ENT Flashcards Preview

Extra > ENT > Flashcards

Flashcards in ENT Deck (35):
1

most common mouth cancer

oral keratosis (cancer on the side of the tongue)

2

dental caries/acute pulpitis

cause- strep mutans
pathophys- destroys hard tissue of teeth; progresses into dental pulp (acute pulpits)
sx- throbbing pain; hot and cold sensitivity
prevention- fluoride, brushing, flossing, routine cleanings
tx- simple caries-resotoration (fillings)
pulpitis- abx and NSAIDS; root canal may be needed
high risk pop- anything that causes spit to decrease and have a dry mouth (chemo, drugs, xerostomia secondary to other stuff)

3

vincent's angina (trench mouth)

sign/sx- halitosis
tx- pcn + metroniadazole or clindamycin alone

4

Ludwig's angina

MUST GET TO HOSPITAL/SURGEON
GRAPEFRUIT OF LOWER JAW
patho- spreading cellulitis of sublingual spaces
sign/sxs-febrile, drooling, trismus, edema in sublingal area spreading down neck
tx- pcn or unasyn plus metronidazole (Flagyl)

5

most common oral ulceration in north america

recurrent aphthous stomatitis

50% due to CMV

6

what is most important factor in flavor

smell or aroma of food

7

hypogeusia

diminished taste to 1 or more tastants

8

ageusea

absent taste func

9

dysgeusia

persistent sweet, sour, salty, bitter or metallic taste

10

allegeusia

unpleasant taste of food or drink that is usually pleasant

11

phantogeusia

unpleasant taste produced indigenously due to gustatory hallucination
can get before migraine and other neurological stuff

12

etiology and tx of halitosis

80-90% in oral cavity
5-8% nasal passages
3% tonsils (tonsillioiths)
tx- tx underlying cause
clean posterior tongue
good dental hygiene
rinsing and DEEP gargling of mouth wash
chew gum
decrease alcohol and coffee intake
drink water

13

odynophagia

pain produced from swallowing
mouth pain

14

stomatitis

blanket term for inflammatory cone of mouth
Oral infections- HSV, VZV, HIV infection, Candida
Autoimmune- Bechets syndrome, Sicca syndrome
Recurrent aphthous stomatitis (RAS)--most common cause of mouth ulcers in North America
always r/o cancer for persistent or unusual lesions

15

stomatitis tx

Symptomatic relief:
Triamcinolone acetonide in Orabase gel (for inflammation)
Topical analgesics (OTC)
Oragel
Anbesol
Magic mouthwash
Antivirals- acyclovir (if a viral infxn)
Chemical cautery w/ silver nitrate or sulfuric acid
Severe: intralesional or oral cortisone

16

xerostomia

dry mouth
causes:
diuretics
Drugs w/ anticholinergic effects (antihistamine, tricyclic antidepressant)
autoimmune (sicca and sjogrens)
normal aging

17

xerostomia presentation and tx

pres: C/O oral dryness, burning of mouth, difficulty eating and swallowing, tongue irritation, painful ulcerations.
tx-Salivary stimulation with sugarless hard candies
Saliva substitutes
Sialogogues: pilocarpine or cevimeline
Meds that increase salivation

18

laryngitis

hoarsness and dysphonia
freq seen w/ URI
inflammation of vocal fold mucosa and larynx
actue sx3 weeks

19

most common cause of laryngitis

VIRAL
can be bacterial, vocal trauma, gerd, autoimmune, environmental factors, use of asthma inhalers

20

what is most important management for laryngitis

vocal cord rest

21

indications for indirect laryngoscopy

Hoarseness > 2 weeks
Odynophagia
Voice change
Dysphagia
Hemoptysis
Foreign body sensation
Contraindications:
Uncooperative pt, or one w/ a strong gag reflex
Compromised airway (croup or epiglotitis)‏

22

Polypoid corditis (Reinke’s edema)

Isolated edema of the mucosal edge of the vocal fold
Etiology
Usually due to smoking
Maybe hormonal changes
Menopause
Hypothyroidism
Allergy, vocal abuse or URI
Therapy
Vocal rest
Medical management of etiology

23

vocal nodules

Thickened areas on the vocal cord, bilaterally occurring at the junction of the anterior and middle thirds (analogous to a callus)
Usual cause: smoking, reflux, muscle tension dysphonia, vocal abuse
Treatment:
Adults: excision
Children: monitor (these frequently regress in adolescence)

24

vocal polyps

Usual cause: smoking, reflux, muscle tension dysphonia, vocal abuse
More common in men
Unilateral
Sessile or pedunculated lesion on the vocal fold
Tx: excision

25

how to tell difference between polyps and nodules

nodules are bilateral
polyps are unilateral

26

what is the primary laryngeal cancer

squamous cell

27

most common cause of pharyngitis

viral
Over treatment of acute pharyngitis represents one of the major causes of antibiotic abuse.

28

complications of strep

rheumatic fever
post strep glomerular nephritis
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (group A strep)

29

fxs of GABHS

Unusual before 3 years of age and highest incidence of occurrence between 6-15 years of age (25-40% of pharyngitis cases)
More frequent in late winter and spring (Jan-Apr), uncommon in summer
Classic symptoms
Acute onset of discomfort/sore throat
Dysphagia- usually from odynophagia
Malaise
Headache
Absence of other URI symptoms (rhinorrhea, conjunctivitis, diarrhea or cough)
Occasionally abdominal pain and vomiting
Classic physical signs
Exudative pharyngeal erythema
Palatal petechiae
Tender anterior cervical adenopathy
Fever (>101F or 38.3C)
Absence of post-nasal drainage

30

Gold standard test for strep

throat culture

31

tx for GABHS

DOC- oral pcn for 10 days
if allergic to pcn- z pack

32

what does tonsillitis usually cause

bacterial infxn: (usually children 6-15)
GABHS
viral infxn (usually children less then 6)

33

indications for tonsillectomy

>6 episodes culture-confirmed GABHS pharyngitis in 1 year

3 or more infections of tonsils and/or adenoids in 1 year despite adequate therapy

Chronic or recurrent tonsillitis associated with GABHS carrier state unresponsive to beta-lactamase resistant antibiotics

Chronic tonsillitis affecting work/school

Others

34

vincent's agngina (trench mouth)

Pathophysiology
Acute inflammation and necrotizing ulceration of the pharyngeal tonsils
Usually caused by mixed bacterial-spirochetal infection

Symptoms: Severe throat pain, often radiating to the ears, halitosis, bad taste
Signs: Tonsil is covered by pseudomembrane formed from necrosis of the superficial layer of the mucous membrane

Treatment
Oral/parenteral penicillin
Vigorous oral hygiene

35

ludwig angina

grapefruit on side of neck
Acute cellulitis, usually of dental origin, extending into the submaxillary and sublingual space
Can cause airway compromise because of the swelling in the floor of the mouth and neck which makes it an emergency
10% mortality rate