ENT

Question 1

most common mouth cancer

Answer 1

oral keratosis (cancer on the side of the tongue)

Question 2

dental caries/acute pulpitis

Answer 2

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)

Question 3

vincent’s angina (trench mouth)

Answer 3

sign/sx- halitosis

tx- pcn + metroniadazole or clindamycin alone

Question 4

Ludwig’s angina

Answer 4

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)

Question 5

most common oral ulceration in north america

Answer 5

recurrent aphthous stomatitis

50% due to CMV

Question 6

what is most important factor in flavor

Answer 6

smell or aroma of food

Question 7

hypogeusia

Answer 7

diminished taste to 1 or more tastants

Question 8

ageusea

Answer 8

absent taste func

Question 9

dysgeusia

Answer 9

persistent sweet, sour, salty, bitter or metallic taste

Question 10

allegeusia

Answer 10

unpleasant taste of food or drink that is usually pleasant

Question 11

phantogeusia

Answer 11

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

Question 12

etiology and tx of halitosis

Answer 12

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

Question 13

odynophagia

Answer 13

pain produced from swallowing

mouth pain

Question 14

stomatitis

Answer 14

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

Question 15

stomatitis tx

Answer 15

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

Question 16

xerostomia

Answer 16

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

Question 17

xerostomia presentation and tx

Answer 17

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: pilocarpineorcevimeline
Meds that increase salivation

Question 18

laryngitis

Answer 18

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

Question 19

most common cause of laryngitis

Answer 19

VIRAL

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

Question 20

what is most important management for laryngitis

Answer 20

vocal cord rest

Question 21

indications for indirect laryngoscopy

Answer 21

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)‏

Question 22

Polypoid corditis (Reinke’s edema)

Answer 22

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

Question 23

vocal nodules

Answer 23

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)

Question 24

vocal polyps

Answer 24

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

Question 25

how to tell difference between polyps and nodules

Answer 25

nodules are bilateral | polyps are unilateral

Question 26

what is the primary laryngeal cancer

Answer 26

squamous cell

Question 27

most common cause of pharyngitis

Answer 27

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

Question 28

complications of strep

Answer 28

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

Question 29

fxs of GABHS

Answer 29

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

Question 30

Gold standard test for strep

Answer 30

throat culture

Question 31

tx for GABHS

Answer 31

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

Question 32

what does tonsillitis usually cause

Answer 32

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

Question 33

indications for tonsillectomy

Answer 33

>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

Question 34

vincent's agngina (trench mouth)

Answer 34

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

Question 35

ludwig angina

Answer 35

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