HEENT QUIZ 3- MOUTH & THROAT

Question 1

types of leukoplakia

Answer 1

1. homogenous: uniform white patch on buccal mucosa, most common type, likely cancer
2. verrucous: white patch on red base

Question 2

etiology of leukoplakia

Answer 2

chronic irritation – chronic smokers

Question 3

peak age of incidence of leukoplakia

Answer 3

40-60 y/o

Question 4

possible complications of leukoplakia

Answer 4

2-6% are early squamous cell carcinoma

Question 5

sx of leukoplakia

Answer 5

leukoplakia is usually asymptomatic

Question 6

which is more likely to become squamous cell carcinoma , leukoplakia or erythroplakia?

Answer 6

erythroplakia– 90% are SCC

Question 7

who is at a high risk of developing oral candidiasis “thrush”

Answer 7

-infants
-denture wearers
- immunocompromised
-broad spectrum antibiotics

Question 8

candidiasis sx:

Answer 8

white patches , raw at base and painful
can be scraped off

Question 9

glossitis sx:

Answer 9

glossitis is painless loss of papillae

Question 10

possible causes of glossitis

Answer 10

severe fe deficiency and megolablastic anemia

Question 11

glossodynia definition and causes

Answer 11

-pain/burning of the tongue
-asociated with irritants(psoriasis), menopause, nutritional deficiencies (b12)

Question 12

symptoms of geographic tongue

Answer 12

-surpiginous border
-erythma
-not painful, asymptomatic
-changes shape and location , bening
- loss of papillae
-hyperkeratotic

Question 13

etiology of necrotizing ulcerative gingivitis

Answer 13

-eating rodents in the wawar in the trenches
-smoking
-poor oral hygiene

Question 14

what is another name for vincent’s infection

Answer 14

necrotizing ulcerative gingivitis aka trench mouth

Question 15

pt presents abrupts onset of painful, bleeding gingiva, what is a likely finding in physical exam

Answer 15

dx:necrotizing ulcerative gingivitis
finding: punched out lesions with grayish membrane on gingiva

Question 16

Would a patient with necrotizing ulcerative gingivitis have a fever?

Answer 16

usually no fever , not contagious

Question 17

what bacteria is associated with necrotizing ulcerative gingivitis ?

Answer 17

fusiform bacillus which is part of the normal flora and becomes pathogenic

Question 18

pt presents with small ulcers in soft palate, under the tongue and buccal mucosa. she says the have been there for 2 weeks and are painful. she has a hx of chohn’s disease. possible dx ?

Answer 18

aphthous stomatitis aka canker sores

Question 19

what can cause a canker sore to flare up

Answer 19

foods and high fever

Question 20

where are canker sores found

Answer 20

unkeratinized mucosa: soft palate, under tongue, cheeks, inside of the lips

Question 21

aphthous stomatitis sx:

Answer 21

1-5 painful and discrete ulcers (1-10mm)

unkeratinized mucosa

Question 22

what is a possible association of canker sores

Answer 22

possible autoimmune etiology: association with inflammatory bowel disease

Question 23

cause of herpetic stomatitis aka fever blisters

Answer 23

HSV-1

Question 24

onset of herpetic stomatitis

Answer 24

usually before 10 years old in 90% of pts
-usually recurrent (sickness, fever, sunburn )
-initial illness with systemic sxs

Question 25

where is herpatic stomatitis found?

Answer 25

unkeratinized and keratizined mucosa

Question 26

6 year old presents with sudden onset of fever and dysphagia, on exam you find white/gray vesicles with red halos 1mm in diameter, possible dx ?

Answer 26

herpangina

Question 27

etiology of herpangina

Answer 27

coxsackie virus A and B

Question 28

where is herpangia usually found?

Answer 28

tonsilar fossa

Question 29

incidence of herpangina

Answer 29

children less than 6 y/o in the summer

Question 30

Etiology of hand-foot-mouth disease

Answer 30

coxsackie virus A-16

Question 31

incidence of hand-foot-mouth disease

Answer 31

young children in the spring and summer

Question 32

where is hand-foot-mouth disease seen

Answer 32

lips and buccal mucosa

Question 33

sx of hand-foot-mouth diseases

Answer 33

-vesicles, small ulcers -transient, macular rash on trunk and extremities -mild systemic fever- low grade fever

Question 34

most common site of oral cancer? most common type ?

Answer 34

tongue is the most common type of oral cancer -over 90% are squamous cell cancers

Question 35

what is the 5 year survival rate of oral cancers?

Answer 35

5 year survival rate is 50%

Question 36

etiology of pharyngitis/ tonsillitis

Answer 36

usually viral

Question 37

sx of pharyngitis/ tonsillitis

Answer 37

-may or may not have exudate -may or may not have LAO

Question 38

possible complications of strep throat and mononucleosis

Answer 38

carditis via strep -splenomegaly via mononucleosis

Question 39

definition of scarlet fever

Answer 39

scarlet fever is strep throat with sandpapery rash (red papules)

Question 40

sings and symptoms of strep pharyngitis

Answer 40

1. strawberry tongue and circumoral pallor 2. pastias lines in antecubital fossa 3. sandpapery rash ( strep is g+ and releases exotoxins) 4. hot potato voice ( due to avoiding rubbing together of throat structures)

Question 41

Centor's criteria (what is it for?)

Answer 41

to determine if strep testing needs to be done 1. hx of fever 2. no cough 3. tender anterior cervical LAO 4. exudate or tonsillar swelling

Question 42

etiology and incidence of rheumatic fever

Answer 42

-sequelae of strep pharyngitis - peak ages of 5-15 y/o

Question 43

jones criteria

Answer 43

must have have 2 major manifestations or 2 minor, 1 major and a positive strep test

Question 44

major manifestations in jones criteria

Answer 44

1. carditis: high fever and chest pain, valvular defects 2. migratory polyarthritis: lasts for 3-4 wks, 5 or more joints, usually larger joints 3. erythema marginatum: lasts <1 day , sort lived surpiginous macular rash 4. subcutaneous nodules on extensor surfaces of larger joints 5. sydenham's chorea (St. vitus dance): lasts 3-6 months, inapproapriate bizarre movements

Question 45

minor manifestions in jones criteria

Answer 45

-arthralgias -fever -evelated CRP,ESR -prolonged PR interval in EKG

Question 46

infection between the tonsils and the superior pharyngeal muscle is called ?

Answer 46

peritonsillar abscess aka quincy

Question 47

where would the uvula and tonsils be moved to if a peritonsillar abscess is present

Answer 47

uvula will be displaced to the unaffected side tonsils will be moved medially

Question 48

symptoms of a peritonsillar abscess

Answer 48

severe pain and fever

Question 49

etiology of peritonsillar abscess

Answer 49

Strep group A - not treated

Question 50

does a referral need to be made if a patient has a peritonsillar abscess?

Answer 50

yes, refer to ENT for Irrigation and drainage (I&D)

Question 51

incidence of epiglottis

Answer 51

2-5 years old , pre-school age

Question 52

onset of epiglottis

Answer 52

6-8 hours onset -go down for a nap and wake up unable to breathe, drooling and looking at you

Question 53

sx of epiglottis

Answer 53

- high fever -tachypnia -drooling - inspiratory stridor -severe respiratoy distress- life threathening

Question 54

etiology of epiglottis

Answer 54

haemophilus influenzae type B

Question 55

treatment for epiglottis

Answer 55

- antibiotics and mechanical ventilation - do not visualize pharynx until in a controlled environment

Question 56

what is the most common congenital cystic neck mass ?

Answer 56

thyroglossal duct cyst

Question 57

when is a thyroglossal duct cyst usually discovered?

Answer 57

infancy or childhood

Question 58

cause of a thryoglossal duct cyst?

Answer 58

failure of tract to involute after embryonic descent of the thyroid

Question 59

symptoms of a thyroglossal duct cyst . location?

Answer 59

painless, cystic lesion in anterior midline of he neck

Question 60

when is a branchial cleft cyst usually diagnosed?

Answer 60

in adulthood. often with ear or dental infection

Question 61

location of a branchial cleft cyst

Answer 61

area of the lower pole of the parotid