Last updated on 21 Jan 2016 at 4:01 PM (ORL04)

Upper airway disease
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