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Clinical med > HEENT mouth > Flashcards

HEENT mouth Flashcards

1
Q

Common causes of pharyngitis are

A

infectious,

immune

xerostomia

dehydration

GERD

degenerative

trauma

congenital

vitamin - zinc

neoplastic

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2
Q

most common cause of pharyngitis ..

A

viral

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3
Q

T/F, 40 % of children and 20 % of adults are affected by GABHS, streptoccus pyogenes

A

True

cause of pharyngitis

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4
Q

which viruses causes viral pharyngitis

A

EBV (mono), rhinovirus, HSV-1 and 2, CMV, and coxsackie virus

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5
Q

Pt has a history of sore throat, odynophagia, rhinitis, acute onset, what does this pt have?

A

viral pharyngitis

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6
Q

upon a PE for viral pharyngitis, you see..

A

erythema of the tonsils and posterior oropharynx without exudate

+/- fever

+/- adenopathy

*rapid strep screen + culture

treatment : supportive bc its viral

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7
Q

what is the clinical presentation for GABHS strep pharyngotonsillitis

A

fever
anterior cervical adenopathy
posterior oropharyngeal exudate
lack of cough, common cold symptoms

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8
Q

diagnostic test and antibiotic Rx for GABSH is

A

strep and cultural strep

PEN VK 50 mg/kg/pediatric X 10 days

PEN VK 1 - 2 grams/day/adults x 10days

allergic to PEN VK: cephalosporin and erythromycin

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9
Q

which criteria do you use to diagnose GABHS strep? and what are you looking for

A

centor

absence of cough
tonsillar exudates
history of fever
tender anterior cervical adenopathy

age under 15 = +1
age over 44 = - 1

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10
Q

pt has a 2-3 centor score, you do the following:

A

supportive care, rapid strep test, abx is positive, if not, culture, if positive,

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11
Q

infectious mononucleosis is caused by which virus, affects who, and how it is contracted

A

EBV
young adults
oral contact

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12
Q

for IM (infectious mononucleosis), you see the following on PE exams

A

lymph node enlargement: posterior triangle neck

hepatosplenomegaly (possible)

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13
Q

diagnosis for infectious mononucleosis will be

A

monospot to check for heterophile Ige (prior)/ Igm (Acute) (delayed)

lymphocytosis on WBC differential
increase in monocytes
atypical lymphocytes

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14
Q

treatment for mononucleosis

A

supportive, hydration

no contact sports within 6 weeks

check liver and spleen for hypertrophy

steroids

antibiotics for secondary bacterial infection

DO not give amoxicillin and ampicillin = rash with mono

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15
Q

how to gonococcal pharyngitis acquired, which bacteria, and what are the symptoms

A

oral sex

N. gonorrhoeae

mostly asymptomatic, but can have sore throat, pharyngeal exudate, cervical lymphadenitis

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16
Q

diagnosis and treatment for gonococcal pharyngitis

A

diagnosis: NAAT of a pharyngeal swab (faster)/ culture

treatment: single 500 mg IM dose of ceftiaxone or
1g if over 300 lbs

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17
Q

reasons to treat pharyngitis is so you can prevent the following complications

A

peritonsillar abscess

retropharygneal abscess

rheumatic fever

post-strep acute glomerular nephritis

Ludwig’s angina

supportive care - fluids, lozenges, analgesics

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18
Q

when do you refer pt to ENT for pharyngitis

A
  • peritonsillar abscess
  • deep neck and retropharyngeal abscess
  • recurrent tonsillitis
  • tonsillar hyperthropy/ asymmetry/ lesion
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19
Q

what is the difference between peritonsillar abscess and cellulitis.
what exam do you do to tell the difference

A

peritonsillar abscess is collection of pus between the palatine tonsil capsule and pharyngeal mms

cellulities is a inflammatory reaction of the tissue between the palatine tonsil capsule and the pharyngeal mms . (no pus) (aka phlegmon)

needle aspiration/ CT neck

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20
Q

pt has a history of sore throat, and on PE, you hear a hot poato voice, displaced uvula, and fluctance

A

peritonsillar abscess

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21
Q

what is the management for peritonsillar abscess

A

clindamycin, oral steroids

incision and drainage

refer for tonsillectomy

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22
Q

Ludwig’s angina common area, cause, and PE

A

neck space infection

dental infection/ sublingual and submaxillary spaces infections

pe: edema and erythema of neck and floor of mouth / dysphagia, odynophagia, pain, and airway compromise

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23
Q

treatment for Ludwig’s angina

A

IV antibiotics, I & D, protect airway (tracheostomy)

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24
Q

source of infection for deep neck infections for kids is

A

tonsil, otitis media, and sinus

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25
Q

source of infection for deep neck infections for adults is

A

teeth/ salivary gland/ skin

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26
Q

signs and symptoms for deep neck space infections is

A

fever, pain, swelling (90)
dysphagia, trismus (18)
fluctuance - uncommon (27)

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27
Q

most common bacterial cause of deep neck infection is

A

staph and strep

but can also be

gram negative
anaerobic
mixed flora (40)

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28
Q

how to manage deep neck infection

A

secure airway

CT scan with contrast
* cellulitis vs abscess
* neck space involved

culture : blood and needle aspiration

IV antibiotics

incision and drainage
* obv abscess, abx not working, complications

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29
Q

retropharyngeal space expands from the base of skull to mediastinum. infection in this area can spread from …… and is most common under which age

A

lateral pharyngeal space infection
lymphatic spread from posterior sinus, adenoids, and nasopharynx

age 5

30
Q

causes of retropharyngeal infection/ abscess is

A

adults: endoscopy or FB

kids: lollipop-stick perforation or URI in children

31
Q

risk factors for retropharyngeal infection/ abscess is

A

oral hygiene
diabetes
immunocompromised
low socioeconomic status

32
Q

pt is showing symptoms of fever, dysphagia, dyspnea, hot potato voice, and torticollis.

PE: posterior wall swelling

has…

A

retropharyngeal infection/ abscess

33
Q

diagnosis and treatment for retropharyngeal infection/ abscess is

A

lateral neck x ray - screen

CT with contrast - definitive

IV antibiotics - strep, staph, anaerobes

incision and drainage

34
Q

TM joint dysfunction

affects:
common S/S:
Cause:

A

women in childbearing age

jaw pain/ dysfunction …. earache…. headache… facial pain

direct trauma, indirect trauma (whiplash), and stress / grinding and clenching teeth (microtrauma)

35
Q

diagnosis and treatment for TMJ dysfunction

A

imaging = malocclusion or intra-articular problems

treatment:
*education, self-care, cognitive behavior
*nonsteriodial-noninflammatory drugs and mm relaxants - INITAL
* benzo and antidepres - CHRONIC

36
Q

Aphthous Ulcers

name:
cause:
found on:

A

canker sore, ulcerative stomatitis

Human herpes virus 6

buccal and labial mucosa

37
Q

pt has cranker sore (aphthous ulcers), it is painful, shallow ulcers with red halos and recurrent. you give them which med?

A

lidocaine
topical steriod in orabase

38
Q

oral herpes simplex virus

called:
PE:
cause:

A

fever blister or cold sores

fluid-filled blisters on lips, gums, hard palate

reactivated or primary HSV - active from stress, sunlight, hormones, trauma, fever

39
Q

pt felt pain on their lips a few days before seeing lesions. pt said the lesions blisters ruptured within hours and became crusty. what does this pt has and how do you treat it

A

oral herpes simplex virus

topical or oral antivirals (zovirax, famvir, valtrex, denavir)

40
Q

herpetic gingivostomatitis is caused by

common in:
S/S
treatment:

A

HSV - 1
young kids- first exposure to herpes
high grade fever, mm painful oral lesions

immunosuppressed / HIV pts: treat –> oral acyclovir, famciclovir, valacyclovir

41
Q

oral candidiasis, thrush, risk factors and S/S includes

A

dentures, diabetes, anemia, recent chemo/ radiation, recent antibiotic/ steroids, immunocompromised

s/s: burning on tongue, cheek, or throat

42
Q

pt has creamy curd like patches that can be scrapped off. the overlying mucosa is erythematous, raw, and friable. what treatment do you give

A

pt has oral candidiases

tx:
underlying cause
antifungals
* liquid
* troche - dissolve in mouth
* pills - diflucan

43
Q

pt has painless white area on the tongue, inside of cheek, lower lips, and floor of mouth. you try to scrap it off but can not. you learn that the pt has etoh abuse, smokes, chhew tobacco and uses denture.

what is it and whats the next step

A

oral leukoplakia

biopsy to rule out cancer

refer to ENT

44
Q

sialadenitis/parotitis

is…
cause…
risk factors…

A

inflammation of the salivary gland - common the parotid gland

bacterial infection (staph aureus) or ductal obstruction

dehydration, chronic illness (sjogrens)

45
Q

pt has sjogrens, a chronic illness. pt has pain and swelling, worsens with eating, and erythema of the parotid duct opening. you also notice pus and stone. what is it

A

sialadenitis/ parotitis

46
Q

treatment for sialadenitis/ parotitis

A

conservative: hydration, warm compresses, local message, sialagogues

anti-staph antibiotic

47
Q

sialolithiasis

is:
common in:
s/s:
treatment:

A

stone in the salivary duct

common in the wharton’s duct (drain submandibular gland)

post-prandial pain/ swelling

treat if infected, conservative treatment

refer to ENT

48
Q

epiglottis

is
caused
common in

A

life threatening infection of epiglottis that can lead to airway obstruction

H. influenzae Type B

adults

49
Q

pt is a kid and comes in with high fever, difficulty swallowing, sore throat, abrupt onset, drooling, tripod/sniffing position (only in kids) , what is it

A

epiglottitis

50
Q

diagnosis for epiglottis is

A

lateral softer tissue neck x ray will show thumb sign

intubate

iv fluid and antibiotics, then oral antibiotics

prophylaxis with rifampin for unimmunized pts

51
Q

breathy hoarseness is when

A

vocal cords do not close complete ( nodules, lesions, polyps)

52
Q

raspy hoarseness is when

A

vocal cords are thickened from edema or inflammation

53
Q

when there is decreased respiratory force (edlerly), you have … hoarsness

A

shaky

54
Q

muffled hoarseness is when

A

airway obstruction (PTA, epiglttis)

55
Q

harsh hoarseness is

A

largyngitis

56
Q

stridor hoarseness is

A

narrowing above cords, high pitched

57
Q

acute hoarseness can be due to 3 things

A

laryngitis - viral, allergy. vc abuse

laryngeal edema - hereditary angioneurotic edema ( c1 esterase inhibitor deficiency) , trauma, infection, cough, choking

epiglottis

58
Q

laryngitis is typically

A

viral and little to no pain

59
Q

laryngitis conservative treatment is

A

hydration, no yelling, whispering, voice rest, quit smoking, avoid spicy / acidic food

60
Q

if laryngitis does not improve, refer to

A

laryngoscopy and videostroboscopy

61
Q

chronic hoarseness is due to

A

tobacco, allergy, vc abuse, GERD, LPR,

VC polpys/nodules

chronic environmental exposure

MS

VC paralysis, CVA, neoplasm

myasthenia gravis

Parkinsons disease

presbyphonia

paradoxical VC motion - psych

62
Q

associated symptoms of hoarseness is

A

sore throat, globus, dysphagia, mucus, cough

63
Q

PMH of thyroid, neck, head, lung cancer can lead to

A

hoarsness

64
Q

which PT exam and diagnosis will u do for hoarseness

A

HEENT

LUNG

neurological exam

nasopharyngolaryngoscopy

65
Q

for hoarseness, you will do the following work up

A

labs: cbc, ESR, TFT (enlarged thyroid)

chest ct

neck ct, mri

videostroboscopy

barium swallow

treatment: treat underlying cause
* PPI for gerd, steriods, surgery, voice therapy
&hydration, voice rest, stop smoking

66
Q

pt has hoarsness, cough, mucus in throat, globus, halitosis, dysphagia, sore throat. no heart burn. pt has

A

GERD

67
Q

which diagnosis will do you for Gerd

A

HEENT exam

NPL

H. pylori test

barium swallow

transnala esophagoscopy (TNS)

upper endoscopy

treat: diet and life changes

PPI medication, H2 blocker

68
Q

how will you diagnosis and treat VC polyps and nodules

A

microdirect laryngoscopy (MDL) with biopsy

speech therapy and stop smoking

69
Q

how will you treat leukoplakia/erthyroplakia/lesion in the VC

A

MDL with Bx

70
Q

for VC paralysis, you have to

A

diagnos the cause

rule out neoplasm

thyroplasty with VC medialization or injectables (radiesse)

video swallow to rule out apsiration

tracheostomy with bilateral VC paralysis

speech therapy

Clinical med (6 decks)

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