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Session 3 CM- ENT-2

CM- ENT-2- Disorders nose, sinuses, larynx and trachea

QuestionAnswer
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: Max Smith Max Smith on 2010-04-23



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