Exam 2 Flashcards by Brittni Coppola

Leukoplakia

adherent white patches/plaques on oral mucosa or tongue
not painful
can present as erythroplakia (red) or leukoerythroplakia (speckled)

*tobacco and alcohol use

Treatment: refer to ENT for biopsy and monitor closely

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Squamous Cell Carcinoma (SCC)

ulcers or masses that do not heal
*exophytic (protruding outward) lesions on tongue and lip that are often painful

*tobacco and alcohol use

Treatment: refer to ENT for surgical resection or radiation/chemo –> poor prognosis

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Melanoma

*if pigmented oral lesion, MUST consider melanoma in DDx
ABCD’s
often 5th - 7th decade and often missed

Treatment: excision with clear margins, radiation

note - amalgam tattoo DDx look for dental filling nearby

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Mucoceles

pinkish/blue soft papules/nodules filled with gelatinous fluid
variable size
may rupture spontaneously

Treatment: generally asymptomatic and resolve on their own via reabsorption or rupture
cryotherapy or excision if necessary

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Herpes Simplex Virus (HSV)

etiology: HSV-1 via direct contact
sunlight, trauma, stress
painful grouped vesicles on an erythematous base on buccal mucosa

recurrent infection generally on skin surface, not mucosa
burning/pain/tingling prodrome

Treatment: antiviral at onset of prodrome (acyclovir, valacyclovir, famciclovir)
supportive care (fluids, analgesics, miracle mouthwash)

note - herpes zoster is unilateral/dermatomal on palate

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Coxsackie Virus (hand, foot, mouth)

painful oral lesions, but tends to spare gingiva and lips (unlike HSV)
palmar/plantar lesions - pale, oval-shaped papules with rim of erythema

Treatment: supportive (hydration and analgesics)
lesions resolve 5-6 days

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Oropharyngeal Candidiasis (Thrush)

etiology: Candida albicans (yeast)
opportunistic infection

mouth pain/sore throat
creamy white patches/plaques with underlying erythematous mucosa
“THRUSH WILL BRUSH”
KOH prep

Treatment: topical (nystatin suspension or troche, clotrimazole troche)
patient education (clean dentures and rinse mouth after using inhaler)

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Erythema Multiforme Major

acute, immune-mediated condition (HLA gene)
etiology: commonly HSV

target-like lesions on skin
mucosal erythema
painful, burning erosions or bullae
70% oral

Treatment: self-limiting (2 weeks)
symptomatic relief (topical corticosteroid or oral antihistamine)
*refer if ocular involvement

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Stevens-Johnson Syndrome (SJS)

etiology: med induced (sulfa, NSAIDs, etc.)

prodrome of flu-like sxs 1-3 days
tender, erythematous pruritic macules, vesicles
edema of lips
SKIN SLOUGHING
conjunctivitis

Treatment: discontinue medication, corticosteroids (ie. Prednisone)
*Bacteremia is highest risk of death

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Pemphigus

vulgaris is most common form
life-threatening blistering disorder
etiology: autoimmune, idiopathic, or drug-induced

FLACCID bullae that will spread when pressed
*Nikolsky sign - gentle application of pressure in uninvolved layer = sloughing –> early acantholysis

Treatment: systemic corticosteroids, immunosuppressive agents, antibiotics for secondary infection

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Pemphigoid

chronic autoimmune blistering disorder (less severe than pemphigus)

prodrome of pruritic eczematous, urticaria-like lesions
TENSE bullae (deeper in dermis)

Treatment: topical or systemic corticosteroids

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Aphthous Ulcers

“canker sores”
recurrent aphthous stomatitis most common cause of mouth ulcers

shallow, round/oval, painful with grayish base on buccal and labial mucosa (single or multiple)

Treatment: typically heals in 10-14 days
symptomatic relief with topical steroid (ie. triamcinolone)

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Behcet’s Syndrome

recurrent oral and genital ulcers (3+/yr)
painful, shallow or deep with central yellow necrotic base
often multiple

Treatment: refer to rheumatology

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Oral Lichen Planus

etiology: chronic inflammatory disorder
reticular - *Wickham’s striae (lacy, thin white plaques)
erythematous and erosive = painful

Treatment: pain relief, topical corticosteroids, refer to ENT

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Black Hairy Tongue (Lingua villosa nigra)

BENIGN associated with antibiotics, candida infection or poor oral hygiene

elongated filiform papillae
yellow-white to brown dorsal tongue surface

Treatment: BRUSH

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etiology: unknown
erythematous patches on dorsal tongue with circumferential white borders

Treatment: reassurance

Geographic Tongue ( Benign migratory glossitis)

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etiology: nutritional deficiency, dry mouth, oral candida
*atrophy of filiform pupillae
tongue appears smooth, glossy, erythematous

Treatment: address underlying condition

Atrophic Glossitis

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heat/moisture, trauma, associated skin disease
bacterial (pseudomonas or staph) or fungal

ear pain (movement of tragus)
pruritic, erythematous, edematous
pseudomonas discharge = green
staph = yellow
fungal = fluffy white or black
decreased hearing

Treatment: fungal - Clotrimazole 1% soln
bacterial - cortisporin or ofloxacin otic soln if TM perf
pain control

Otitis Externa (“swimmer’s ear”)

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DM and immunocompromised pts
*Pseudomonas infection

intense otalgia and otorrhea
red, granulated tissue of EAC
trismus, edema, LAD

Treatment: IV Ciprofloxacin

Malignant Otitis Externa

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etiology: strep pneumoniae, H. influenzae, M. catarrhalis
peak incidence 6-18 months
usually precipitated by URI

+/- fever
otalgia - “tugging” on the ear
N/V and otorrhea
conjunctivitis (H. influenza)

opaque/reddened BULGING TM, decreased mobility
*check for conductive hearing loss

Treatment: antibiotics for all under 6mo
6-23mo if bilateral or severe sxs
older than 24mo if dx certain and illness severe
*otherwise, observation and follow-up

Amoxicillin (high dose) 80-90mg/kg/day divided Q12 x7-10d
*Augmentin if antibiotics in past 30d or conjunctivitis
*Cef drugs if PCN allergy - IV daily x3d
tympanostomy tubes for recurrent AOM

Acute Otitis Media (AOM)

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etiology: recurrent OM, trauma or cholesteatoma (accumulation of epithelial cells in middle ear)
pseudomonas, MRSA

otorrhea >2wks and associated TM perf
conductive hearing loss

Treatment: refer to ENT

Chronic Otitis Media

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postauricular pain
edema, fever
erythema
protrusion of pinna

Treatment: IV antibiotics, mastoidectomy if needed

Mastoiditis

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etiology: viral URI, AOM, AR

ear fullness and decreased hearing
pt afebrile (not acutely ill) - no infection associated with fluid in the ear
neutral or retracted TM - TYPE B tympanogram
conductive hearing loss

Treatment: “watchful waiting”, intranasal steroids if underlying AR

Otitis Media with Effusion

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inflammation or blockage resulting in negative middle ear pressure
ear fullness and hearing loss
retracted TM - TYPE C tympanogram

Treatment: steroid nasal spray
topical nasal decongestant (ie. Afrin) but limit to 3 days or rebound congestion

Eustachian Tube Dysfunction

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discomfort or damage to ear due to pressure difference ear fullness pain tinnitus hemotympanum (bloody otorrhea) if TM perf Treatment: supportive

Ear Barotrauma

benign acute inflammation/infection of vestibular system may follow AOM and/or precede URI N/V acute onset severe vertigo horizontal nystagmus + head thrust (cannot maintain visual fixation) Treatment: symptomatic (bed rest, hydration) meclizine (Antivert) 25mg TID benzodiazepines

Labyrinthitis

etiology: inherited hyper-responsiveness to allergen exposure (IgE antibodies) rhinorrhea sneezing itchy eyes and nose (allergic salute) nasal congestion pale, "blue" mucosa and clear discharge Allergic Shiners - bluish, purple ring around eyes Denie Morgans lines - skin folds under eyes ImmunoCAP - IgE or scratch skin testing (wheal&flare) Treatment: avoid allergens topical intranasal corticosteroids (Flonase, Nasocort) antihistamines (Benadryl 25-50mg BID or Claritin/Allegra) decongestants (Sudafed) immunotherapy (last resort)

Allergic Rhinitis (AR)

Stress, sex, perfume, etc. induced normal IgE and nasal mucosa nasal congestion rhinorrhea Treatment: avoid triggers topical steroids, antihistamines and anticholinergics

Vasomotor (non-allergic) Rhinitis

nasal congestion/obstruction non-tender soft grey tissue growths Treatment: intranasal glucocorticoids refer to ENT if obstructive

Nasal Polyps

tachyphylaxis with overuse of topical decongestants (decreased response to successive doses of drug) REBOUND CONGESTION nasal mucosa is erythematous Treatment: discontinue med and intranasal glucocorticoid

Rhinitis Medicamentosa

etiology: adults- rhinovirus, coronavirus peds- parainfluenza virus ``` rhinitis/congestions sore throat hacking cough mild headache and fatigue +/- fever nasal mucosa edema and pharyngeal erythema clear lungs ``` Treatment: supportive (analgesics, antihistamines) 1-2 wk duration, pt education

Common Cold

etiology: influenza virus type A (most severe) and B ``` abrupt onset fever prominent headache general aches/pains and fatigue coughing PND (post nasal drainage) hot, dry skin and flushing ``` Diagnostics: RAT (rapid antigen tests), viral culture Treatment: antiviral (Tamiflu PO, Relenza inhalation)

Influenza

etiology: group A strep or virus ``` cervical LAD sore throat fever headache *palatal petechiae purulent exudate tonsillar hypertrophy ``` ``` Dx Group A Strep (3 of 4): pharyngeal exudates cervical LAD fever lack of cough/rhinorrhea ``` Non-group A treatment: supportive HSV - acyclovir, famcyclovir Gonnorhea - ceftriazone Group A treatment: PCN-V 500mg po BID-TID x10d *clindamycin if PCN allergy

Pharyngitis/Tonsillitis

severity of sore throat out of proportion stridor/resp. distress peritonsillar abscess trismus Tonsillectomy if: 7+ episodes in 1 year 5+ episodes in each of past 2 years 3+ episodes in each of past 3 years

Emergent Acute Pharyngitis

etiology: polymicrobial (group A step & staph) ``` severe sore throat - usually unilateral muffled voice drooling trismus - spasm of internal pterygoid muscle) fever ipsilateral ear pain neck swelling/pain with cervical LAD deviation of uvula to opposite side ``` Treatment: drainage antimicrobial - oral = amoxicillin or clindamycin x14d parenteral (IV/IM/SubQ) - ampicillin or vancomycin

Peritonsillar Abscess

etiology: viral, bacterial, or non-infectious (ie trauma) ``` hoarseness rhinorrhea nasal congestion cough and sore throat direct laryngoscopy = laryngeal erythema and edema ``` Treatment: underlying cause (resp. virus) humidify voice rest and hydration

Acute Laryngitis

etiology: viral (rhinovirus, influenza) bacterial (H. influenza) ``` fever >102 severe headache periorbital edema abnormal vision facial pain maxillary teeth discomfort ``` Treatment: viral - supportive days 1-9 (analgesics, decongestants, saline irrigation) bacterial - Augmentin 500/125mg TID, doxycycline if PCN allergy

Acute Rhinosinusitis

``` 4 cardinal symptoms: mucopurulent white/yellow nasal drainage nasal obstruction/congestions facial pain, pressure or fullness reduction or loss of smell (adults) cough (children) ``` ``` Treatment: nasal saline lavage intranasal corticosteroids oral antimicrobials antihistamines topical/systemic antifungals ```

Chronic Rhinosinusitis

etiology: Epstein Barr Virus (EBV) ``` cervical/general LAD fever/malaise pharyngeal exudative petechiae on soft palate splenomegaly drug-induced ampicillin rash ``` Diagnostics: CBC, LFTs, Monospot +IgM/-IgG = acute infection Treatment: supportive (NSAIDs, fluids and rest) 4wk sport restriction

Infectious Mononucleosis

age-related or traumatic opacity of the lens gradual, chronic, painless loss of vision decreased visual acuity yellowing of lens Treatment: referral, intraocular lens implant (phacoemulsification)

Cataracts

etiology: decreased aqueous outflow resulting in increased intraocular pressure chronic, painless visual loss *peripheral first, central late increased cup/disc ratio Treatment: refer topical anti-ocular hypertensives

Primary Open Angle Glaucoma

separation of retina from underlying choroid layer *associated with myopia and DM floaters photopsias (light flashes) acute loss of vision - "CURTAIN-LIKE" raised, whitish retina Treatment: refer, cryotherapy, vitrectomy

Retinal Detachment (RD)

``` common in the elderly more commonly gradual blurred vision metamorphopsia (wavy/distorted) *central scotoma (blind spot) Amsler Grid distortion Dry = Drusens Wet = neovacularization ``` Treatment: refer (vitamins, quit smoking, photocoagulation)

Macular Degeneration

embolic - different location acute TOTAL painless loss of vision afferent pupillary defect "cherry red spot" Treatment: refer, non effective poor prognosis

Central Retinal Artery Occlusion (CRAO)

thrombotic acute VARIABLE painless loss of vision "blood and thunder" retinal appearance Treatment: aspirin and observation

Central Retinal Vein Occlusion (CRVO)

retinal vascular changes due to systemic HTN ``` asymptomatic systemic HTN characteristic fundus findings AV nicking cotton-wool spots ``` Treatment: systemic BP control refer if severe

Hypertensive Retinopathy

``` #1 cause of blindness non-proliferative = cotton-wool spots, microaneurysms proliferative = non + neovascularization macular edema = hard exudates ``` Treatment: blood sugar control

Diabetic Retinopathy

eyelid inflammation CHRONIC itching, burning, scratching (worse in AM) no vision decrease erythema, scales, meibomian gland disease Treatment: warm compress antibiotics/steroids for severe cases

Blepharitis

infection of periorbital tissue ACUTE onset of pain, swelling +/- vision decrease warm, edema, erythema, tender Treatment: systemic antibiotics

Cellulitis

deficient aqueous tear production CHRONIC itching, burning, scratching "tired" eyes esp. in PM vision fluctuation punctate epithelial erosions Treatment: artificial tears topical cyclosporin

Dry Eye

``` Viral ACUTE bilateral burning soreness watery discharge URI sxs and preauricular LAD Treatment: vasoconstrictors and artificial tears ``` ``` Bacterial ACUTE unilateral irritation mucopurulent discharge adherent lids Treatment: topical and/or systemic antibiotics ``` ``` Allergic CHRONIC (seasonal) bilateral stringy/mucoid discharge chemosis - fluid within conjunctiva causing swelling Treatment: topical antihistamines ```

Conjunctivitis

blood in conjunctiva ACUTE asymptomatic vision unaffected diffuse red patch Treatment: reassurance

Subconjunctival Hemorrhage

inflammation of episcleral or scleral tissue SUBACUTE onset of foreign body sensation/pain vision usually unaffected focal injection (deep, bluish hue around sclera) Treatment: topical/systemic steroids refer

Episcleritis/Scleritis

corneal epithelial defect ACUTE onset of pain, foreign body sensation and epiphora +/- vision affected irrigate numb with topical anesthetic fluorescein use blue light to see if stain lights up Treatment: topical lubricants and antibiotics, oral pain medicines NO TOPICAL ANESTHETICS

Corneal Abrasion

caustic chemical exposure ACUTE pain/burning decreased vision red/pink.white Treatment: IRRIGATE!! topical lubricants or antibiotics refer

Chemical Injury

"speck in my eye" ACUTE onset of foreign body sensation vision usually unaffected Treatment: irrigation, cotton-tipped applicator lubricant/antibiotic drops refer

Corneal Foreign Body

``` infection of the cornea ACUTE onset of pain mucous discharge *contact lens abuse vision usually decreased white infiltrate *hypopyon - WBC and mucous in anterior chamber ``` Treatment: intensive topical antibiotics refer

Keratitis/Corneal Ulcer

dendritic pattern on fluorescein stain Treatment: topical antivirals NO STEROIDS

Keratitis: HSV

``` inflammation of uveal tissue ACUTE onset *photophobia +/- vision decrease ciliary flush around iris hypopyon ``` Treatment: topical steroids, dilation drops, refer

Iritis/Uveitis

``` blood in anterior chamber due to trauma of iris/uvea ACUTE onset pain photophobia +/- vision decrease layered heme ``` Treatment: eyeshield/bedrest refer

Hyphema

PAINFUL ACUTE rise of intraocular pressure due to outflow obstruction (rare) ``` decreased vision *halos around lights nausea +/-pain *ciliary flush *steamy cornea mid-dilated pupil crescent shadow ``` Treatment: refer topical anti-ocular hypertensives oral/intravenous osmotic agents

Acute Angle Closure Glaucoma

Exam 2 Flashcards

(61 cards)