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Didactic Year > Clin med ENT > Flashcards

Clin med ENT Flashcards

1
Q

The inner portion of the ______ is thin, the dermis is in direct contact with the periosteum

A

External auditory canal

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2
Q

What should you always include in your PE of otalgia or otorrhea, aside from head and neck?

A

Heart and lungs

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3
Q

4 causes of cerumen impaction

A
  1. Obstruction due to ear canal disease
  2. Narrowing of the ear canal
  3. Failure of epithelial migration
  4. Overproduction
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4
Q

Cerumen impaction more prevalent in what demographic?

A

Older adults (1 in 3)

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5
Q

How can a reflex cough in cerumen impaction be explained?

A

Vagus stimulation of the area near the TM

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6
Q

Clinical presentation of cerumen impaction (2)

A

Asymptomatic

Hearing loss, otalgia, fullness, itchiness, reflex cough, tinnitus

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7
Q

Frontline treatment for cerumen impaction

A
  1. Cerumenolytic agents (debrox,mineral oil, colace drops)
  2. Irrigation
  3. Manual removal
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8
Q

What is the name of the tool that can be used to remove foreign bodies?

A

Katz-Extractor

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9
Q

Inflammation of the external auditory canal or auricle

A

Otitis externa (swimmers ear)

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10
Q

3 causes of OE

A
  1. Infectious
  2. Allergic
  3. Dermatologic
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11
Q

What is the most common etiology of OE?

A

Bacterial (98%)

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12
Q

What are two pathogens responsible for OE?

A

S. aureus
Pseudomonas

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13
Q

Main clinical features/ distinction of OE

A
  1. FAST onset
  2. Pain
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14
Q

What should you do in your PE to test for OE?

A

Palpation of the tragus and auricle (could indicate OE if painful)

Otoscopic exam

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15
Q

The otoscopic exam for suspected OE is critical to distinguish between OE and

A

OM with perforation

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16
Q

Frontline treatment for OE

A

Topical ABx (active acid,quinolone,sulfamonides,Aminoglycosides)

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17
Q

Second line treatment for OE

A

Topical corticosteroids

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18
Q

3rd line treatment for OE

A

Oral ABx only if severe

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19
Q

2 complications of OE

A

Chronic OE
Malignant OE

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20
Q

Most common pathogen of malignant OE

A

Pseudomonas (95%)

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21
Q

Most common cause of chronic OE?

A

Allergies or inflammatory dermatologic conditions

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22
Q

Chronic OE is OE lasting more than __________ months

A

3

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23
Q

“Severe otalgia and otorrhea (not responsive to topical treatment)”
“Nocturnal pain, extending to TMJ”

A

Malignant OE

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24
Q

What imaging should be done for malignant OE?

A

CT/MRI

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25
Q

Tx for malignant OE

A

IV ABx
Cirpofloxacin (can consider pip-tazo or cefepime)

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26
Q

Most common ear neoplasia type

A

SCC

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27
Q

“Failure of the functional valve of the Eustachian tube to open and/or close properly”

A

Eustachian Tube Dysfunction

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28
Q

Functions of the Eustachian tube (3)

A
  1. Equalize pressure
  2. Protect middle ear from pathogens
    of oropharynx
  3. Clearance of middle ear secretions
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29
Q

What is the most important factor in the pathogenesis of middle ear infections?

A

ETD

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30
Q

The #1 clinical feature of ETD is

A

Recurrent OM

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31
Q

Infection or inflammation of the middle ear marked by the presence of middle ear fluid

A

Acute OM

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32
Q

AOM found overwhelmingly in what population?

A

Pediatrics

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33
Q

Causative pathogens for AOM

A

Strep pneumo
H. influenza

RSV, influenza, rhinoviruses

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34
Q

Clinical features of AOM

A

Otalgia, unilateral, fever may/may not be present, often preceded by URI or exacerbation of allergic rhinitis

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35
Q

Otoscopic findings for AOM

A

Bulging, erythematous TM, or opacified. Purulence if perforated

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36
Q

What can pneumatic otoscopy be used to do?

A

Test for AOM (TM membrane movement limited could indicate inner ear pressure/infection)

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37
Q

Frontline ABx for pediatric AOM?

A

Amoxicillin
Augmentin if failed

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38
Q

Frontline ABx for adult AOM?

A

Augmentin

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39
Q

PCN allergic alternative for AOM

A

Cephalosporin, doxycycline, Azithromycin

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40
Q

Observation criteria for AOM

A
  1. Healthy children
  2. Ages 6-24 months
  3. Unilateral, non severe pain
  4. Age >24 mo with non severe pain, unilateral or bilateral
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41
Q

Otitis media with effusion (OME): infected or not infected

A

Not infected (“Serous OM”)

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42
Q

When to refer OME to ENT

A

If symptoms persist beyond 3 months or anytime there is a language or speech delay/ sig hearing loss

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43
Q

Most common cause of ruptured TM

A

OM

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44
Q

Key clinical distinction of ruptured TM

A

Pain RESOLVES with rupture

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45
Q

Frontline treatment for ruptured TM

A

Oral ABx (amoxicillin or augmentin)

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46
Q

Clinical hallmark of chronic OM

A

Purulent discharge

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47
Q

Most common cause of chronic OM

A

acute OM and ETD

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48
Q

Treatment for chronic OM

A
  1. ENT
  2. surgical repair (TM tubes)
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49
Q

Clinical hallmarks of mastoiditis

A
  1. Post auricular pain
  2. Fever
  3. Otalgia
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50
Q

What causes mastoiditis?

A

Bacteria invading the bone

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51
Q

Frontline Tx for mastoiditis

A

IV ABx directed at S. Pneumo, H. Influenza, S. Pyogenes)

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52
Q

Myringotomy

A

Incision into the tympanic membrane

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53
Q

Highest demographic of having TM tubes

A

Children attending daycare, DD and ASD, craniofacial abnormalities

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54
Q

Why has TM tube placement declined since 2000?

A

Pneumococcal and H. flu vaccines

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55
Q

4 indications of TM tube placement

A
  1. Long term ventilation of the middle ear space
  2. Control conductive hearing loss
  3. Reduce risk of recurrent AOM
  4. Prevent cholesteatoma due to TM retraction
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56
Q

Why are oral ABx not needed with TM tubes?

A

Topicals will work to get to the site of infection through TM opening

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57
Q

“Keratinized mass in the middle ear or mastoid, may occur as a lesion due to ETD or TM perforation”

A

Cholesteatoma

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58
Q

How do cholesteatomas develop?

A

Prolonged exposure to negative middle ear pressure ———inflammation——— Keratinized debris collects

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59
Q

This type of hearing loss results from external or middle ear dysfunction

A

Conductive

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60
Q

This type of hearing loss results from deterioration of the cochlea (inner ear)

A

Sensorineural

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61
Q

What type of hearing loss is most common?

A

Sensorineural

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62
Q

Common causes of conductive hearing loss

A

Infections
Cerumen
TM perforation

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63
Q

Common causes of sensorineural hearing loss

A

Presbycusis (age related)
Meniere disease
Noise exposure

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64
Q

Normal Weber test findings

A

Vibrations heard equally on both sides
No lateralization.

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65
Q

In the Weber test with someone with conductive hearing loss, the sound will lateralize to which side?

A

Defected ear

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66
Q

In the Weber test with someone with sensorineural hearing loss, the sound will lateralize to which side?

A

Normal ear

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67
Q

Rinne test used to test for which type of hearing loss?

A

Conductive

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68
Q

Normal Rinne test findings

A

AC > BC

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69
Q

AC > BC (diminished) Rinne finding indicates

A

Sensorineural hearing loss

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70
Q

Acoustic neuroma, also known as

A

Vestibular schwannoma

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71
Q

Where do vestibular schwannomas commonly arise?

A

Vestibular portion of CN8

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72
Q

Clinical presentation of acoustic neuroma

A

Hearing loss
Tinnitus
Unsteady gait
Vertigo uncommon
Facial numbness/paralysis (compression of CN 5 or CN 7)

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73
Q

Test of choice for acoustic neuroma

A

MRI

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74
Q

Tx for acoustic neuroma

A

Surgical resection
Radiation
Observation

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75
Q

When would observation be the treatment of choice of acoustic neuroma?

A

Elderly population, slow growing

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76
Q

What causes tinnitus? (2)

A
  1. Sensorineural hearing loss with resulting dysfunction within the auditory system
    -Ototoxic meds
    -Presbycusis
    -Otosclerosis
    -acoustic neuroma
  2. Vascular disorders (venous hums)
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77
Q

Gold standard for assessing vascular tinnitus?

A

CTA or MRI

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78
Q

When you plug your nose and bear down, what is happening inside your ear?

A

ET opening, increasing middle ear pressure to match the pressure outside the ear

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79
Q

Etiologies for barotrauma

A

Flying
Blast injury
Diving

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80
Q

Most common clinical features of barotrauma

A

Pain/pressure
Hearing loss
Bleeding into TM
Vertigo/Tinnitus = more emergent

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81
Q

Tx for barotrauma

A

Prevention (oral decongestants, swallowing, ear plugs)
Surgical repair
Emergent ENT referral
ABx - only in TM perf
Analgesia

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82
Q

Auricular hematoma, AKA

A

Cauliflower ear

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83
Q

Tx for auricular hematoma

A

Needle aspiration
I&D
ABx - cover skin pathogens
Follow-up

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84
Q

What size/presentation of auricular hematoma necessitates needle aspiration?

A

<2 cm or present <24 hrs

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85
Q

ABx for auricular hematoma

A

Doxycycline, Bactrim

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86
Q

Medical term that describes the sensation of whirling and loss of balance, associated with looking down from a great height, or caused by disease affecting inner nerve or vestibular nerve

A

Vertigo

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87
Q

Sensation of impending fall or of the need to obtain assistance for proper locomotion

A

Disequilibrium

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88
Q

T/F Vertigo is a diagnosis

A

False, symptom

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89
Q

T/F: Syncope and near syncope are not dizziness or vertigo

A

True

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90
Q

Vertigo is divided into what two causes

A

Peripheral or central

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91
Q

What structure in the inner ear detects angular movement

A

Semicircular canals

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92
Q

What structure of the inner ear detects linear motion

A

Otolith organs

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93
Q

80% of all vertigo is

A

Peripheral

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94
Q

Common etiologies of peripheral vertigo

A

Benign paroxysmal positional vertigo (BPPV)
Vestibular neuritis
Meniere disease

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95
Q

Etiologies of central vertigo

A

Vestibular migraine
Brainstem ischemia (bad)
Cerebellar infarct/hemorrhage (bad)

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96
Q

Nystagmus direction in central vertigo

A

Any direction

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97
Q

Nystagmus direction in peripheral vertigo

A

Horizontal, unilateral

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98
Q

Neurologic signs in peripheral vertigo

A

Absent

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99
Q

Postural instability in central vertigo

A

Severe, falls

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100
Q

Postural instability in peripheral vertigo

A

Mild

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101
Q

Tinnitus, hearing loss in central vertigo

A

Absent

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102
Q

Tinnitus, hearing loss in peripheral vertigo

A

May be present

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103
Q

Pathophysiology of BPPV

A

Canalithiasis causes inappropriate endolymph motion in the semicircular canals, resulting in sensory mismatch and sensation of spinning with head movement

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104
Q

Clinical hallmarks of BPPV

A

Provoked by head movement
Typically no other Neurologic complaints
Hearing loss absent

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105
Q

Dix-hllpike maneuver used to provoke what

A

Nystagmus, indicative of BPPV

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106
Q

Treatment for BPPV

A

Epley maneuver
Meds: antihistamines - Meclisine (Bonine) frontline
Benzodiazepines (caution in elderly)

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107
Q

Vestibular neuritis, AKA

A

Labyrinthitis

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108
Q

Pathophysiology of Labyrinthitis

A

Inflammation of CN 8

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109
Q

Clinical features of Labyrinthitis

A

Rapid onset
Severe vertigo
Associated N/V

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110
Q

PE findings in Labyrinthitis

A

Horizontal, unilateral nystagmus fixed with visual fixation
Positive head thrust test

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111
Q

What is a more severe differential for Labyrinthitis

A

Vascular event affecting cerebellum or brainstem

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112
Q

What factors should move you towards a central cause of vertigo

A
  1. Nystagmus NOT suppressed with visual fixation
  2. Nystagmus can be vertical or change direction
  3. Typically patient cannot walk or stand
  4. Constant symptoms
  5. Consider in patients with other risk factors
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113
Q

Treatment for Labyrinthitis

A

Corticosteroids - prednisone taper after 10 days
Antihistamines - meclisine 25-50 mg q8h or diphenhydramine 25 mg q4-q6h

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114
Q

Meniere disease triad

A

Episodic vertigo, tinnitus, hearing loss

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115
Q

Tx for Meniere disease

A

Chronic condition - receive symptoms

Lifestyle adjustments - diet
Medical management
Vestibular rehab
Interventional tx - ENT

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116
Q

Medical tx for Meniere disease

A

Diuretics
Antiemetics
Anxiolytics
Antihistamines
TCAs
(“Vestibular suppressants”)

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117
Q

Ebselen (gluthione peroxidase mimetic)

A

In phase 3 clinical trial, medication strictly for Meniere disease, 2023 expected

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118
Q

Most common viral etiologies of Pharyngitis

A

Rhinovirus
Coronavirus
Flu
Adenovirus
HSV
Cocksackie virus
EBV
CMV

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119
Q

Most common age group for beta hemolytic strep

A

5-15 yo

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120
Q

What pathogen accounts for 15-20% bacterial pharyngitis

A

S. aureus

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121
Q

Pharyngitis route of spread

A

Droplet exposure

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122
Q

Coryza symptoms (runny nose, scratchy throat) is suggestive of what viral etiology

A

Rhinovirus/coronavirus

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123
Q

Fever, fatigue, “shaggy” exudate, generalized adenopathy, splenomegaly suggestive of what viral etiology

A

EBV/CMV

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124
Q

Fever, myalgias, headache, cough suggestive of what viral etiology

A

Flu

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125
Q

Conjunctivitis suggestive of what viral etiology

A

Adenovirus

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126
Q

Exudate, vesicles & ulcers on palate suggestive of what viral etiology

A

HSV

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127
Q

Vesicles on soft palate/uvula rupture to what ulcers, HFM suggestive of what viral etiology

A

Cocksackie

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128
Q

Yellow-green exudate, dysuria suggestive of what etiology

A

Gonnococcal

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129
Q

Name the four centor criteria

A

Fever
Tonsillar exudate
Tender cervical lymphadenopathy
No URI/cough symptoms

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130
Q

“Other” pharyngitis criteria/findings

A

Scarlatiniform rash, strawberry tongue

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131
Q

Centor criteria is best for negative or positive predictive value

A

Negative (RULE-out disease)

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132
Q

Dx of pharyngitis

A

Rapid antigen test and/or throat culture

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133
Q

What % of children are carriers of strep A

A

20

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134
Q

Tx for viral pharyngitis

A

Supportive care (pain meds, gargling)

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135
Q

Tx for bacterial pharyngitis

A

Penicillin (VK PO or G IM) 1st line
Alternatives:
Amoxicillin, cephalosporin, Clindamycin, Azithromycin

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136
Q

Typical abx treatment course length for bacterial pharyngitis

A

10 days

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137
Q

How many of the centor criteria should be present to justify strep test

A

3-4

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138
Q

Negative predictive value of <3 centor criteria

A

<80%

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139
Q

Positive predictive value of 3-4 centor criteria

A

40-60%

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140
Q

Complications of strep throat

A

Rheumatic fever
Glomerulonephritis
Peritonsillar/retropharyngeal abscess

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141
Q

What is a pediatric complication of strep throat

A

PANDAS

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142
Q

PANDAS

A

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections

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143
Q

Viral illness could take how many days to resolve?

A

10 days

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144
Q

Strep patients are still contagious in the first ______ hours on ABX

A

24

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145
Q

1/3 of mononucleosis cases have

A

Strep

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146
Q

What is the importance of ABX choice with suspected strep

A

Careful of potential for EBV and amoxicillin reaction

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147
Q

Name the tonsillectomy criteria (3 options)

A

7+ episodes of sore throat in last year
OR
at least 5 episodes in each of the previous two years
OR
at least 3 episodes in each of the previous 3 years

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148
Q

“episode” defined as sore throat plus one of the following

A

Temp >100.9
Cervical adenopathy
Tonsillar exudate
Positive group A B hemolytic strep culture

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149
Q

Peritonsillar abscess, AKA

A

quinsy

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150
Q

Trismus, deviation of soft palate/uvula, “hot potato” voice suggestive of

A

Peritonsillar abscess

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151
Q

Work up for peritonsillar abscess

A

Ultrasound, CT, manual exam, labs

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152
Q

Tx for peritonsillar abscess

A

Aspiration and/or I&D
IV amp-sulbactam or clinda
Pain meds
Steroids?

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153
Q

Most common age and gender for retropharyngeal abscess

A

Boys > girls
Ages 3-4 most common

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154
Q

Causative pathogens for retropharyngeal abscess

A

Strep
Staph
H. flu
Klebsiella

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155
Q

Fever, drooling, stiff neck (torticoillis), toxic looking, stridor, bulging of pharynx suggestive of

A

Retropharyngeal abscess

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156
Q

Workup for Retropharyngeal abscess

A

Soft tissue neck X-ray
Labs and CT is most likely Dx

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157
Q

Tx for Retropharyngeal abscess

A

IV ABx (amp-sulbactam or clinda +/- Vanco)

I&D possible

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158
Q

Complications of Retropharyngeal abscess

A

Airway obstruction
Rupture leading to pneumonia

Thrombophlebitis of IJV or erosion into carotid sheath (Lemierre syndrome ~also associated with Ludwigs angina)

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159
Q

Deep tissue infection into the submandibular space secondary to poor dentition

A

Ludwig’s Angina

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160
Q

Pathogens associated with Ludwig’s angina

A

Staph
Strep
Bacteroides
Fusobacterium

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161
Q

Submittal and or sublingual swelling, drooling, fever suggestive of

A

Ludwig’s angina

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162
Q

Workup for Ludwig’s angina

A

CT or ultrasound for cellulitis vs. abscess

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163
Q

Treatment for Ludwig’s angina

A

IV ABx
Surgical I&D
Dental F/U

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164
Q

Complications of Ludwig’s angina

A

Lemierre syndrome
Airway compromise

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165
Q

Dysphonia

A

Abnormal voice quality

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166
Q

Important laryngeal structures

A

Tongue base
Epiglottis
Vocal cords/trachea

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167
Q

Laryngitis, vocal cord polyp, myasthenia gravis, vocal cord paralysis, stroke, GERD, croup:
Painful or painless?

A

Painless (generally)

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168
Q

Tonsillitis, peritonsillar abscess, Retropharyngeal abscess, Ludwig angina, Epiglottitis, foreign body, GERD, croup: painful or painless?

A

Painful

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169
Q

Hoarseness could indicate what pathology

A

Laryngitis
GERD
Lesion

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170
Q

Breathy voice could indicate what pathology

A

Vocal cord paralysis or mass

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171
Q

Harsh/rough voice could indicate what pathology

A

Laryngitis, Mass

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172
Q

Stridor could indicate what pathologies

A

Croup
Foreign body
Anaphylaxis
Laryngomalacia

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173
Q

Muffled voice could indicate what pathology

A

Retropharyngeal abscess
Epiglottitis
Ludwig’s angina

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174
Q

Hot potato voice indicate what pathology

A

Peritonsillar abscess

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175
Q

Gender and age patient that Epiglottitis typically effects

A

Males > females
Child 3-6 years old
Adults > 85 years old (increasing incidence)

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176
Q

Current most common pathogen responsible for Epiglottitis

A

Beta hemolytic group A strep

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177
Q

Fever and irritability, severe sore throat accompanied by drooling and dysphonia, cough or difficulty breathing indicative of

A

Epiglottitis

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178
Q

Epiglottitis usually fast or slow progression

A

Fast

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179
Q

DDx for dysphagia, dysphonia, and fever

A

Pharyngitis
Peritonsillar abscess
Ludwigs angina
Retropharyngeal abscess
Soft tissue neck infection
Croup
Tracheitis
Mono

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180
Q

Tripod position, toxic appearing, mouth open, neck extended, drooling, cervical adenopathy, retractions indicative of

A

Epiglottitis

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181
Q

Avoid _______ if airway compromised

A

Tongue depressor

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182
Q

First thing you’ll do for Epiglottitis

A

AIRWAY (intubation if compromised)

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183
Q

Workup for Epiglottitis

A

Soft tissue neck X-ray (“thumbprint sign”, “vallecula sign”)
Direct laryngoscopy in OR

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184
Q

Tx for Epiglottitis

A

Intubation
IV access
CBC, BMP, cultures
ABx: ceftriaxone (rocephin) 100 mg/kg/day IV x7 days
(Clindamycin or Vanco if PCN allergic)
Dexamethasone 4-10 mg/day (meds 0.6mg/kg)
IV floods, analgesics, antipyretics, extubate after 2-3 days

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185
Q

Etiologies of laryngitis

A

Viral
Bacterial (staph, strep, or candida/fungal)
Excessive voice use
Environmental allergies
Irritant inhalation

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186
Q

History for laryngitis

A

Recent URI or voice overuse

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187
Q

Reinkes edema

A

Fluid in the vocal cords secondary to smoking and overuse

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188
Q

Laryngitis caused by paralysis of the cords often involves what nerve and how can it be damaged?

A

Superior or recurrent laryngeal nerve
Cause: surgery, intubation, trauma, masses, stroke, MS, ALS

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189
Q

Tx for laryngitis

A

Strict voice rest, cool mist humidification, smoking cessation, hydration
NSAIDs
Antihistamines

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190
Q

Laryngotracheitis, AKA

A

Croup

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191
Q

Age and gender of patient usually affected by croup

A

Male 1.5 x more likely
6-36 months old

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192
Q

Causative agent for croup

A

Parainfluenza (common)

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193
Q

Barking cough, Stridor, agitation, rhinorrhea and fevers, nasal flaring, retractions, lack of rhonchi/wheezing indicative of

A

Croup

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194
Q

What is suggestive of more severe disease, inspiratory or expiratory Stridor?

A

Expiratory

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195
Q

Workup for croup

A

Mostly clinical
Soft tissue neck x-ray
Labs: RSV, flu and/or CBC if diagnosis is uncertain

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196
Q

Tx for croup

A

Dexamethasone 0.6 mg/kg PO or IM x 1 dose FRONTLINE
Racemic epinephrine nebulizer followed by 2 hrs observation

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197
Q

What can’t you diagnose infants with?

A

Sinusitis (sinuses filled with fluid until age 1)

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198
Q

Ostiomeatal complex

A

The drainage pathway for the paranasal sinuses

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199
Q

Name a few congenital nose abnormalities

A

Atresia
Deviation of the septum

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200
Q

Name a couple acquired nose abnormalities

A

Nasla polyps
Foreign bodies
Nasal septal disorders
Tumors

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201
Q

The presence of one or more of the following:
Rhinorrhea, sneezing, nasal congestion, nasal itching

A

Rhinitis

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202
Q

Disorder affecting both nasal passages and paranasal sinuses overlapping but distinct symptoms from rhinitis

A

Rhinosinusitis

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203
Q

Atopic triad

A

Atopic dermatitis, allergic rhinitis, asthma

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204
Q

Allergic rhinitis more common in what population

A

Children

205
Q

Is there an increasing or decreasing sensitivity to allergen over time

A

Increased sensitivity (lower threshold)

206
Q

Allergic shiners

A

Dark circles under eyes

207
Q

Allergic salute

A

Transverse nasal crease

208
Q

Lines or folds below lower eyelids, AKA

A

Concomitant allergic conjunctivitis

209
Q

PE findings for allergic rhinitis

A

Nasal mucosa - pale, blueish hue
Edema of turbinates
Clear rhinorrhea
Cobblestoning of posterior pharynx
TM retraction or presence of serous fluid behind TM

210
Q

When _______ coated cells encounter an allergy again, they become _______, leading to release of inflammatory mediators which leads to s/s of allergy

A

IgE
Activated

211
Q

Mast cells are mostly in the

A

Tissue

212
Q

Basophils are in the

A

Blood

213
Q

When is allergy skin testing or in vitro testing for allergen specific IgE indicated?

A

If no improvement with treatment including removal of allergens

214
Q

Frontline pharmacotherapy for mild or episodic allergic rhinitis

A

Oral antihistamine (certrizine, fexofenadine,loratadine)

215
Q

Second line pharmacotherapy for mild or episodic allergic rhinitis

A

Nasal spray antihistamine (azelastine/astelin)

216
Q

Third line pharmacotherapy for mild or episodic allergic rhinitis

A

INGC (fluticasone, mometasone, triamcinolone)

217
Q

Frontline for mod severe or persistent allergic rhinitis

A

INGC

218
Q

Other Tx for allergic rhinitis

A

Montelukast (Singulair) leukotriene inhibitor
Systemic glucocorticoids

219
Q

Two types of non allergic rhinitis

A

Vasomotor rhinitis
Gustatory rhinitis

220
Q

Intermittent nasal congestion and rhinorrhea with an exaggerated response to irritants (cold/dry air, pollution, etc)

A

Vasomotor rhinitis

221
Q

Episodic, watery rhinorrhea triggered by hot/spicy food (vaguely mediated)

A

Gustatory rhinitis

222
Q

Rhinitis medicamentosa

A

Rebound nasal congestion commonly associated with overuse of over-the-counter nasal decongestants (AFRIN)

223
Q

Viral sinusitis, AKA

A

the common cold

224
Q

What percentage of rhinosinusitis is bacterial?

A

2%

225
Q

How long do viral symptoms usually last

A

7-10 days

226
Q

How long do bacterial symptoms last

A

> 10-14 days

227
Q

Workup for infectious rhinosinusitis

A

Thorough history
PE (HEENT, cardiopulmonary)

228
Q

Frontline Tx for infectious rhinosinusitis in immunocompetent patients

A

Observation and symptomatic care
-oral analgesics, INGC, intranasal saline, intranasal decongestant, oral antihistamines, oral expectorants

229
Q

Frontline Tx for infectious rhinosinusitis in immunocompromised or symptoms worsening >7-10 days

A

ABx

230
Q

Most common pathogens for infectious rhinosinusitis

A

Strep. pneumo
H. influenza

S. aureus (lower prevalence)

231
Q

Frontline ABx choice for infectious rhinosinusitis

A

Augmentin
Doxycycline (if PCN allergic)
Fluoroquinolone (levofloxacin) as second line
NOT CIPRO

232
Q

Higher resistance rates seen in what ABx

A

Macrolides and Bactrim

233
Q

Complications of infectious rhinosinusitis

A

Orbital cellulitis (whole orbit)
Preseptal cellulitis (just eyelid)
Intracranial abscesses
Meningitis

234
Q

How should orbital cellulitis be treated

A

IV ABx with admission
Ophthalmology referral

235
Q

Inflammatory disorder of the paranasal sinuses and lining of the nasal passages lasting >12 weeks

A

Chronic rhinosinusitis

236
Q

Clinical manifestations of chronic rhinosinusitis

A

Anterior and or posterior nasal mucopurulent drainage
Nasal obstruction/congestion
Facial pain, pressure, fullness
Reduction or loss of smell in children

237
Q

Gold standard for diagnosing chronic rhinosinusitis

A

CT facial/sinus

238
Q

Tx for chronic rhinosinusitis

A

Intranasal saline (not alone)
Intranasal steroids

239
Q

Indications for sinus intervention

A
  1. Failure of medical treatment
  2. Restoration of patency
  3. Debunking of severe polyposis
  4. Bony erosion or invasion into sinus cavities
240
Q

Important patient education tip for neti pot

A

Purchase or make saline solution, don’t just use any water

241
Q

Nasal polyps associated with

A

Sinusitis
Allergies
Recurring infection
Drug sensitivity
Immune disorders

242
Q

Symptoms of nasal polyps

A

Nasal airway obstruction or congestion
Thick nasal discharge
Anosmia
Recurrent/chronic sinusitis

243
Q

Tx for nasal polyps

A

INGC (fluticasone, budesonide,mometasone)

244
Q

90% of anterior epistaxis occur from what blood vessel

A

Kisselbach’s plexus (nasal septum)

245
Q

Most posterior epistaxis occur from what blood vessel

A

Sphenopalatine artery

246
Q

Initial evaluation in ED for epistaxis

A

Airway, breathing, circulation

247
Q

What is really important to know/find out for your patient with epistaxis?

A

Predisposition for bleeding - anticoagulant use (Coumadin)

248
Q

Pretreatment for epistaxis

A
  1. Blow nose to remove all clots
  2. Oxymetazoline (Vasoconstriction)
  3. Tamponade at septum x10 minutes
249
Q

Tx for epistaxis

A
  1. Conservative (pretreatment)
  2. Cautery
  3. Chemical
  4. Electrical
250
Q

Nasal packing types to treat Anterior nosebleed

A

Nasal tampons
Gauze packing
Thrombogenic foams
Rapid rhino (ant and post)

251
Q

Nasal packing types to treat POSTERIOR nosebleed

A

Epistat double ballon catheter
Foley Catheter

252
Q

Who places a Foley catheter or epistat for control of posterior nosebleed

A

ENT

253
Q

ABx tx for epistaxis

A

Prophylaxis (to prevent toxic shock syndrome)
Augmentin

254
Q

Clinical manifestation of foreign body (nose)

A

History
Mucopurulent nasal discharge
Mouth breathing

255
Q

X-ray of foreign body only if suspicious of

A

Button or magnet

256
Q

Tx of foreign body (nose)

A

Postive pressure (parent to mouth, child blowing)
Instrumentation (Katz-extractor)

257
Q

Most common age group for nasal trauma

A

16-20 yo

258
Q

Complications of nasal trauma

A

Dislocation
Septal hematoma
Nasal fractures

259
Q

Periorbital ecchymosis in the absence of other orbital findings indicative of

A

Nasal fracture

260
Q

External nasal deformity, epistaxis, edema, ecchymosis suggestive of

A

Septal injury

261
Q

How much saliva is produced on average per day

A

1-1.5 L/day

262
Q

Role of saliva

A

Digestion, pH balance, and hygiene

263
Q

98% of saliva is

A

Water

264
Q

Other 2% of saliva is

A

Electrolytes (calcium, phosphorus)
Digestive enzymes (salivary amylase)
Antimicrobial factors (IgA, peroxidase) and mucin (glycoprotein)

265
Q

Functions of saliva

A

Keeps mucous membranes moist
Lubrication of food (bolus)
Starts starch digestion
Natural mouth wash
Essential for taste sensation

266
Q

What % of digestion of starch is done in the mouth

A

30%

267
Q

Salivary stones

A

Sialolithiasis

268
Q

Inflammation of the salivary glands

A

Sialadenitis

269
Q

Dry mouth

A

Xerostomia

270
Q

Xerostomia occurs when salivary flow is <_________%

A

50

271
Q

Most common etiology of Xerostomia

A

Chronic use of anticholinergic medications

272
Q

Other etiologies of Xerostomia

A

Radiation to oropharynx
Autoimmune disorders (Sjorgen’s syndrome)
Chronic disease (DM, eating disorders)
Social habits (tobacco/cannabis, chronic ETOH use)

273
Q

Medication causing disease is known as

A

Iatrogenic

274
Q

Name the anticholinergic agents that cause Xerostomia

A

Tricyclic antidepressants (amitriptyline)
SSRIs (Zoloft)
Diuretics (lasix)
Antihistamines (Benadryl)
Antihypertensive medications (calcium channel blockers)
Anticholinergic drugs for urinary incontinence (detrol)
Antispasmodics (lomotile)

275
Q

Tx for xerostomia

A

Change or eliminate medication
Promote gum chewing
Encourage oral hydration
OTC saliva substitutes
Cholinergic agonist (pilocarpine hydrochloride)

276
Q

Side effects of pilocarpine hydrochloride

A

Excessive sweating

277
Q

“Cavities filled with mucus arising from the salivary glands/ducts due to damage to ducts and extravasation of mucin into surround tissue”

A

Mucocele/Ranula

278
Q

What is more common, mucocele or ranula

A

Mucocele

279
Q

Mucoceles occur in the _________

A

Minor salivary glands

280
Q

Ranulas occur in the floor of the mouth arising from the _________

A

Sublingual gland

281
Q

2 types of ranulas

A

Oral
Cervical AKA “plunging”

282
Q

Chronic lip biting (lip trauma) most likely to cause

A

Mucocele

283
Q

Improper drainage of sublingual glands or acquired after oral trauma

A

Ranula

284
Q

Painless, mobile, dome shaped fluctuate lesion may appear as bluish-clear fluid filled cysts

A

Mucocele/Ranula

285
Q

Where do mucocele commonly occur

A

Lower lip

286
Q

Tx for mucoele/Ranula

A

Surgical removal
Self-resolving

287
Q

80-90% of salivary stones occur in which gland

A

Submandibular gland (Wharton’s duct)

288
Q

6-20% of salivary stones occur in which gland

A

Parotid gland

289
Q

1-2% of salivary gland stones

A

Sublingual

290
Q

Etiology of sialolithiasis

A

Idiopathic

291
Q

Hallmark clinical presentation of sialolithiasis

A

Swelling, pain and erythema of the face/neck that is worse with meals
Pain and swelling may lesson a few hours after eating

292
Q

Risk factors for sialolithiasis

A

Dehydration
Anticholinergic meds
Trauma to duct
Smoking

293
Q

Purulent drainage should or should not be expressed in sialolithiasis

A

Not

294
Q

Can reproduce symptoms of sialolithiasis with

A

Sialagogues

295
Q

What is a great sialagogue?

A

Sour hard candy

296
Q

Workup for sialolithiasis

A

Typically clinical
X-ray, U/C, CT
Sialography (not utilized in practice)

297
Q

Frontline Tx for sialolithiasis

A

Conservative treatment
(Sialagogues, hydration)

298
Q

Only time you prescribe ABx for sialolithiasis

A

If bacterial coinfection (sialadentis)

299
Q

Complications of sialolithiasis

A

Acute bacterial sialadentis

300
Q

Etiologies for acute sialadentis

A

Bacterial
Viral
Salivary stones

301
Q

Sudden enlargement and pain of salivary glands

A

Acute sialadentis

302
Q

Less painful gland enlargement/pain, present for weeks or months

A

Chronic sialadentis

303
Q

Etiologies for chronic sialadentis

A

Tumor
Structure of duct
Immune mediated conditions (Sjorgen’s syndrome)

304
Q

Sjorgen syndrome (SS)

A

Autoimmune process that results in dry eyes, dry mouth, and gradual salivary gland swelling

305
Q

Acute bacterial sialadenitis, AKA

A

Acute purulent sialadenitis or suppurative sialadenitis

306
Q

Acute bacterial sialadenitis most commonly occurs in which gland

A

Parotid

307
Q

Who are most effected by acute bacterial sialadenitis

A

Older adults, elderly and medically compromised (chronic illness)

308
Q

Most common pathogen for acute bacterial sialadenitis

A

Staph aureus

(Strep pneumonia and strep viridians, anaerobic oral bacteria)

309
Q

Risk factors for acute bacterial sialadenitis

A

Increasing age
Chronic illness
Post-op/intubated
Trauma to duct
History of stones
Anticholinergic meds
Poor oral hygiene (periodontitis)

310
Q

Acute bacterial sialadenitis

A

Sudden onset unilateral enlargement more commonly than bilateral movement
Fever and/or chills; may have adenopathy
Purulent drainage from duct may be expressed (bad taste in mouth)

311
Q

Diagnosis of acute bacterial sialadenitis

A

Clinical
Culture purulent discharge
Labs (leukocytosis)
Imaging if you suspect abscess or obstruction

312
Q

Tx for acute bacterial sialadenitis should include

A

IV ABx (cover S. aureus until cultures return)
-Ex. Nafcillin 1gm Q4-6 hr with clinical improvement transition to oral regimen based on cultures, 10-14 course

Supportive
-(hydration/good oral care)
-NSAIDS
-Sialagogues
-Chlorhexidine

313
Q

If symptoms of acute bacterial sialadenitis don’t improve with treatment, pt will require

A

ENT referral
-Possible surgical intervention

314
Q

Viral sialadenitis most commonly occurs in what gland

A

Parotid

315
Q

Most common etiology of viral sialadenitis

A

Mumps virus (paramyxovirus)

316
Q

Least common viral etiology of sialadenitis

A

EBV
Parainfluenza
Influenza A

317
Q

Acute, self limited, systemic viral illness characterized by swelling of one or more salivary glands

A

MUMPS (viral sialadenitis)

318
Q

Clinical presentation of mumps (viral sialadenitis)

A

Short prodrome (low grade temp, malaise, HA, anorexia, ear pain)
Salivary enlargement that is sudden and painful 48 hrs after prodrome

Parotid most common
No purulent drainage from duct

319
Q

Mumps work up

A

Clinical

-serologies (IgG and IgM)
-RT-PCr buccal swab (detects viral RNA)

320
Q

Tx for mumps

A

Symptomatic (Tylenol, warm compresses, fluids)
Prevention (MMR vaccine or MMRV)

321
Q

80-85% of salivary gland tumors occur in what gland

A

Parotid

322
Q

Most common histological type of benign salivary gland tumor

A

Pleomorphic adenoma

323
Q

Two most common types of malignant salivary gland tumors

A

Mucoepidermoid carcinoma
Adenoid cystic carcinoma

324
Q

Mean age for malignant salivary tumors

A

50-60 years

325
Q

Risk factors for salivary gland tumors

A

Radiation exposure
Occupational/environmental

326
Q

Facial nerve involvement = higher correlation with

A

Malignancy

327
Q

Benign tumors grow over _______ to _______

A

Months to years

328
Q

Malignant tumors grow over _________

A

Weeks (rapid)

329
Q

Red flags signs and symptoms for salivary tumors

A

Nerve involvement (facial palsy or decreased sensation)
Fixed adenopathy
Facial pain +/-
Weight loss (advanced)

330
Q

What are you doing to confirm diagnosis of salivary gland neoplasm

A

Biopsy
(FNA or ultrasound guided core needle biopsy)

331
Q

Low grade tx

A

Surgery alone

332
Q

High grade Tx

A

Surgery followed by radiation

333
Q

Unresectable or relapse treatment

A

Radiation alone or radiation + chemotherapy

334
Q

What scan is used for cancer staging?

A

PET or CT

335
Q

Role of the primary care clinician with oral health

A

Education
Screening/risk assessment
Promotion
Oral exam/fluoride varnish
Referral/collaboration

336
Q

Oral health =

A

systemic health

337
Q

The most chronic disease of childhood is

A

Dental caries

338
Q

Dental caries are _____x more common than asthma

A

5

339
Q

How many deaths per hour are a result of oral cancer?

A

1.1

340
Q

Outer protective layer of the tooth (very hard)

A

Enamel

341
Q

Middle layer, most abundant dental tissue

A

Dentin

342
Q

Composed of nerves and blood vessels that exit the tooth via the apices

A

Pulp

343
Q

_______ connects alveolar bone via the periodontal ligament

A

Root

344
Q

Primary dentition = __________ teeth

A

20

345
Q

How many incisors? (primary)

A

8

346
Q

How many canines? (Primary)

A

4

347
Q

How many molars? (primary)

A

8

348
Q

Rarely need to be concerning about lack of tooth eruption unless evidence of

A

Underlying syndrome
Developmental issues
or no teeth have erupted by 18 months

349
Q

How many adult teeth

A

32

350
Q

How many incisors are there (adult)?

A

8

351
Q

How many canines are there? (Adult)

A

4

352
Q

How many premolars are there (adult)?

A

8

353
Q

How many molars are there (adult)?

A

12

354
Q

Yellowish tint of teeth represents what component of tooth

A

Dentin

355
Q

Age related changes to teeth

A

Dark staining
Worn incised edges/yellowing

356
Q

Three categories of oral disease risk factors

A

Individual (history, medications/xerostomia etc)
Behavioral (alcohol, tobacco, lack of dental care)
Environmental (non-fluoridated community water, poor access to care)

357
Q

Name meds that can cause gingival hyperplasia

A

Anticonvulsants (est phenytoin)
Methotrexate
Cyclosporine
Calcium channel blockers

358
Q

Name meds that can cause dental erosion

A

Progesterone
Nitrates
Beta blockers
Calcium channel blockers

359
Q

Name med that can cause osteonecrosis

A

Biphosphonates

360
Q

T/F: Xerostomia can induce caries

A

True

361
Q

Most common cause of xerostomia

A

Polypharmacy (anticholinergic)

362
Q

Effects of cannabis use

A

Dental caries
Increased oral infections
Xerostomia
Periodontal disease
Dysplastic changes/premalignant oral lesions

363
Q

Tx for substance use disorders (oral health)

A

Oral surgery referral and behavioral health interventions

364
Q

Untreated oral infection can spread and cause:

A

Intraoral abscess
Sinusitis
Facial cellulitis
Bacteremia and sepsis
Brain abscesses
Airway compromise
Aspiration PNA

365
Q

untreated oral infection can spread, AKA

A

direct bacterial extension

366
Q

_________ is a major mechanism for link between oral disease and several systemic diseases

A

Inflammation

367
Q

Strong __________ link between periodontal disease and DM

A

Bi-directional (both ways)

368
Q

What is the association between DM and periodontal disease thought to be due to?

A

Poor glycemic control

369
Q

What is the association between CVD and periodontal disease thought to be due to?

A

Inflammatory cytokines implicated in atherogenesis

370
Q

What is the association between rheumatoid arthritis and periodontitis thought to be due to?

A

Bacteria produces toxins/autoantibodies that trigger hypercitrullination in neutrophils

371
Q

A periodontal infection could be a reservoir for ____________, which causes a host response and possible preterm labor

A

gram negative anaerobes

372
Q

Why is oral health important for peri/post menopausal women?

A

Incidence of periodontitis increases after menopause

373
Q

Strengthens enamel and can prevent progression of early caries and slow enamel destruction

A

Fluoride varnish

374
Q

________ % caries reduction with fluoride varnish

A

30-35%

375
Q

3 types of patients in need of care coordination with other providers

A

Medically complex patients
Require ABx prophylaxis
Taking anticoagulation

376
Q

Most patients (do/do not) require ABx prophylaxis

A

Do Not

377
Q

What patients require ABx prophylaxis?

A

Prosthetic heart valves
Prior hx of endocarditis
CHD/unrepaired defects
Post-transplant

378
Q

ABx of choice and dose for dental procedure prophylaxis

A

Amoxicillin

Adults 2g; children 50 mg/kg orally 1 hr before procedure or up to 2 hours after

379
Q

PCN allergic alternative for dental procedure prophylaxis

A

Cephalexin or cefadroxil
Azithromycin or clarithromycin
Doxycycline

380
Q

What ABx do we not use for dental prophylaxis?

A

Clindamycin

381
Q

Common bacteria causing dental caries

A

Mutans streptococci and lactobacilli

382
Q

Risk factor for adult caries

A

Family history
High bacterial counts
Low socioeconomic status
Poor oral hygiene

383
Q

Etiology for root caries

A

Gingival recession causes roots to become

384
Q

S/s of gingivitis

A

Tenderness
Gum swelling
Halitosis
Erythema
Bleeding gums

385
Q

Etiologies for gingivitis

A

Plaque buildup
Changes in hormones (pregnancy, puberty,diabetes)
Oral foreign bodies (popcorn kernels)

386
Q

Etiologies for gingival hyperplasia

A

Poor oral hygiene
Drug induced
Systemic disease underlying(leukemia)

387
Q

ANUG, aka

A

acute necrotizing ulcerative gingivitis
Vincent’s angina
“Trench mouth”

388
Q

ANUG

A

Plaque-associated, non contagious infection of the gums causing painful, bleeding gums and ulcers

389
Q

Acute onset halitosis, severe oral pain, blunting of interdental papilla, ulcerative necrotic slough of gingiva indicative of

A

ANUG

390
Q

Tx for ANUG

A

ABX
-Metronidazole 500 mg PO TID
-Augmentin 875 mg PO BID or 500 mg PO TID
-Clindamycin 450 mg PO TID

Debridement
Antimicrobial rinses (Chlorohexidine BID x 2 weeks)

391
Q

Leading cause of adult tooth loss

A

Periodontitis

392
Q

Tx for periodontitis

A

Effective brushing and flossing
Lifestyle change
Dental referral for deep root scaling

393
Q

_____% of adults >65 y/o are completely edentulous

A

25

394
Q

> 65 y/o have an average of _______ remaining teeth

A

18

395
Q

Negative impacts of tooth loss

A

Difficulty eating
Inadequate nutritional intake
Dissatisfaction with facial appearance

396
Q

Deep infection of the tooth support structures

A

Periodontal abscess

397
Q

Tx for periodontal abscess

A

Analgesics
ABx if indicated
Dental referral

398
Q

Osteonecrosis of the jaw caused by

A

Biphosphonate therapy

399
Q

ABx that can be used to treat oral infections

A

Penicillin VK
Amoxicillin
Augmentin

400
Q

PCN allergic ABx option for oral infections

A

Clindamycin

401
Q

ABx choice for severe oral infections

A

Broad spectrum

Ampicillin-sulbactam
Cefotaxime
Ceftizoxime
Pip-tazo
Imipenem-cilastatin

402
Q

Etiologies for dental erosion

A

Bulimia
GERD
Methamphetamine use
Acidic drinks
Medication effects

403
Q

Aphthous stomatitis, aka

A

Canker sore

404
Q

Discrete round to oval ulcers with an erythematous rim and yellowish exudate

A

Aphthous stomatitis

405
Q

Most common locations of aphthous stomatitis

A

Buccal and labial mucosa, ventral tongue

406
Q

Three clinical forms of aphthous stomatitis

A

Minor <7 mm (common)
Major >7 mm
Herpetiform 1-2 mm in clusters

407
Q

Herpes labilais, aka

A

Cold sore

408
Q

Etiology for herpes labialis

A

Reactivation of latent HSV-1

409
Q

Consider ________ antiviral prescription for recurrent herpes labialis

A

Prophylactic

410
Q

Cocksackie A virus part of what family

A

Enterovirus

411
Q

Most common serotypes of Cocksackie A virus are

A

HFMD and Herpangina

412
Q

Clinical syndrome characterized by oral enanthes and rash on hands and feet

A

HFMD

413
Q

Clinical syndrome characterized by fever and painful papulovesiculo-ulcerative oral enathem

A

Herpangina

414
Q

Tx for cocksackie A virus

A

Supportive

415
Q

75% of HFMD have both

A

Enanthem and exanthem

416
Q

Which presents with an abrupt, high fever: HFMD or Herpangina?

A

Herpangina

417
Q

Rapidly growing tumor like mass in response to local irritation

A

Pyogenic granuloma

418
Q

Erythematous, non painful, smooth or lobulated mass

A

Pyogenic granuloma

419
Q

Geographic tongue: normal or abnormal

A

Normal variant

420
Q

Migratory inflammatory filiform papillae atrophy

A

Geographic tongue

421
Q

Elongation and hypertrophy of filiform papillae

A

Hairy tongue

422
Q

Benign bony protuberances arising from cortical plate

A

Bony Tori

423
Q

Surgical removal of bony Tori only indicated if

A

Affects oral function
Interferes with denture fabrication
Subject to recurrent trauma or ulceration

424
Q

Most common form of oral candidiasis

A

Pseudomembranous

425
Q

Pseudomembranous candidiasis, aka

A

thrush

426
Q

Testing for thrush

A

Gram stain or KOH prep from scrapings

427
Q

Subtypes of candidiasis

A

Angular cheilitis
Median rhomboid glossitis
Erythematous candidiasis

428
Q

Candidiasis treatment

A

Nystatin swish swallow
Clotrimazole
Fluconazole (if topical agent fails or immunocompromised, other risks)

429
Q

Tx for lichen planus

A

Asymptomatic = none

Topical corticosteroids

430
Q

What locations in the mouth are the highest risk sites for malignancy

A

Tongue and mouth floor

431
Q

Leukoplakia/erythroplakia are

A

Premalignant

432
Q

All unexplained white lesions in mouth >________weeks should be referred for biopsy and evaluation

A

3

433
Q

90% of oral cancers are

A

SCC

434
Q

______% of oral cancers are advanced at the time of detection

A

60

435
Q

Risk factors for oral cancer

A

Alcohol and tobacco
HPV

436
Q

BRCA gene is a

A

“Tumor suppressor”; mutation here can cause increase risk of cancer

437
Q

The three main drivers of cancer

A

Proto-oncogenes
Tumor suppressor genes
DNA repair genes

438
Q

“Gas pedal of the car”
Control the regulation of cell growth

A

Proto-oncogenes

439
Q

Regulate apoptosis/identify gene damage

A

Tumor suppressor genes

440
Q

__________ are mutated proto-oncogenes

A

Oncogenes

441
Q

Angiogenesis

A

Formation of new blood vessels that feeds the growing tumor

442
Q

Head and neck cancer account for _______% of cancer cases in the US

A

3

443
Q

Most head/neck cancers are this type

A

SCC

444
Q

Main risk factors for head/neck cancers

A

Tobacco
ETOH
Viral (HPV/EBV)
Betel nut
Male gender
Occupational
High nitrate/salt diet

445
Q

HPV related cancer increasingly recognized in head and neck cancers, particularly at ___________

A

Base of tongue and tonsils

446
Q

What strain of HPV is most concerning for cancer

A

HPV-16

447
Q

Carcinogenic HPV infections that persist beyond ________ months increase likelihood of precancerous or cancerous lesion

A

12

448
Q

S/s of head/neck cancer

A

Oral nonhealing ulcer >3 weeks
Painless neck mass
Trismus
Changes in vocal quality
Numbness/CN deficits

449
Q

Early stages of head/neck cancer patients are often________

A

Asymptomatic

450
Q

Confirmatory testing for suspected malignancy

A

FNA (biopsy)

451
Q

The “T” in TNM staging system refers to

A

Size and extent of the primary tumor

452
Q

The “N” in the TNM staging system refers to

A

the number/location of lymph nodes that are found to be disease positive

453
Q

The “M” in the TNM staging system refers to

A

Whether the cancer has metastasized to distant organs

454
Q

TNM staging varies depending on

A

The primary tumor site

455
Q

3 major factors to consider in the treatment approach to head and neck cancer

A

-Primary site of disease
-Stage of disease
-Patient comorbidities/goals wishes and performance status

456
Q

The ECOG measures

A

Performance status

457
Q

ECOG of 0 indicates

A

Fully active; no performance restrictions

458
Q

ECOG of 1 indicates

A

Strenuous physical activity restricted; fully ambulatory and able to carry out light work

459
Q

ECOG of 2 indicates

A

Capable of all self-care but unable to carry out any work activities.
Up and about >50% of waking hours

460
Q

ECOG of 3 indicates

A

Capable of only limited self-care;
Confined to bed or chair >50% of waking hours

461
Q

ECOG of 4 indicates

A

Completely disabled; cannot carry out any self-care; totally confined to bed or chair

462
Q

Tx for stage 1 or 2

A

Single modality tx
(Surgery or radiation alone)

463
Q

Tx stage 3-4

A

Multi-modality treatment

464
Q

Common sites for Mets

A

Lung, liver, bone

465
Q

Prognosis for head/neck cancer in the first 2 years

A

20-30%

466
Q

Locally advanced head/neck cancer would be evident by which clinical sign

A

Local lymphadenopathy

467
Q

Side effects of chemotherapy

A

Infections
Neuropathy
Electrolyte imbalance
N/V
Rash or allergic reaction

468
Q

Side effects of radiation

A

Taste dysfunction
Infection
Xerostomia
Soft tissue necrosis
Osteonecrosis

469
Q

Side effects of surgical interventions for head and neck cancer

A

Neuropathy
Disfigurement
Effects on speech
One way breaths (stoma)
Dysphagia

470
Q

________% of cancer pt have pain during and post treatment which is not adequately controlled

A

40-85%

471
Q

Most common locations for oral cancer

A

Lateral aspects of tongue
Floor of the mouth

472
Q

Average age of oral cancer

A

63 year old

473
Q

Males or females more prevalent oral cancer

A

Male (2:1)

474
Q

90% of oral cancer are

A

SCC

475
Q

Risk factors for oral cancer

A

Tobacco
ETOH
Betel nut
Sunlight exposure/artificial sunlight

476
Q

Most common symptom of oral cancer

A

Non-healing ulcer/lesion >3 weeks (biopsy)

477
Q

RULE acronym

A

Red
Ulcerated
Lump
Especially in combination

478
Q

Erythroplakia/leukoplakia has a higher rate of malignant transformation

A

Erythroplakia

479
Q

Dysarthria

A

Change in speech

480
Q

Lymphadenopathy in which lymph nodes could show up oral cancer

A

Cervical chains
Submandibular
Submental

481
Q

Prognosis of lip cancer:better or worse

A

Best

482
Q

Most affected paranasal sinus

A

Maxillary

483
Q

Age most affected by paranasal sinus/nasal cavity cancer

A

> 55 yrs

484
Q

Risk factors for paranasal sinus/nasal cavity cancer

A

Tobacco
Occupational exposure (woodworking, carpentry,metal plating)

485
Q

S/s of paranasal sinus/nasal cavity cancer

A

Persistent blocked sinuses
Sinus headache
Epistaxis
Lump/mass
Nasal obstruction
Swelling around eyes/blurry vision

486
Q

Prognosis for paranasal sinus/nasal cavity cancer

A

Poor cure rates <50% because delay in care

487
Q

Nasopharyngeal cancer more common in what endemic areas

A

Asia and southern China

488
Q

Risk factors for nasopharyngeal cancer

A

EBV
High salt diet
Asian ancestry

ETOH and tobacco lower prevalence

489
Q

Most common #1 symptom of nasopharyngeal cancer

A

Neck mass
(Spreads to nodes early)

490
Q

Other symptoms of nasopharyngeal cancer

A

Otalgia
Hearing loss
Recurrent serous otitis

491
Q

With nasopharyngeal cancer, high viral loads of EBV correlates with

A

Poorer outcomes

492
Q

Mainstay of treatment for nasopharyngeal cancer

A

Radiation

493
Q

Age and gender most affected by oropharyngeal cancer

A

Males (3:1)
40-70 years of age

494
Q

Risk factors for oropharyngeal cancer

A

HPV (particularly HPV-16)
Tobacco
ETOH

495
Q

S/s of oropharynx carcinoma

A

Persistent sore throat
Lump in mouth or throat
Mass in neck
Dysphagia
Odynophagia

496
Q

What improves prognosis by 30-50% in oropharyngeal cancer?

A

+ HPV status

497
Q

Most common site of hypopharynx cancer

A

Pyriform sinus

498
Q

Other sites of hypopharynx cancer

A

Post cricoid area
Inferoposterior pharyngeal wall

499
Q

Age prevalence of carcinoma of hypopharynx

A

> 50 yrs

500
Q

What is concerning about carcinoma of the hypopharynx

A

Aggressive early local spread to lymph nodes
High risk of distant metastatic disease

501
Q

50% initial symptom of carcinoma the hypopharynx

A

Enlarged lymph node or lump in neck

502
Q

Other symptoms of carcinoma of the hypopharynx

A

Persistent sore throat
“Something caught in throat”
Dysphagia
Airway obstruction, difficulty breathing, noisy breathing

503
Q

_____% of patients (hypopharyngeal carcinoma) have stage 3 diesease by the the time of diagnosis

A

50

504
Q

Treatment goal for carcinoma of the hypopharynx

A

Organ preservation

505
Q

Advanced stage 3-4 hypopharynx carcinoma tx

A

Resection + post radiation
Or
Concurrent chemo/radiation

506
Q

Supraglottic, glottic, subglottic cancer:
Which is most favorable? Least favorable?

A

Glottic: most favorable
Subglottic: least favorable

507
Q

Risk factors for carcinoma of larynx

A

Tobacco
ETOH
HPV

508
Q

Most common symptom of carcinoma of larynx

A

Hoarse voice
(New, persistent >2 weeks)

509
Q

4 goals of Tx of carcinoma of larynx

A
  1. Cure
  2. Preservation of swallowing
  3. Preservation of useful voice
  4. Avoidance of permanent tracheostoma

Didactic Year (24 decks)

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