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Session 3 CM- ENT-2
CM- ENT-2- Disorders nose, sinuses, larynx and trachea
| Question | Answer |
|---|---|
| Why don't you want to miss a septal hematoma | if you don't remove the clot destruction of the cartilage can occur because it cuts off blood flow to the septum. |
| pt is a heavy cocaine snorter what finding may you find on nasal exam | perforation of the nasal septum |
| this can arise from trauma or congenital deformities with a C-shaped deformity that is often only symptomatic if the deformity is in the anterior deviation | deviated septum |
| Where do majority of epistaxis arise from | 90% Kiesselbach's plexus (little's area) |
| What increases your risk of having a posterior nose bleed | HTN and atherosclerosis |
| what is nasal hyperfunction and tissue inflammation called | rhinitis |
| What are the sx of rhinitis | nasal congestion/obstruction (from blood vessel engorgement), Rhinorrhea (hypersecretion of nasal glands), pruritis and or sneezing |
| What is the most common cause of rhinitis | allergic |
| What is rhinitis called when it is secondary to taking medications for rhinorrhea | Rhinitis medicamentosus |
| Pt present with pale blue, swollen nasal mucosa what is the likely cause what other signs would help confirm your diagnosis | allergic rhinitis, if pt has allergic salute, shiners, or gape or puffy eyes all would help confirm your dx |
| If a child presents with new onset of unilateral persistent rhinitis what should be suspected | foreign body until proven otherwise |
| What is the most common cause of infectious rhinitis | viral |
| If you have a long standing viral rhinitis what are some complication that can arise | you can get a bacterial sinus infection if it blocks off the sinus |
| what are the drugs that cause rhinitis medicamentosa | long term daily use of decongestants especially afrin, oxymetazoline, phenylephrine |
| what nasal problem is associated with allergies and cystic fibrosis | nasal polyps |
| What is the most common cause of sinusitis | blockage of sinus outflow initially caused by upper respiratory viruses and then allows bacteria to grow in stagnated sinus- (S. Pneumoniae, H. Flu, S. Aureus, S. Pyogenes or Moraxella catarrhalis |
| what are the s/sx of sinusitis | URI present for 7 or more days and nasal obstruction, congestion or rhinorrhea. Then facial pain, headache and poor response to decongestants |
| do most cases of sinusitis require medical intervention | no most will resolve spontaneously because they are caused by viral infections. You might need to do more if they have a fever over 102, upper teeth pain not of dental origin, severe symptoms, known anatomical blockage |
| If pt has chronic sinusitis that doesn’t respond to antibiotic tx what might be causing the infection (assume there is no drug resistance) | most likely cause is a fungal infection |
| Why are acute invasive fungal sinus infections caused by Rhizopus or Mucor concerning | they are an aggressive invasive disease that can cause tissue necrosis, have a poor prognosis of 50% mortality rate but good news is it generally only infects immunocompromised |
| what is the tx for an acute invasive fungal sinusitis | surgical debridement and amphotericin B |
| Pt complains of a chronic pressure sensation in one of their paranasal sinuses and a foul smell. PE reveals nasal discharge. What is the likely cause of your pts sinus complaint and what test would you order | Mycetoma (fungus Ball) in their sinus- order a CT scan |
| You dx your pt with mycetoma sinusitis what prognosis should you give the pt | excellent prognosis surgical tx generally provides a cure after you remove the debris and open the sinus ostia |
| Stridor occurring several weeks after birth and is the most common congenital anomaly causing AIRWAY obstruction and is due to an immature laryngeal cartilage | laryngomalacia |
| What is the tx for laryngomalacia | most spontaneously resolve by 1 years of age, though may need to do a tracheotomy or laser surgery if no resolution |
| pt is a neonate who has inspiratory noises that sound like nasal congestion but problem has been persistent and there are no nasal secretions. Noise is increased when baby is supine and during crying and agitation what is likely the cause | laryngomalacia |
| this condition may result in tracheal collapse during exhalation and is due to immature tracheal rings | tracheomalacia |
| pt has breath sounds that change with position and improve during sleep, problems are worsened by coughing, crying, feeding or URI, the breathing is high-pitched and has rattling noisy breaths what is likely cause | tracheomalacia |
| What is a common complication of tracheomalacia | bouts of pneumonia |
| What is the tx for tracheomalacia | generally resolves by age 18-24 months but may need CPAP, or tracheostomy |
| This disorder can be congenital or acquired. Acquired often occurs after prolonged intubation with an incorrectly sized trache tube | Subglottic stenosis |
| Where is the stenosis if a child has inspiratory stridor where is it if they have expiratory stridor | remember I over E; Insp = Supraglottic , Exp = subglottic |
| You are monitoring a child with stridor and it sounds like the stridor is not as intense as it was an hour or so ago is the pt fine | could be but decrease in stridor intensity does not = improvement you need to check ABG and be prepared to intubate as it could just mean pt is reaching exhaustion and not breathing as deep |
| What is the most common cause of laryngitis | viral infection of the upper airways; bacteria rarely cause laryngitis. Other causes can be excessive use of the voice, allergic rxn, or inhalation of irritants such as smoke etc. |
| Pt has been complaining of hoarseness that has lasted for several weeks now despite resting their voice what should you be concerned about | generally laryngitis that causes a hoarse voiced will resolve within a week or two because it is caused by a viral infection. Sx lasting over a few weeks may indicate laryngeal cancer pt should be evaluated to rule out cancer |
| what is the tx for laryngitis | rest the voice, drink plenty of fluid and inhaling steam may relieve symptoms. |
| this is a rapidly progressing acute laryngitis often caused by H. Influenza | Acute epiglottitis |
| pt has a hot potato voice, sore throat with dysphagia, when you walk into the room you notice they are sitting upright leaning slightly forward what should you not do during you PE of this pt | don't take a quick look in the mouth with a tongue blade because you can irritate the epiglottis and end up causing a total airway obstruction |
| What sign might you see on lateral neck film with epiglottitis | thumbprinting of epiglottis |
| What is the tx for epiglottitis | ENT consult immediately, blood culture if adult, get oral intubation, direct laryngoscopy, and possible tracheostomy, + broad spectrum antibiotics |
| What is the common name for laryngotracheobronchitis | the croup- infection of lower respiratory passageway |
| What is the most likely cause of croup | parainfluenza |
| What is the characteristic sign on AP neck film in laryngotracheobronchitis | steeple sign |
| what is the tx for croup | hospitalize and observe, humidified oxygen, racemic epinephrine and steroids. Broad spectrum antibiotics, when in doubt intubate |
| Patient presents with croup signs and symptoms but a higher fever what is the likely cause and name of this infection | atypical croup (membranous tracheitis) caused by staph aureus, and strep pneumoniae |
| What is the most typical type of cancer to affect the larynx squamous cell or adenocarcinoma | squamous cell >90% |
| what risk factor increase your chance of developing laryngeal carcinoma | smoking and alcohol |
| of the three areas where laryngeal cancer can develop which is most likely to present earlier w/ hoarseness of voice, resp difficulty, throat pain, otalgia, cough, hemoptysis or dysphagia | glottic presents earlier |
| What is the tx for small laryngeal cancers | radiation 85% cure rate may be combined with surgery depending on stage of disease when dx |
| What are the s/e of radiation therapy for laryngeal cancer | mucositis, xerostomia, dysphagia |
| If you patient has a large aggressive laryngeal cancer what tx may be given to them that would require a stoma and what is a stoma | Total laryngectomy, a stoma is a direct connection to the lungs unlike a tracheostomy which connects to the trachea. The reason for this is you have removed the pharynx completely |
| What procedure can be done to allow patient to still have a voice after a total laryngectomy | tracheoesophageal puncture |
| What is the most common benign neoplasm in the larynx | papilloma from HPV 16 usually transmitted via vertical delivery during child birth from mother to child |
| What problem can voice abuse cause in the larynx | ulcer of larynx nodules or polyps r/o cancer common in professors, teachers, singers |
| Pt has laryngeal trauma with fracture what tx should you consider | tracheostomy if airway is unstable as intubation may obscure the larynx and disrupt the tenuous framework. ENT consult |
| If patient has laryngeal trauma but no fx what tx should you consider | voice rest, humidified oxygen and steroids |
| what is a major contributing factor in 2/3 of patients with voice disorders | GERD and LPR- the acid from the stomach irritates the larynx sx include dysphagia, dysphonia, chronic throat clearing, excessive throat mucous, voice fatigue, globus |
| what is the gold standard test for GERD and LPR | 24 hour double PH probe monitor |
| What problems can be secondary to vocal cord paralysis | may affect phonation, respiration and increase likelihood of food/fluids being aspirated |
Created by:
smaxsmith
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