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Upper airway disease

Clinical Discipline(s)/Organ System(s)
Emergency Medicine, Otorhinolaryngology, General Practice, Ethics
Progress Test Topic(s)
Seriously ill patient
Description
A 65 year old Chinese man is seen by a GP on a house call. His breathing has become more difficult over time. Now he is making a harsh noise when he breathes in.
Applied Science for Medicine 
   - Anatomy of mouth, nasopharynx, pharynx and larnrynx airway
   - Physiology of breathing, speech, swallowing
   - Physiology of acute airway obstruction; intra- vs extra-thoracic, focal vs diffuse airflow obstruction
   - Mechanism, physiology and diagnosis of stridor
   - Pathology of upper respiratory tract malignancy; role of viral infection
   - Pathology of tonsillitis and deep neck space infection
   - Microbiology of streptococcus pharyngitis
   - Pharmacology of glucocorticoids, penicillins, penicillins with special properties, clavulanic acid, aminoglycosides, nystatin
Clinical and Communication Skills 
   - Elicit a history form a patient with upper airway disease
   - Examine the upper airway and recognise airway compromise
   - Perform basic airway management
   - Differential diagnosis of upper airway obstruction; causes of stridor, hoarseness, ear pain
   - Indications for CT chest, broncoscopy, laryngeal biopsy, upper airway endoscopy
   - Interpret pulmonary function tests, chest X-ray, C-reactive protein (CRP), full blood count, coagulation screen, C1 esterase levels
   - Complications of streptococcal pharyngitis
   - Management of compromised airway; indications (and contraindications) for intubation
   - Role of the anaesthetist/intensivist , otorhinolaryngology (ORL) surgeons, respiratory physician in management of a compromised airway
   - Management of anaphylaxis, tonsillitis
   - Outline management for laryngeal and other upper airway malignancy, inhalation injury
Personal and Professional Skills 
   - Practise self-care by keeping vaccinations up to date
   - Effectively communicate and empathise with a patient who has difficulty speaking and laryngeal malignancy
   - Explore the ethics of consent and 'best interests' principle
   - Self-care: coping under pressure and the ability to reflect in action
Hauora Māori 
   - Awareness of differing risk profiles for Māori compared with non-Māori, for different types of upper airways disease
   - Consideration of access to cultural/spiritual support for patient and whānau
   - Appropriate engagement and consultation with whānau
Population Health 
   - Health and safety in the home
   - New Zealand immunisation programme
   - Social determinants of disease
   - Epidemiology of upper respiratory tract malignancy
   - Epidemiology of tonsillitis in adults
Conditions to be considered relating to this scenario
Common
tonsillitis, laryngitis, inhaled foreign body, paratonsillar abscess
Less common but 'important not to miss'
laryngeal squamous cell carcinoma, anaphylaxis, deep neck space infection, inhalation injury, facial trauma
Uncommon
recurrent laryngeal nerve palsy, epiglottitis/supraglottitis, angioedema