Infections And Diseases Of The Larynx And Nasopharynx Question And Answers

Infections And Diseases Of The Larynx And Nasopharynx Important Notes

  1. Arteries supplying tonsils
    • Anterior tonsillar
    • Posterior tonsillar
    • Ascending pharyngeal
    • Superior tonsillar
    • Inferior tonsillar
  2. Acute tonsillitis
    • It is generalised inflammation of the tonsils
    • Causative organisms
      • Viral
      • Bacterial
    • Acute Tonsillitis Types
      • Acute catarrhal tonsillitis
      • Acute follicular tonsillitis
      • Acute parenchymatous tonsillitis
      • Acute membranous tonsillitis
    • Acute Tonsillitis Clinical features
      • Sore throat
      • Difficulty or painful swallowing
      • Earache
      • Enlai’ged and congested tonsils
      • Cervical lymphadenopathy
  3. Quinsy
    • Collection of pus in peritonsillar space is called quinsy
    • Causative organisms
      • Streptococcus pyogenes
      • Staphylococcus aureus
      • Anaerobes
    • Quinsy Clinical features
      • Severe pain in throat
      • High temperature
      • Dysphagia
      • Dribbling of saliva
      • Trismus
      • Torticollis
      • Bulging of tonsillar, peritonsillar, and palatal region
      • Cervical lymph nodes are tender and enlarged
  4. Ryle’s tube
    • It is one meter long tube made up of red rubber or plastic
    • It has got markings at different levelsInfections And Diseases Of The Larynx And Nasopharynx Ryle's Tube
  5. Obstructive lesions of oesophagus
    • Oesophageal stricture
    • Oesophageal cancer
    • Lower oesophageal ring
    • Dysphagia
    • Scleroderma
    • Achalasia

 

Infections And Diseases Of The Larynx And Nasopharynx Long Essays

Question 1. Describe signs, symptoms, and treatment of carcinoma of larynx
Answer:

Carcinoma of Larynx: It is a malignancy involving true vocal cords and anterior and posterior commissures

Carcinoma of Larynx Clinical Features:

  • Carcinoma of Larynx Types
    • Supraglottic
      • Throat pain
      • Dysphagia
      • Referred ear pain
      • Lump in the neck
      • Hoarseness of voice
      • Weight loss
      • Respiratory obstruction
      • Persistent cough
      • Haemoptysis
      • Halitosis

Read And Learn More: General Surgery Question and Answers

    • Glottic
      • Hoarseness of voice
      • Stridor
    • Subglottic
      • Stridor
      • Hoarseness of voice

Carcinoma of Larynx Investigations:

  • Chest X-ray- to rule out lung disease
  • Lateral veiw of the neck- to detect extension of tumor
  • CT scan- to detect
    • Extension of tumour
    • Cartilage invasion
    • Nodal metastasis
  • Direct laryngoscopy
    • For staging of tumour
  • Microlaryngoscopy
  • Biopsy- to confirm diagnosis

Carcinoma of Larynx Treatment:

  • Radiotherapy
    • Indicated in early lesions when the vocal cords are not involved
  • Surgery
    • Done to
      • Preserve voice
      • Prevent permanent tracheostoma
      • Allow adequate resection of tumour
    • Total laryngectomy
      • Structures removed are
        • Entire larynx
        • Hyoid bone
        • Pre-glottic space
        • Strap muscles
        • Tracheal rings
  • Combined therapy

Question 2. Discuss the differential diagnosis of obstructive lesions in the oesophagus
Answer:

Various differential diagnosis of obstructive lesions in the oesophagus are as follows:

  • Oesophageal stricture
    • It is complication of acid reflux
    • Oesophagus Causes
      • GERD
      • Zollinger- Ellison syndrome
      • Trauma from nasogastric tube placement
      • Chronic acid exposure
    • Oesophagus Features
      • Progressive dysphagia
  • Oesophageal Cancer
    • Oesophageal Cancer Clinical features
      • Progressive dysphagia
      • Insidious in onset
      • Retrosternal discomfort
      • Indigestion
      • Weight loss
      • Mild anaemia
      • Hoarseness of voice
    • Oesophageal Cancer Treatment
      • Radiotherapy
      • Surgery
        • Resection
        • Intubation
        • Laser photocoagulation
        • Diathermy
  • Lower oesophageal ring
    • Schatzki’s ring
    • It is an oesophageal web in its lowermost part
    • It contains only mucosa and submucosa
    • Covered by squamous epithelium- above and columnar epithelium- below
    • Appears at the Squamocolumnar junction
    • It is asymptomatic
  • Dysphagia lusoria
    • It is caused by compression of the oesophagus from any congenital vascular abnormality
    • The abnormality may be in
      • Aberrant right subclavian artery
      • Double aortic arch
      • Right aortic arch with left ligament- martyrium
  • Scleroderma
    • It is a collagen vascular disease of unknown etiology
    • Scleroderma Features
      • Induration of skin
      • Fibrous replacement of the smooth muscle of internal organs
      • Dysphagia
      • Severe heartburn
    • Scleroderma Treatment
    • Treat gastro-oesophageal reflux disorder
    • Use of H2 inhibitors like cimetidine or ranitidine
  • Achalasia
    • In it peristalsis is absent
    • Lower oesophageal sphincter fails to relax during swallowing
    • Achalasia Features
      • Dysphagia
      • Regurgitation
      • Weight loss
    • Achalasia Treatment
      • Use of calcium channel antagonist
      • Mechanical dilatation
      • Oesophago cardiomyotomy

Question 3. Mention the indications for tracheostomy. Describe the steps of the operation
Answer:

Tracheostomy: It is a procedure of making an opening in anterior wall of trachea and converting it into a stoma on skin surface

Tracheostomy Indications:

  • To bypass obstructions
    • Infections
    • Trauma to larynx
    • Tumour
    • Foreign body
    • Laryngeal edema
    • Congenital anomaly
    • Supraglottic or glottic pathologic condition
  • Retained secretions
    • Comatose patient
    • Respiratory muscle paralysis
    • Painful cough
    • Aspiration of pharyngeal secretions
  • Respiratory insufficiency
    • Emphysema
    • Chronic bronchitis
  • Facial fractures
  • To provide a long-term route for mechanical ventilation
  • Prophylactic
  • Severe sleep apnoea

Tracheostomy Steps:

  • Position the unconscious patient in a supine position with the neck extended
  • Vertical skin incision is given n Veins are ligated n Muscles are separated
  • Subcutaneous fat is removed with electrocautery to aid in exposure
  • Thyroid gland is retracted upwards n Trachea is exposed
  • 4% xylocaine is infiltrated into the trachea
  • Suction secretions and blood out of the lumen
  • n Place appropriate size tracheostomy tube with an inflated cuff
  • Secure it to the skin with 4-0 permanent sutures
  • Attach a tracheostomy collar
  • Place a sponge soaked in iodine between the skin and the flange for 24 hours

Question 4. Discuss the types, postoperative management, and complication of tracheostomy.
Answer:

Tracheostomy Types:

  • Emergency
  • Elective
  • Permanent

Tracheostomy Postoperative Management:

  • The site should be kept clean and dry to minimize infection
  • Monitor
    • Bleeding
    • Breathing difficulty
    • Displacement of tube
    • Subcutaneous emphysema
  • Irrigate with normal saline regularly
  • Suctioning done regularly in every Vi hour
  • Use of humified oxygen
  • Use of mucolytic agents
  • Deflate cuff every hour for 5 minutes

Tracheostomy Complications:

  • Immediate complications
    • Bleeding
    • Apnoea
    • Pneumothorax
    • Injury to adjacent structures- recurrent laryngeal nerve, vessels, and oesophagus
    • Postobstructive pulmonary edema
    • Endotracheal tube ignition
  • Early complication
    • Bleeding- due to increased blood pressure
    • Plugging of mucus
    • Tracheitis
    • Cellulitis
    • Displacement of tube
    • Subcutaneous emphysema
  • Intermediate complications
    • Secondary infection
    • Blockage of tube
  • Late complications
    • Tracheal stenosis
    • Scar
    • Tracheomalacia
    • Tracheoesophageal fistula
    • Tracheocutaneous fistula
    • Granulation

Infections And Diseases Of The Larynx And Nasopharynx Short Essays

Question 1. Retropharyngeal abscess
(or)
Chronic retropharyngeal abscess
Answer:

Retropharyngeal Abscess: Collection of pus in retropharyngeal space is called a retropharyngeal abscess

Retropharyngeal Abscess Types:

Infections And Diseases Of The Larynx And Nasopharynx Retropharyngeal Abscess Types

Question 2. Peritonsillar abscess
(or)
Quinsy
Answer:

Peritonsillar abscess

Collection of pus in peritonsillar space is called quinsy

Peritonsillar abscess Etiology:

  • Acute tonsilitis
  • De novo
  • Causative organisms
    • Streptococcus pyogens
    • Staphylococcus aureus
    • Anaerobic organisms

Peritonsillar abscess Clinical Features:

  • High-grade fever with chills
  • Malaise
  • Headache
  • Neck pain
  • Throat pain
  • Dysphagia
  • Change in voice
  • Oralgia
  • Odynophagia
  • Nausea
  • Constipation
  • Trismus
  • Halitosis
  • Ipsilateral earache

Peritonsillar abscess Treatment:

  • Conservative
    • 4 fluids
    • Systemic antibiotics
    • Analgesics
    • Antipyretics
  • Surgical treatment
    • Needle aspiration- to drain the abscess
    • Incision and drainage for larger abscess
    • Tonsillectomy

Peritonsillar abscess Complications:

  • Parapharyngeal abscess
  • Laryngeal oedema
  • Septicaemia
  • Endocarditis
  • Lung abscess
  • Nephritis
  • Brain abscess
  • Jugular vein thrombosis

Question 3. Acute tonsilitis
Answer:

Acute tonsilitis

It is inflammation of tonsil

Acute tonsilitis Types:

  • Acute catarrhal tonsillitis
    • Seen in viral infections
  • Acute follicular tonsilitis
    • Crypts are filled with purulent material
  • Acute parenchymal tonsilitis
    • Tonsils are inflamed and enlarged
  • Acute membranous tonsilitis
    • Exudates from crypts forms a membrane over the surface

Acute tonsilitis Etiology:

  • Hemolytic streptococci
  • Staphylococci
  • Pneumococci

Acute tonsilitis Clinical Features:

  • Sore throat
  • Dysphagia
  • Fever
  • Earache
  • Headache
  • Abdominal pain
  • Body ache
  • Malaise
  • Foetid breath
  • Coated tongue

Acute tonsilitis Treatment

  • Bed rest
  • Increased fluid intake
  • Analgesics
  • Antibiotics

 

Infections And Diseases Of The Larynx And Nasopharynx Short Answers

Question 1. Quinsy
(or)
Peritonsillar abscess
Answer:

Quinsy

Collection of pus in peritonsillar space is called quinsy

Peritonsillar abscess Etiology:

  • Acute tonsilitis
  • De novo
  • Causative organisms
    • Streptococcus pyogens
    • Staphylococcus aureus
    • Anaerobic organisms

Peritonsillar abscess Clinical Features:

  • High-grade fever with chills
  • Malaise
  • Headache
  • Neck pain
  • Throat pain
  • Dysphagia
  • Change in voice
  • Oralgia
  • Odynophagia
  • Nausea
  • Constipation
  • Trismus
  • Halitosis
  • Ipsilateral earache

Question 2. Tracheitis
Answer:

Tracheitis

It is the inflammation of trachea

Tracheitis Causative Organism:

  • Staphylococcus aureus
  • Clinical Features:
  • Fever
  • Stridor
  • Tachypnoea
  • Respiratory distress
  • High WBC count
  • Cough

Tracheitis Treatment:

Systemic antibiotics

Question 3. Pharyngitis
Answer:

Pharyngitis

It is an infection of the pharynx

Pharyngitis Etiology:

  • Infections
  • Allergy
  • Trauma
  • Toxins
  • Neoplasia

Pharyngitis Clinical Features:

  • It can be acute or chronic
  • Enlarged tonsils
  • Difficulty in swallowing and breathing
  • Cough
  • Fever

Question 4. Arterial supply to tonsils
Answer:

Arterial supply to tonsils

Infections And Diseases Of The Larynx And Nasopharynx Arterial Supply To Tonsils

Question 5. Collar stud abscess
Answer:

Arterial supply to tonsils

  • It is an acute suppurative infection of a digit presenting as a stud-like blister
  • It results when a cold abscess which is deep to deep fascia ruptures through the deep fascia and forms another swelling in the subcutaneous plane which is fluctuant

Collar stud abscess Treatment:

  • Simple incision does not resolve the case
  • Nondependent aspiration avoids formation of sinus
  • Systemic antibiotics are preferreds

Question 6. Pharyngocele
Answer:

Pharyngocele

  • Pharyngocele refers to the lateral pharyngeal wall herniation

Pharyngocele Clinical features

  • Dysphagia
  • Lateral cervical mass
  • Valsalva maneuver
  • It is diagnosed by pharyngoesophageal swallow

Question 7. Endotracheal intubation
Answer:

Endotracheal intubation

  • Endotracheal intubation secures the airway by placing a tube into the trachea either via nose, mouth, or tracheostomy
  • This tube has an inflatable cuff
  • Once the tube is placed into the trachea, the cuff is inflated
  • This prevents the aspiration of debris
  • This tube is connected to an anaesthetic machine to allow the delivery of oxygen, nitrous oxide, and inhalation anesthesia
  • A throat pack is used as a supplement to the cuff to prevent aspiration of blood, saliva, and debris

Question 8. Nasogastric intubation
Answer:

Nasogastric intubation

  • Nasogastric intubation refers to insertion of nasogastric tube through the nose into the stomach

Nasogastric intubation Uses:

  • In acute gastric dilatation
  • To aspirate gastric contents in intestinal obstruction
  • To diagnose GI bleeding
  • To provide enteral feeding in comatose patients

Question 9. Acute glottic edema
Answer:

Acute glottic edema

  • Acute glotticedemaia a rare condition when not associated with an infectious disease or other clinical symptoms
  • It is one of the complication of prolonged orotracheal intubation

Acute glottic edema Clinical Features:

  • Hoarseness of voice
  • Cough
  • Short expiration
  • Swelling in the throat

Acute glottic edema Treatment:

  • Application of ice externally
  • Holding small pieces of ice in the back part of mouth and frequently swallowing a small piece
  • Alternate hot and cold application

Question 10. Ryle’s tube
Answer:

Ryle’s tube

  • It is also called nasogastric tube
  • At the end of this tube there are lead shots
  • After introducing within the stomach its position is confirmed by pushing 5-10 ml of air and auscultating in the epigastrium
  • It is a long tube having 3 marks
  • When the tube is passed upto 1st mark it enters stomach
  • Usually it is passed upto 2nd mark

Ryle’s tube Uses:

  • In acute gastric dilatation
  • To aspirate gastric contents in intestinal obstruction
  • To diagnose GI bleeding
  • To provide enteral feeding in comatose patients

Question 11. Signs and symptoms of acute pharyngitis
Answer:

Signs and symptoms of acute pharyngitis

  • Acute pharyngitis is related to sore throat
  • Symptoms are:
    • Sore throat
    • Running nose
    • Sneezing
    • Cough
    • Headache
    • Body aches
    • Muscle pain
    • Fever
    • Malaise
    • Fatigue
    • Nausea
    • Loss of appetite

Question 12. Causes of acute tonsillitis
Answer:

Causes of acute tonsillitis

  • Bacteria causing acute tonsillitis are
    • Haemolytic streptococci
    • Staphylococci
    • Pneumococci

Question 13. Singer’s nodule
Answer:

Singer’s nodule

  • It is vocal cord nodule
  • Results from repetitive overuse or misuse of the voice
  • This causes irritation of vocal cords
  • They are hard, rough, callous-like growth
  • They can small as pinhead size or large as pea
  • Site: midpoint of vocal folds
  • Occasionally associated with abnormal blood vessels
  • Women between 20-50 years of age are more prone to develop

Singer’s Nodule Clinical features

  • Hoarseness of voice
  • Shooting pain in ears
  • Coughing
  • Tiredness

Singer’s Nodule Treatment: Vocal rest

Infections And Diseases Of The Larynx And Nasopharynx Viva Voce

  1. Tonsils drains into jugulodigastric lymph nodes
  2. High tracheostomy can cause tracheal stenosis
  3. Mid-tracheostomy is ideal
  4. Low tracheostomy impinges the suprasternal notch
  5. Tracheostomy is ideal for intermittent positive pressure ventilation

 

 

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