited intensity but of good quality.

Front 36

Vocal Cord Paralysis Management;

Back 36

The cause must always be sought by; Laryngoscopy, Bronchoscopy, Esophagoscopy, Neurologic exam (enhanced CT of the head, neck & chest),Thyroid gland scan & upper GI.

Front 37

Vocal Cord Paralysis Tx;

Back 37

Teflon suspension to bring cords closer together & prevent aspiration, Tracheostomy, Arytenoidectomy (improves airway but may alter voice) Laryngoplasty (external incision in the thyriod cartilage & insertation of material to move the cord medially.