Material for exam 1 (Larynx and Pharynx)
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| 3 divisions of pharynx | Nasopharynx
Oropharynx
Laryngopharynx
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| Definition of larynx | "voicebox"
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| Larynx functions | Airway
Voice production
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| Nasopharynx | Upper pharynx
Extends from choanae to inferior soft palate
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| Oropharynx | Middle pharynx
Directly behind oral cavity
Visible pharynx
Extends from inferior soft palate to lingual surface of epiglottis
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| Laryngopharynx | Hypopharynx
Lower pharynx
Located behind larynx and below aperture of larynx
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| Nerves associated with (facial) aspects of ENT | Trigeminal (V)
Facial (VII)
Auditory (VIII)
Glossopharyngeal (IX)
Vagus (X)
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| Salivary glands | Parotid
Submandibular
Sublingual
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| Duct of parotid gland | Stensen
Located across from 2nd molar
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| Duct of submandibular | Wharton
Located near base of tongue
Primary involvement in sialolithiasis
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| Examples of oral and throat disorders | Parotitis
Sialadenitis
Nerve complications (Bell's, Trigeminal neuralgia)
Pharyngitis/Laryngitis
Epiglottitis
Peritonsillar abscess
Tonsillitis
Tongue diseases
Dental
Cancers
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| Parotitis | Inflammation of the parotid gland
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| Causes of parotitis | Viruses
Bacterial: Staph. aureus
Mumps (children)
Sjogren syndrome (adult females)
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| Complications of parotitis | Deafness
Orchitis
Encephalitis
Pancreatitis (self-resolution)
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| Labs to test for parotitis | IgM serum test
CBC: mild leukopenia
BMP: elevated BUN/SCr
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| Parotitis dx | Clinically
May check labs
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| Sialadenitis | Inflammation of parotid or submandibular gland
(Mumps is one form)
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| Primary gland involved in sialolithiasis | Submandibular gland
Wharton's ducts
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| Causes of sialadenitis | Bacterial infection: Staph. aureus
Ductal obstruction (ex, stones in submandibular)
Autoimmune diseases
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| Primary symptom of sialadenitis | Pain with eating
Pain with salivation
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| Sialadenitis dx | CBC (if fever, should be checking WBC count)
CT scan
Ultrasound
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| Sialadenitis tx | IV abx: nafcillin
I/D
Lemon drops
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| Appearance of stones in Stensen ducts | radiopaque
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| Suppurative sialadenitis | Glands cease to work (may be due to severe dehydration)
Medical Emergency!
Critical care
IV abx
Hydration
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| Sialolithiasis stone composition | K
Mg
Ca
(Similar to kidney stones)
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| Sjogren syndrome | Autoimmune disease
Systemic
Affects females, particularly older
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| Symptoms and complications of Sjogren syndrome | Xerostomia: "cotton mouth"
Dry eyes
Keratoconjunctivitis
Dysphagia
Hard to speak for long periods
Changes in taste
Oral complications (increase in dental caries, infections, and acidity; dentures problems)
(Can present w/other autoimmune diseases)
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| Sjogren syndrome dx | Labs: elevated rheumatoid factor/ANA
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| Sjogren syndrome tx | Eye drops (Restasis)
Hydration
Refer to rheumatologist
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| Bell's palsy | Facial paresis (paralysis)
Usually idiopathic
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| Nerve affected by Bell's palsy | Facial nerve (CN VII)
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| Symptoms and complications of Bell's | Unilateral symptoms
Eyebrow sagging
Inability to close affected eye
Mouth is drawn to unaffected side
Affects sense of taste
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| Onset of symptoms w/Bell's | Can present quickly
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| Differential dx of Bell's | Stroke
Autoimmune diseases
Tumors
Ramsay Hunt
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| Bell's tx | Benign
Resolves spontaneously
No tx needed
Steroids may be given
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| Who does Bell's affect? | Usually women
Pregnant
Diabetic
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| Prognosis of Bell's | Good
Usually resolves spontaneously
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| Bell's dx and assessment | Have patient:
Raise eyebrows
Wrinkle forehead
(Stroke patients will be able to do both actions)
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| Ramsay Hunt (RH) | Complication of herpes zoster
Sudden onset
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| Nerves affected by RH | CN V: Trigeminal
CN VIII: Auditory
CN IX: Glossopharyngeal
CN X: Vagus
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| Symptoms of RH | Tinnitus
Otalgia
Loss of taste
Vesicles in ear
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| Prognosis of RH | Total recovery not as good as Bell's
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| RH tx | Acyclovir (antiviral)
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| Trigeminal neuralgia | Sudden episodes of lacinating facial pain
"Tic deulereux"
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| Who is affected by trigeminal neuralgia? | Middle age
Older patients
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| Differential dx for trigeminal neuralgia | In younger individuals: think MS
(Check FH for MS, also living in/from midwest)
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| Epiglottitis | Medical Emergency!
Inflammation of epiglottis
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| Who is seen with epiglottitis? | Mostly children
May be some adults
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| Symptoms and complications of epiglottitis | Potential for airway obstruction!
Respiratory distress
Drooling
Stridor
"Tripod posture"
Anxiety
Sudden sore throat
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| Vaccine for epiglottiitis | Hib
2, 4, 6, and 12 months old
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| Causes of epiglottitis | Hib (children)
Bacterial or viral (adults)
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| How should an exam for epiglottitis be performed? | With the patient in an upright position
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| Tests for epiglottitiis | Lateral radiograph of neck
"Thumb sign"
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| Epiglottitis tx | 3rd gen cephalosporins
Ceftriaxone
Vancomycin/Clindamycin
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| Laryngitis | Hoarseness
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| Causes of laryngitis | URI
Usually viral
M. catarrhalis
H. flu
Cancer (smokers)
GERD
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| What is important to remember with laryngitis? | Patient's hx
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| Symptoms of laryngitis | May be flu-like symptoms
Hoarse voice
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| Laryngitis tx | Usually supportive
Rest
Avoid rigorous or excessive use of voice
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| Peritonsillar abscess | Infection of tonsils
Most common deep neck infx of children (and ~smokers)
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| Causes of peritonsillar abscess | Staph.
Strep. (pyogenes)
MRSA
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| Symptoms of peritonsillar abscess | Severe sore throat
"Hot potato voice"
Trismus
Odynophagia
Deviation of soft palate
White spots
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| Peritonsillar abscess tx | Penicillin
Penicillin-based abx
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| Indications for tonsillectomy | Airway obstruction (sleep apnea, daytime fatigue, loud snoring, etc.)
Recurrent/chronic Strep. pyogenes tonsillitis
Recurrent peritonsillar abscess
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| Is tonsillectomy an inpatient or outpatient surgery? | Outpatient, if followed up w/in 6 hours of surgery
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| Who should perform a needle aspiration? | The physician
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Created by:
Carrie D.
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