Mouth/Throat Disorders

Question 1

You are examining a patient and notice a thickened, white patch underneath the patient’s tongue on one side. You cannot scrape the lesion off. What broad term describes this condition?

Answer 1

Leukoplakia

Question 2

A patient presents with a red, velvety, non-ulcerated growth along the side of his tongue. On examination, you find that the affected area is hardened. How would you describe this lesion?

Answer 2

Erythroplakia

Question 3

A patient presents with a round, smooth, red “patch” on the top of his tongue. He states that it is painless, but is concerned because the spot seems to move around on his tongue periodically. What is the most likely diagnosis?

Answer 3

Geographic tongue

Question 4

A PA student presents with a round, white ulcer on the unattached tissue inside her cheek. There is a red halo around the lesion. She states that she’s had them before, often during finals in undergrad, and that they resolve within a week or so. What is your diagnosis, and what treatment do you recommend?

Answer 4

Apthous ulcer, lysine

Question 5

A patient with a history of heart transplant presents with a sore throat. On examination, you notice creamy white lesions on the soft palate. When you scrape them for culture, the white substance comes off. What is the most likely diagnosis?

Answer 5

Oral candidiasis

Question 6

A pediatric patient presents with severe sore throat, high fever, and painful swallowing. Upon entering the exam room, you find the patient sitting upright, leaning forward, and drooling. He appears quite anxious. The patient is the child of migrant farm workers and does not receive routine medical care. You have a high index of suspicion for what condition?

Answer 6

Epiglottitis

Question 7

A patient with poor dental health presents with fever, dysphagia and trismus. On exam, you note swelling under the chin that crosses the midline and that the tongue is displaced upward. What is the likely diagnosis, and what triage priority might you assign this condition (routine, urgent, or emergent)?

Answer 7

Ludwig’s angina, emergent

Question 8

A patient presents with sore throat, dysphagia, fever, and cervical lymphadenopathy. On exam, you find the oropharynx edematous and erythematous with exudate. What is the probable diagnosis?

Answer 8

Strep pharyngitis

Question 9

What two tests might you use to confirm a diagnosis of strep pharyngitis?

Answer 9

Rapid strep test, throat culture

Question 10

What is the most common etiology of strep pharyngitis?

Answer 10

Group A beta hemolytic streptococcus

Question 11

A patient being treated for strep pharyngitis develops a rash on the trunk and palms and soles of the feet. You suspect which complication has developed?

Answer 11

Scarlet fever

Question 12

An 18 year-old female patient presents with sore throat, dysphagia, trismus, fever, and a “hot potato” voice. On exam, you find that the uvula is laterally displaced. What is the most likely diagnosis?

Answer 12

Peritonsillar abscess

Question 13

A patient presents with what he calls “chapped” skin in the corners of his mouth. What is the most likely diagnosis, and what is the etiology of this disorder?

Answer 13

Angular chelitis, fungal

Question 14

A patient presents with cough and hoarse voice. Oropharyngeal exam is unremarkable. What is the most likely diagnosis?

Answer 14

Laryngitis

Question 15

A pediatric patient presents with ulcerative lesions in the mouth, along with blisters to the hands and feet. He has also had diarrhea. What is the most likely diagnosis, and what is its etiology?

Answer 15

Hand, foot, and mouth disease, coxsackie virus

Question 16

A patient presents with white, lacy patches on the underside of his tongue. What is the most likely diagnosis?

Answer 16

Oral lichen planus

Question 17

A patient presents with unilateral vesicular lesions on the border of the lip. What is the most likely diagnosis?

Answer 17

Oral herpes simplex

Question 18

A patient with a history of anorexia presents with fever and swelling of the left parotid gland. On exam, you find that pus is excreted through the parotid duct when pressure is placed on the gland. What disorder do you suspect?

Answer 18

Sialadenitis

Question 19

A patient with poor dental hygiene presents with fever of unknown origin. On examination, you notice a foul smell in the mouth, swollen gums, and a “chopped off” appearance to the papillae between the teeth. What disease do you suspect?

Answer 19

Acute necrotizing ulcerative gingivitis

Question 20

What term describes salivary gland swelling that is, among other things, a key feature in mumps infection?

Answer 20

Parotitis

Question 21

A patient presents with sore throat and dysphagia. On exam, you note that the tonsils are red and inflamed, but the rest of the oropharynx appears normal. What is the most likely diagnosis?

Answer 21

Tonsillitis

Question 22

Most cases of laryngitis are ______ (viral/bacterial) and ______ (do/don’t) require antibiotic treatment.

Answer 22

Viral, don’t

Question 23

What is your most immediate concern for a patient with suspected epiglottitis?

Answer 23

Airway compromise

Question 24

What is probably the most significant risk factor for developing oral candidiasis?

Answer 24

Immunocompromise

Question 25

Erythroplakia almost always portends what ominous diagnosis?

Answer 25

Squamous cell carcinoma

Question 26

A patient had a molar removed and later developed a white, hardened spot from contact with the tooth above. What word would you use to describe this condition?

Answer 26

Hyperkeratosis

Question 27

The rapid strep test has a ______ (high/low) false negative rate.

Answer 27

High