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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